For Parents

FAQ Categories

What can families and friends do to help?

Many parents find that explaining their child's appearance to close friends and family is essential, since these are people that your child will see often. Start with the facts - define body-focused repetitive behaviors and how they affect your child. Remind your friends and family members that your child's BFRB is a medical diagnosis that doesn't define them, it's only one part of them. People with BFRBs lead full and productive lives. They attend college, hold down employment, get married, and have children. BFRBs are not self-harm and are not a result of trauma. Parents don't cause BFRBs. People with BFRBs are worthy of love and support, just like anyone else.

Share health education resources, like TLC's website, www.bfrb.org. Encourage ongoing conversations with family members and answer questions to help them better understand.

Your journey is not unique, and you are not alone.

My child hasn't pulled/picked in over a year. Will it come back?

Once a BFRB has developed, it is important to be aware that it is possible to reoccur, even after a significant period without acting on urges. In the event of the return of the BFRB itself, or of strong urges, techniques and strategies that worked best during active treatment can be re-employed during vulnerable phases. Some individuals find it especially useful to check in with their therapist for added support. In some situations, the formerly useful techniques may no longer be as effective as they once were. This would present a good opportunity to see a therapist and explore some additional interventions or approaches.

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.

Are BFRBs harmful for my child?

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.

I'm an adult who has a BFRB. Does that mean my child will get a BFRB?

Research shows that some people may have an inherited predisposition to skin picking or hair pulling. Several studies have shown a higher number of BFRBs in immediate family members of persons with skin picking or hair pulling than would be expected in the general population. However, this does not mean your child will develop a BFRB; there are a number of other factors that are involved, such as temperament, environment, age of onset, and family stress factors.

How do I ensure my child will not start pulling/picking from other parts of their body?

Unfortunately, there is nothing you can do to ensure this won't happen. It is not uncommon for people with BFRBs to pick/pull from other areas of their body, so don't be alarmed if your child starts to do so. It's very hard to stop pulling/picking from an area once you start, so don't expect your child to automatically stop. The best thing you can do is offer your support and unconditional love.

Do not scold your child or punish them 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.

Will my child "grow out" of their BFRB?

This is a hard question to answer. We don't know why some children are able to move on from having a BFRB and not be affected again, while others struggle. What we do know is that learning to pay attention to the needs of the body, even after the behavior has stopped, is the most effective way to manage. Some clinical evidence shows that toddlers or infants who have a BFRB (known as "baby trich") may stop the behavior as they grow and develop; however, this is not always the case. Usually, BFRBs which typically begin at the age of 12 are chronic disorders, that may wax and wane over time.

Did I do something wrong? Is this my fault?

It's a big myth that parents are responsible. No, your child's BFRB is not your fault. You are not to blame for your child's BFRB. Your child's BFRB is not a reflection of you as a parent. BFRBs are caused by a multitude of things, such as temperament, environment, age of onset, etc. Even if you personally struggle with a BFRB yourself, it is still not your fault.

Why can't my child just stop pulling/picking/biting?

Body-focused repetitive behaviors are complex mental health disorders. Most people who experience BFRBs can't just simply stop, and some simply don't want to stop pulling, picking, or biting, as it helps their bodies self-regulate.

Is it because I am not there for my child 100% of the time?

No, not at all. Chances are, your child would have developed their BFRB even if you were around all of the time. Try not to blame yourself (or your child) for this problem! It is truly out of their control and you have not caused their BFRB in any way whatsoever.

How do I get treatment for my child?

The TLC Foundation for BFRBs is an excellent resource to find well trained professionals who have experience treating BFRBs. Many of these therapists have participated in an intensive training program called the Virtual Professional Training Institute (VPTI) created by The TLC Foundation to provide training in state-of-the-art treatment for BFRBs. However, if you cannot find someone who has this specific training, a therapist with a cognitive behavior therapy (CBT) background may be helpful.

Should I take my child to a therapist?

While taking your child to a therapist is optional, without therapeutic treatment such as cognitive behavioral therapy (CBT), habit reversal training (HRT), or other form of psychotherapy, managing behaviors can be challenging. Your child may at first be resistant to try therapy or access therapeutic support for their BFRBs. Being honest and encouraging about how therapy can help them manage their behaviors is a great start. It is extremely important to find a therapist who you and your child both trust, and is knowledgeable about BFRBs.

Most therapists specializing in BFRBs have waiting lists. Be prepared to wait from between two to six months. Be patient and persistent.

While you're waiting to access therapeutic support, register for TLC's health education and community programs, to get connected and learn more.

Should I take my child to get formally diagnosed?

Receiving a formal medical diagnosis provides your child with access to therapeutic support and possibly academic accommodations. It's important that your family discuss the pros and cons of receiving a formal medical diagnosis and check with your insurance provider to determine coverage. Most therapeutic providers specializing in BFRBs have long waiting lists, so be prepared for a wait of between two and six months, possibly longer.

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What role do parents play in the treatment process?

Parents play an important role in the treatment process for BFRBs. Your most important role is to educate yourself about BFRBs in order to be your child's best advocate and find a therapeutic match.

It's also important that you listen to your child's feedback on a therapist to gauge treatment efficacy. What's working and what's not? What therapeutic intervention needs your support? Where can you be most helpful? Are there opportunities for you to meet with the therapist to gain insight on how best to support your child?

Children do best in treatment when their parents are supportive and loving, without adding pressure, judgment, or expectations. Refrain from telling your child to stop pulling, picking, biting, or scolding them when they act on their behaviors. This only leads to increased behaviors and emotional shut down.

Keeping the lines of communication open with your child is important to their overall physical health and emotional well-being.

Are there support groups or places to take my child where other people will understand us?

Yes! The TLC Foundation has compiled a list of BFRB support groups, which you can access below. In addition, TLC offers health education and community programs to connect, grow, and learn together. This is a great way for both you and your child to find support, along with attending BFRB Awareness Week, annually on October 1-7, along with TLC's Conference.

Find support groups here

How do I cope with this?

There is no one way to cope with your child's BFRB medical diagnosis. You have two options on this journey: let the tide pull you down, or let a friend throw you a buoy to help you, by getting connected to resources through TLC. It is also important to remember that a BFRB is a medical diagnosis. It does not define your child's ability to live a full, productive life. You are not alone. Your family is not alone. Your child is not alone. There is a community full of people who are on the same journey. Reach out, get connected. You've got this, and we've got you!

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Will my child ever have a relationship, go to prom, go away to college?

A BFRB medical diagnosis is a label that provides individuals with access to medical and educational supports to reach their full potential. That medical diagnosis does not define one's life. People with BFRBs live full and productive lives. They participate in arts and sports activities, are engaged in their community, attend college, pursue meaningful employment, get married, and have children. Encouraging your child to live fully into themselves from a young age despite their medical diagnosis gives them courage to explore who they are, as a person, first.

How do I respond to people asking questions about my child/staring at them?

First and foremost, make sure your child feels safe. Then smile and make it a no-big-deal. Our world is filled with insensitive individuals who don't quite know how to interact when encountering a situation that makes them uncomfortable.

Remember, disclosing your child's BFRB is their decision, not yours. It's up to them if they want to tell anyone, let alone a stranger, about their BFRB.

Making sure your child's emotional and physical well-being is protected during uncomfortable encounters in public helps them know they can engage in community settings without fear, which in turn helps them participate more fully in community as their authentic selves.

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How do I explain my child's appearance to friends and family?

Share health education resources, like TLC's website, www.bfrb.org. Encourage ongoing conversations with family members and answer questions to help them better understand.

Your journey is not unique, and you are not alone.

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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.

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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.

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

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.

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

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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.

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Is there anything I can do to help them?

Love, love, love your child, on the good days and on the challenging days. Love your child as your child first - not their BFRB. This is your child's journey. Standing alongside them with encouragement and not judgment keeps the lines of communication open - a critical component of ensuring their emotional and physical well-being. You may not understand what drives their behaviors to pull, pick, or bite. Asking gentle clarification questions, instead of judging, may give you better awareness of what they may be experiencing before, during, and after acting on their urges. Please do not tell your child to stop pulling, picking, or biting. BFRB community members will tell you that telling them to stop their behavior only makes it worse - further inducing shame and isolation. Some say it makes them pull, pick, or bite even more.

Becoming as informed as you can about body-focused repetitive behaviors helps you become your child's best advocate. The TLC website is a great resource, as are TLC's health education and community programs. You are not alone.

How can I teach my child the best way to react and respond to negative comments about their BFRB?

First and foremost, help your child determine if the person giving the negative comment is a friend, acquaintance, or a stranger in public. When friends make negative comments, they may be lacking information.

Education is the most powerful way to react. Most negative comments are born from ignorance. Providing useful pieces of information can be very helpful. Suggest they visit TLC's website, www.bfrb.org.

How can I empower my child to manage this behavior on their own?

Knowing that this is your child's journey, clearly listening to their needs, hopes, and dreams can help you navigate best practices in empowering them to live fully into themselves. Asking gentle clarification questions like, "How can I support you?", "What would you like me to know about your BFRB?", "How can I be your best advocate?" can be a great place to start a conversation. Keep in mind that this is a journey; that means there will be good days and there will be difficult days - but through it all, focus on the person your child is first, not their behaviors. What do they need to feel safe? What do they need to feel supported? What do they need to honor themselves?

As parents, it's not always easy to take a step back and let our children guide us. Asking for help from others on this journey connects you to resources and support. Signing up for TLC's health education and community programs to learn more helps you become the best parent you can be.

Should I let them get a wig? Isn't that enabling them?

The hair loss experienced from hair pulling can impact self-esteem and self-confidence. Many BFRB community members, especially girls and teens, share that not having hair impacts their feeling of femininity and/or belonging with peers. A wig can restore their self-confidence while also helping manage their behaviors. Although a wig may not stop their hair pulling, having a wig allows them to feel more comfortable at school and in community.

Will my child be bullied?

The physical effects of BFRBs on one's appearance can lead to unpleasant interactions with classmates and other peers. Meeting with your child's teacher (if your child agrees to this; ultimately it is their decision whether to disclose their BFRB or not) before the school year starts to talk about their BFRB and discuss opportunities to educate classmates and other peers about the reasons behind their physical appearance may lessen negative interactions. Encourage your child to be proud of who they are, that they are worthy and important. Try to create peer bonds through sports, clubs, and other activities that help your child see that they have many special gifts beyond their BFRBs.

Getting connected to community also helps. It's as easy as registering for an upcoming TLC health education and community event.

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