Skin-, Hair-, and Nail-Picking (And Other Body-Focused Repetitive Behaviors)

Body-Focused Repetitive Behaviors (BFRBs) refer to behaviors like nail-biting, skin-picking, lip-chewing, and hair-pulling that are done compulsively despite a child’s efforts to stop and which damage a child’s body (e.g., causing sores, bald patches, etc.). They are considered a “related disorder” to OCD, but they are distinct from OCD, and treatment recommendations are separate as well. These books validate the seriousness of BFRBs and present a pathway to relief.
Age range: 1st grade through 5th grade.
Recommended for: This interactive workbook is a must-read for a child who is struggling with a body-focused repetitive behavior such as nail-biting, hair-pulling, skin-picking, lip-chewing, nose-picking, or thumb-sucking and who wants to stop. Children often develop shame about these behaviors and can’t stop despite caregivers’ frequent urging. This workbook is super destigmatizing–in fact, it explains to children why it makes sense that they feel the urge to do these things. It then presents five “keys”–very doable, evidence-based behaviors–that children can use to start new habits that will make the old ones obsolete. This book can be used in therapy sessions, as therapy “homework” between sessions, or at home with a caregiver.
Age range: Preschool through 2nd grade.
Recommended for: This book is a good introduction to the idea that picking/pulling at an “imperfection” (in this book, a loose thread) often makes it worse, and the more one picks/pulls, the harder it is to stop. The book ends with Rose (the stuffed bunny protagonist) realizing that instead of trying to fix her imperfection, she can practice tolerating it until she no longer notices it much at all. It’s a good fit for a child who is struggling to stop picking at imperfections in their skin, hair, or nails to the point that they’re causing sores or bald patches. It could also potentially be used to start a conversation about intrusive thoughts and/or “not just right” thoughts in OCD, but an adult would need to facilitate a child’s understanding of this metaphor.

Sensory Seeking Sloth

Written and illustrated by Jennifer Jones
Age range: Preschool through 3rd grade.
Recommended for: This book is a relatively fun way to introduce the idea of increasing a child’s sensory input throughout the day to meet their sensory needs. This can be a helpful intervention for some children with autism, ADHD, anxiety, and body-focused repetitive behaviors (e.g., skin-picking and hair-pulling). It introduces the concept of sensory seeking and provides many concrete examples a child can try out (e.g., jumping on a trampoline, eating something crunchy, playing with a fidget toy). School psychologists and counselors, as well as OTs, may particularly find this book useful when discussing interventions for kids to try out.