What causes BFRBs?

Research indicates that some people may have an inherited predisposition for 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 disorders than would be expected in the general population. In addition, a recent study examined hair pulling in both identical and fraternal twins and produced results consistent with a significant inherited component in hair pulling disorder. So we can safely say that BFRBs are more than likely inherited, at least to some degree.

However, even if a predisposition toward BFRBs is inherited, there are other factors involved as well, including temperament, age of onset, and environmental stress factors. More than likely BFRBs are caused by a variety of factors that interact with each other, resulting in the behavior. It is possible that a person has a predisposition to pull or pick, and the right stressor does not happen at the right time, so the behavior never manifests. Conversely, when a person starts experiencing a BFRB, it is not helpful to blame any one aspect of that person’s life that is happening at that time, but one might assume that the behavior most likely would have come to light at some point in the person’s life.

One interesting point is that other species engage in similar behaviors. Primates such as the great apes or certain types of monkeys will pull hair, over-groom, and pick at nits and insects on their own fur and the fur of others. Birds will pull out their feathers; mice will pull fur or “barber” themselves and their cage mates; dogs and cats may lick their skin or bite at an area, removing fur until there are bald spots. Researchers interested in animal models of BFRBs are trying to understand these behaviors in animals in order to shed some light on the complex neurobiology that underlies the human experience of BFRBs. What these animal studies tell us is that BFRBs are likely, in part, hard-wired behaviors that are not solely the result of environmental factors.