My Anxiety Plan (MAP) for Body Focused Repetitive Behaviours (BFRB) - Trichotillomania (TTM) and Skin Excoriation (SE)

The following strategies are designed for you, the parent, to use with your child as s/he begins to tackle his/her BFRB- either TTM or SE. These strategies are best used for children with mild to moderate signs of this type of problem. For children with more severe symptoms or who have been diagnosed with either TTM or SE, we recommend treatment with a mental health professional, although MAP strategies can be used at home to support your child’s therapy work.

Step 1. Helping your child become an expert on anxiety 

This is a very important first step, as it helps children understand what is happening to them when they experience stress and anxiety. Stress is a normal and routine part of living in the modern world, and is defined as any demand placed upon the body and mind. Stress may be both negative and positive, but only becomes a problem when we let life’s demands exceed the resources we have to cope. Resources can be both internal, such as our thoughts and feelings, and external, such as our actions, environment, friends, and family. In addition, help your child to recognize that the worries and physical feelings s/he is experiencing has a name -anxiety- and that millions of other people also have anxiety, as this can be a great relief. Finally, support your child in becoming an expert on anxiety by providing him or her with facts and important information. 

To learn how to explain this to your child, see Anxiety 101: What You and Your Child Need to Know About Anxiety and How to Talk to Your Child about Anxiety and The ABCs of Anxiety: Understanding How Anxiety Works and Fight-Flight-Freeze.

Step 2: Teaching your child about TTM or SE

  • Reading or explaining some of the information outlined on the Body Focused Repetitive Behaviours can help your child feel more in control of what is happening to him or her. Knowledge is power.
  • Explain to your child that Trichotillomania (TTM) and Skin Excoriation (SE) are part of a cluster of habitual behaviors that make up the broader name: Body-Focused Repetitive Behaviours, or BFRBs. In both TTM and SE, the child experiences ongoing and repetitive urges and actions towards either pulling out of one’s hair, or skin picking (dependent on the disorder), resulting in noticeable hair loss, or skin abrasions or lesions. This occurs despite extensive efforts to stop these behaviours. In both disorders there is significant impairment and disruption in routine life functioning. For the child this can include social isolation, trouble concentrating in school, school absences, and family conflict.
  • Talk with your child about how TTM and SE are not simply habits s/he could stop if s/he tried harder. Rather TTM and SE are conditions that involve complex brain mechanisms that generate urges and actions of pulling/picking. As a result, specialized help is required to help your child learn how to manage.
  • Finally, let your child know that both TTM and SE occur in the lives of other children, and s/he is not the only one who feels this way.

Step 3: Creating your child’s MAP

The best way to help your child deal with TTM or SE is to give him or her tools that can be used to cope with the symptoms, urges, and behaviours associated with hair pulling or skin picking.  These tools are intended to increase your child's ability to tolerate stress and anxiety, rather than to eliminate stress and anxiety, which accompanies urges and actions associated with both TTM and SE.  Stress and anxiety exist everywhere, and therefore it is an illusion to believe we can eliminate the source and experience of these emotions. It is far more effective to provide your child with the tools to tolerate and cope, rather than to control and escape.  For TTM or SE, you can use any or all of the following anxiety tools to create your child's My Anxiety Plan (MAP). These tools are listed in a recommended order, although proceeding in this order will depend on the needs and interests of your child. For TTM and SE, Methods for Addressing BFRBs in Children, will be the most important tool for your child to obtain relief from his or her symptoms.

Final point:
Although increased knowledge and the many tools available on this website can be very effective in helping you to manage your child’s anxiety and TTM or SE, sometimes it is not enough. Sometimes children have very severe anxiety, and despite all your best efforts, your child might still be struggling daily with anxiety and symptoms of TTM or SE. If this is the case, seek some professional help through a consult with your family doctor, psychiatrist, or a child psychologist/mental health worker.