BFRBs are stubborn problems with many different inputs that must all be addressed in a comprehensive way. Getting recovered therefore takes time, hard work, motivation, and a lot of persistence; even under the best of circumstances. BFRBs are also still very much under the radar of most people. They have had little contact with them, and have probably never heard of them. Many people still view them as some kind of 'bad habit.' When significant others find themselves face-to-face with disorders of this type, they now suddenly have to cope with something they know little or nothing about. This, of course, can lead to all kinds of difficulties. It is important to be aware of these potential problems and possible solutions if they are to be remedied. Failure to recognize or fix them can, of course, cause relationship damage, and possibly breakups. As with many things, education is the key.
A lot of us go forth in life with the naïve idea that we will eventually find the perfect job, partner, child, home, etc. Life, of course, teaches us that such is not the case. There really are very few perfect things in life, especially when it comes to people. This does not stop some of us from refusing to accept this fact, however. When they discover that their partner has a particular problem, they view it as something that just shouldn't exist for them. After all, they demand angrily, "This wasn't the way things were supposed to be." Holding on to ideas such as this this can clearly be a great source of anger and resentment; as if they were somehow cheated of something that was rightfully theirs. Feeling entitled to not having to have problems or imperfections in life is a very irrational idea. Seeing your partner with bald or thin spots on their head, missing eyebrows, or scarred skin may be a reminder of this fact of life, and also that it might be a good idea to challenge your notions of entitlement. In the end, you do not have to like the fact that your partner didn't turn out to be the perfect human being with pristine hair and skin, but you may have to accept that you are in a relationship with a real, flesh-and-blood, imperfect human being. Remember that your partner may also be working to accept certain things about you as well, as you are also unlikely to be a perfect being either. Peace of mind and a good relationship can be the result of accepting things we cannot change.
Another important point in making any relationship work, is that along with accepting your partner's imperfections, it is important that you learn to accept them unconditionally, in their entirely – imperfections and all. If you focus in exclusively on this BFRB-related behavior you don't like, you risk reducing them to just one small facet of who they really are. People are made up of thousands of different abilities, qualities, dreams, beliefs, and acts. To ignore everything else about them is to risk shutting out all their good qualities, and all the things that attracted you to begin with.
Many SOs think that along with having a relationship, they also have a special responsibility to get their loved one to do things that are good for them. This might include such things as eating properly, exercising, etc. They believe this concern shows that they are really concerned, and are taking care of the other person. Unfortunately, when they apply this to their loved one's BFRB, things can go very wrong. They may, for instance, take on the role of being the 'pulling' or 'picking police.' It usually starts by the SO watching the sufferer like a hawk, and then having to alert them every time they notice them pulling or picking. They may do this by calling out to them, touching them, making a noise (finger-snapping, throat clearing, etc.), or even throwing things at them (yes, I have actually encountered this). They may even go well beyond this by grabbing their arm or hand and trying to physically restrain them. On a different level, some also use sarcasm, guilt, or anger as a way to try to get them to change their behavior.
As we well know, however, none of us really has the power to control the behavior of another. Even if someone wants to change, it takes a lot of work. The only person you can control is yourself, so all these tactics are obviously doomed to failure. This can then go on to create even greater and more long-lasting problems; as such failures then lead to blame, resentment, frustration, and anger. You tend to hear SOs voice all sorts of angry or guilt-provoking remarks such as, "Why can't you just stop," or, "I can't stand watching you do that over and over," or "I hate the way it makes you look," or, "Our relationship would be perfect if it weren't for your pulling/picking," or "I don't like being seen in public with you, it's embarrassing." In our appearance-conscious society, BFRBs can be stigmatizing disorders of shame and isolation. Sufferers frequently harbor feelings of defectiveness and freakishness. Everyone with a BFRB would dearly like to stop, if only they could. Trying to make them feel badly about themselves for having a problem such as this can only add to their burden, make them feel more demoralized, and make them feel less like being able to change. On a further note, the whole situation really isn't about you. What might it say about you, if while your partner is suffering with their problem, the only thing you appear to be concerned about is how you look when seen with them in public. Do you fear being rejected or stigmatized by simply associating with them? Sounds pretty selfish and self-centered, doesn't it?
Unfortunately, in our society, we only tend to have sympathy for those who appear to be doing something active to help themselves. Conversely, those who do not appear to be trying to do something about their problem are usually blamed for their ongoing difficulties. We also tend to characterize those who can't seem to help themselves as somehow being weaker than others, and having less strength of character. BFRBs are genetically-based neurochemical problems that can be very persistent and difficult to get under control. No one asks for them, and as we said, every sufferer would like to stop what they are doing. SOs need to get it through their heads that these are real biological problems and not indications of weakness. I have always believed that people tend to rise to the level of expectation that we place on them, and that labeling someone as weak and incapable may only contribute to their feelings of being helpless and ineffective.
Treating people with BFRBs harshly can also have another bad paradoxical side-effect. One apparent function of these behaviors is to help people regulate their own nervous systems. They seem to pull and pick when overstimulated (stressed or anxious) or under stimulated (bored or physically inactive). Creating emotional scenes, using criticism, anger, or shame, etc. can only create stress, and your partner will then seek to relieve this stress by further pulling and picking. If you truly want them to stop, you can see how anything besides staying out of it can only have the opposite effect.
Just because a loved one is in treatment, it doesn't mean that potential problems still don't exist for SOs. You aren't responsible for making them follow their particular program. Even if you could get them to follow it perfectly when you were supervising, what would they do when you weren't around? What matters most is what they do when they are on their own. Additionally, don't expect therapy to go perfectly without any hitches. There are always setbacks and slip-ups – good days and bad. These are a normal part of the process. Everyone must go through them. Sometimes they teach sufferers more than the things they get right! No one learns a complex new skill without making mistakes. It is a normal part of the learning process. Each person must be allowed to learn in their own way. Your partner is no different. The best advice is to stay out of it, and allow them to find their way by themselves. At the most, you can support their efforts and be encouraging about the whole process and their need to keep working at it until they succeed.
Whatever your issues with your partner's BFRB, one overall problem you need to beware of is becoming obsessed and over involved in it. If this is the case, you might consider getting some counseling of your own, to help you to concentrate on living your own life, pursuing your own self-improvement goals, and allowing your partner to take responsibility for their own behavior and emotions. You can tell if you are getting in much too deeply if you note one or more the following about yourself:
- You find that your emotional state is tied to how well they are handling their problem on a given day (up when they're doing well, and down when they aren't).
- Thoughts about their BFRB seem to occupy your thinking more than most other topics.
- The BFRB seems to be a daily topic of conversation with your partner.
- You simply cannot stop watching them when they are engaged in the behavior, and cannot resist commenting on it.
- A lot of your time is spent in researching the problem, beyond the point where you are doing anything useful.
- If they are in treatment, you find that you must have constant updates on how and if they are following their therapy. If you feel they are not following it exactly, you find yourself constantly reminding and nagging them about it.
- You find yourself discussing the BFRB with everyone else who will listen.
- So after reviewing all these things that don't work, what are you, as an SO to do when faced with your partner's BFRB? Should you do nothing? Is that all there is? The answer is that there are fortunately a number of do's and don'ts that really can help. Let's outline them:
- Stop watching your partner. If you don't like seeing what they are doing, look away and ignore the behavior.
- Don't be the pulling or picking police. It isn't your job to prevent the behavior. You will not succeed no matter how hard you try. Many have tried and all have failed. Only one person can control the behavior, and it isn't you.
- Give up the idea that you can somehow motivate them to change their behavior. Change is the sole responsibility of the person with the behavior. People only recover when they take responsibility for their own symptoms.
- Avoid the use of shame, sarcasm, anger or guilt to try to get them to change. It simply cannot and will not work. It will cause a lot of resentment and other bad feelings that can only damage your relationship. Also, the stress will likely only lead to an increase in pulling and picking.
- Don't blame them for having the problem. It's not their fault. As was mentioned, this is a biological problem, and not some kind of weakness. They would gladly stop if they could.
- Don't make comments on their appearance. Anything you say about it just won't help. If they are in treatment, you can encourage them if they seem discouraged. Tell them that they will make it if they keep working at it.
- Resist the urge to discuss it with numerous other people – they can't help, and it isn't their concern. You will also be guarding your loved one's privacy.
- If they are in treatment and are making some progress, don't point out the things they are still unsuccessful with. You will otherwise risk damaging their motivation.
- If they are in treatment, don't expect things to always go perfectly. Recovery is generally not a smooth process, and slip-ups and setbacks are so common that therapists have learned to expect them.
- Don't be the therapy police. Don't remind them or nag them to do their homework. If they aren't motivated to do it on their own, your efforts won't be able to make up for it.
- Do be supportive of their efforts to help themselves, and be encouraging about the importance of persistence – even when things don't seem to be going very well.
Busy yourself with your own life goals and put your efforts into them. This is where you can make a real difference in life, and do something that may actually improve your relationship.
Dr. Fred Penzel is a licensed psychologist who has specialized in the treatment of hair pulling and OCD since 1982. He is the executive director of Western Suffolk Psychological Services in Huntington, Long Island, New York. Dr. Penzel is a founding member of The TLC Foundation for Body-Focused Repetitive Behaviors Scientific Advisory Board. He is the author of "The Hair Pulling Problem," a self-help book dedicated exclusively to hair pulling, as well as "Obsessive-Compulsive Disorders: A Complete Guide To Getting Well And Staying Well," a self-help work covering hair pulling and other OCD spectrum disorders.