Although BFRBs may, in some forms, be relatively benign, when they are done in excess they can cause serious medical problems. For the subset of individuals who swallow pulled hairs (a BFRB called trichophagia), gastrointestinal distress or even digestive blockage called a trichobezoar (or hairball) can occur, sometimes requiring surgical removal. This is a very serious medical condition that may require immediate action. It is important to see a doctor if your child eats their hair. Regarding skin picking, it is important to keep wounds clean and treat them with antibiotic cream to prevent infection. In some cases, frequently practiced BFRBs may result in repetitive motion injuries.

It is critically important that you keep the lines of communication open with your child in order to support their overall physical health and emotional well-being. The more informed you become about BFRBs, the better advocate you can be for your child.

For Parents

What should I say and not say to my child?

Say

I love you

You are beautiful

You are important

You are worthy

Your BFRB does not define you

‍

Do not say

Stop pulling, picking, biting

You look like you've been pulling, picking, biting a lot

Cover that spot

Do not tell other people about your child's BFRB without their permission

Do not scold, shame, or punish your child for their BFRBs. Your child's BFRB is not something they can control and it is not their fault. It's not your fault either. BFRBs are not self-harm. BFRBs are not caused by trauma.

‍

My child wants to tell their friends about their BFRB. Should I let them?

Your child's journey with BFRBs is very personal. Remember that a BFRB is a medical diagnosis that doesn't define your child. They have so many special gifts beyond their hair pulling, skin picking, nail biting, or cheek biting. Disclosing to anyone should be their decision. If they're at a place where they feel comfortable sharing their medical diagnosis with their friends - trust them, even though you may be afraid their choice to disclose may hurt them. Perhaps they've discovered that their friends have interests in common like music, movies, fashion, art, sports, or more. Trust your child to make a good decision for themselves; and be there to celebrate if things go well or with encouragement if things become challenging.

Offer to role-play with your child how they plan to tell their friends. Make gentle suggestions where needed, coming from a place of love.

Keeping the lines of communication open with your child is important for their overall physical health and emotional well-being. Learning more about BFRBs gives you the opportunity to become your child's best advocate. The TLC website is a good start, along with participating in TLC's health education and community programs.

My child wants to get a haircut. Is there a salon near us familiar with hair pulling disorder?

Going to a salon can be a big emotional step for people with hair pulling. TLC offers a referral directory listing of BFRB-friendly salons. We're working every day to grow the number of salons listed with TLC, so come back regularly to check for updates near you.

Remember that it may take some time to find the right stylist for your child.

It's okay to try several before you decide on the one that works best.

Find a Salon

Are there accommodations for BFRBs that I should request from the school?

If your child is struggling at school with BFRBs consider the types of interventions that work well in other environments. Engage your child in a dialogue about what they think might be helpful, then approach your child's teacher about coming up with a plan together. If your child qualifies for special education services, additional accommodations may be possible through their Individual Education Plan (IEP) or 504 Plan. Additional articles regarding school interventions can be found here.

Should I tell my child's teachers and/or their school administration about the disorder?

When teachers and school staff know about your child's BFRB, it may make for an easier school year for the child, family, and school. However, disclosing your child's BFRB is a very personal decision. Start by talking with your child about their comfort level of sharing their BFRB at school. If they're new to the school, it may take time to build rapport and trust with teachers and school staff. If they're a returning student, ask them if there's a teacher or school staff member who they trust to be their safe person/advocate in case uncomfortable interactions with peers occur during the school day. If your child's BFRB is noticeable, such as bald patches, heavy scarring, etc., consider asking the teacher if additional education can be provided to classmates and their parents about body-focused repetitive behaviors to help break down myths and misperceptions and build inclusion.

Forming a strong school and home partnership sets everyone, most importantly your child, up for a successful school year.

‍