Podcast Summary: Get to Know OCD

Episode: Why You Can’t Stop Hair Pulling, Skin Picking, or Nail Biting

Host: Dr. Patrick McGrath (NOCD Chief Clinical Officer)
Date: December 7, 2025

Overview

In this episode, Dr. Patrick McGrath explores body-focused repetitive behaviors (BFRBs)—such as hair pulling, skin picking, and nail biting—which often co-occur with obsessive-compulsive disorder (OCD). He distinguishes between OCD and BFRBs, highlights their impact, and discusses practical, evidence-based treatment options, focusing particularly on Habit Reversal Training (HRT).

Key Discussion Points & Insights

1. Defining Body Focused Repetitive Behaviors (BFRBs)

• Connection to OCD:
  • BFRBs are classified under OCD and related conditions in mental health manuals.
  • They frequently co-occur with OCD:

    “21% of people with OCD also had co-occurring body focused repetitive behaviors. And people with OCD are more likely to develop these than people without OCD.” (01:02)

• Examples of BFRBs:
  • Hair pulling (trichotillomania)
  • Skin picking (excoriation)
  • Nail biting (onychophagia)
  • Cheek or lip biting, nose picking

2. Common Misunderstandings and Stigma

• Oversimplification by Others:
  • People are often told to “just stop” the behavior, reflecting a misunderstanding of BFRBs:

    “If it was that easy, I wouldn’t have a job, right?... But it’s so much more than that.” (01:49)

• Societal Pressure:
  • Shame and embarrassment are common, especially due to visible effects (bald spots, scabs, damaged nails).
  • The impact of beauty standards and the misconception that BFRBs are simply “bad habits.”

3. Causes and Characteristics of BFRBs

• Difference from OCD Compulsions:
  • Unlike OCD, BFRBs aren’t usually about preventing specific feared outcomes.

    “Body focused repetitive behaviors don’t appear to be fueled by fear of specific consequences… instead it seems to be more of a self regulatory function or done in response to wanting to be regulated or soothed.” (04:36)

• Genetic & Neurobiological Overlap:
  • BFRBs may share neurobiological and genetic factors with OCD, which is why they appear together in diagnostic manuals.
  • Short-term relief from anxiety is common, but behavior worsens over time.

4. Real-Life Impact

• Automatic Nature:
  • Many engage in these behaviors “without even recognizing doing them,” later feeling guilt or shame.
  • Example: Searching for specific hair texture and pulling it out, sometimes even ingesting the pulled hair, which can have medical consequences:

    “...you can get a hairball in a human—that’s called the trichobezoar—and if it gets too big, it has to be surgically removed.” (03:54)

• Concealment Strategies:
  • Wearing hats, bandanas, gloves, or makeup to mask visible evidence of BFRBs.

    “Wearing gloves all of the time... bandages... covering up your arms. All of these can be very difficult.” (05:24)

Treatment & Practical Help

5. Habit Reversal Training (HRT)

• Primary Intervention:
  • “The goal of habit reversal training is really to bring awareness to people so that they’ll know that they’re doing a behavior.” (06:04)
• Examples of Techniques:
  • Wearing a glove or programmable bracelet while in situations where the behavior usually occurs (e.g., watching TV), making the person more aware.

    “There’s even bracelets... if it goes in a certain position, it will send a little buzz... to your wrist just to say, 'hey, by the way, you’re doing this thing again.'” (06:31)

  • Replacing the behavior with another action—e.g., playing with a Koosh ball instead of pulling hair.
• Awareness as the First Step:
  • Once someone becomes conscious of their triggers and actions, they can begin to substitute healthier behaviors.

6. Integrating OCD and BFRB Treatment

• Collaboration at NOCD:
  • NOCD offers tailored treatment for both OCD (using Exposure and Response Prevention, ERP) and BFRBs (using HRT), along with between-session support and community resources.
• Message of Hope:
  • “Body focused repetitive behaviors can be managed. And if you’re struggling with OCD or BFRBs or both, they can be treated at the same time. It is okay.” (07:56)

Notable Quotes & Memorable Moments

• “If it was that easy, I wouldn’t have a job, right?... But it’s so much more than that.” (01:49)
• “There’s even bracelets... it will send a little buzz... just to say, 'hey, by the way, you’re doing this thing again.'” (06:31)
• “Body focused repetitive behaviors can be managed… remember, BFRBs don’t have to be in control of your life. You can live the life that you want.” (07:56)

Timestamps for Important Segments

• 00:20 – 02:50: Defining BFRBs and their connection to OCD
• 02:51 – 04:35: Causes, characteristics, and the difference from OCD compulsions
• 04:36 – 05:32: Societal pressures, real-life impact, and concealment strategies
• 05:33 – 07:01: Introduction to Habit Reversal Training (HRT) and treatment techniques
• 07:02 – 07:56: Support resources and encouragement for treatment

Tone and Closing Thoughts

Dr. McGrath speaks in an empathetic, down-to-earth style, aiming to destigmatize BFRBs and emphasize that professional, compassionate support is available:

“You’re not alone in this whatsoever. I want you to know this. Body focused repetitive behaviors can be managed.” (07:41)

The episode closes with reassurance that with evidence-based care, recovery is possible, and that BFRBs do not need to control anyone’s life.