This chapter provides a concise but comprehensive overview of body focused repetitive behaviors (BFRBs), focusing on the two disorders recognized in the American Psychiatric Association’s diagnostic manual (DSM 5), hairpulling disorder (HPD), also known as trichotillomania, and skin picking disorder (SPD), also known as excoriation disorder. It addresses diagnostic issues, causation, demographics, course of the disorders, comorbidity, prevalence, emotional and interpersonal sequelae, and phenomenology. Furthermore, common misconceptions about BFRBs are addressed, providing the reader with a solid information base upon which to build effective treatment.

Both hair pulling disorder (trichotillomania) and skin picking disorder (excoriation disorder) are legitimate clinical disorders that are neither rare nor benign. For almost half a century, habit reversal training (HRT) has dominated the clinical literature as treatment for these body-focused repetitive behaviors (BFRBs), yet clinicians and researchers have recognized the limitations of this treatment and have utilized numerous treatment modifications in attempts to bolster its effectiveness. Comprehensive behavioral (ComB) treatment, a newer approach to BFRB treatment, has been described in professional publications and is widely used by expert BFRB clinicians The ComB treatment model provides a guiding, comprehensive, conceptual framework that encompasses and integrates sensory, cognitive, affective, motor, and environmental variables into an individualized treatment package geared to the unique clinical phenomenology of each patient. In this chapter, ComB treatment is described in detail and an illustrative case highlights its unique advantages over other BFRB treatments.