“BFRBs are not the enemy, they are the messenger.”

-Dr. Renae Reinardy

The above is just one of several quotations that had an impact on me at the Trichotillomania Learning Center’s annual conference. For the first time ever, CBSN got to attend the conference, and we were not disappointed.

Although there were many things we knew going into the conference, for me especially there were these gems of moments that changed my perspective or really caught my attention in some way.

For instance, many think of their BFRBs as the enemy. Something that must be fought and defeated. But what happens if we change that perspective? What if instead we look at BFRBs as our bodies trying to tell us something? Something we need?

Sure, they have a shoddy way of doing it by making us respond by picking, pulling or biting, but that’s just a faulty coping method. If we learn to identify the need before the BFRB kicks in, however, we can perhaps minimize the damage. Work with our bodies instead of against them.

It’s not as easy as a snap of the fingers, but it is perhaps something new that many of us haven’t tried or thought of. It is perhaps something that is worth a shot.

“There’s nothing wrong with you, we just don’t know enough.”

-Dr. Jon Grant

Another brilliant mind and speaker at the conference was Dr. Jon Grant. He has a wealth of information to share about all BFRBs and the research that it being done for them. He spoke of how BFRBs have been around since the dawn of humans, but didn’t hesitate to admit how little is known about them, even today.

What is known is that 1-3% of people have trich, whereas 1.5-5% have derm. Many people have multiple BFRBs, and there are likely 6-10 subtypes of each BFRB. This confirms what we in the community have noticed: each of us experiences BFRBs differently and they manifest in different ways. SSRIs are not a beneficial or effective form of medication, generally speaking, and NAC has had better results, especially in adults.

Behavioural therapy appears to be most effective overall, however the doctors are still trying to understand why therapy works for some and not for others. They’re also still trying to understand why our minds don’t have an effective enough off switch for these behaviours.

Picking looks different in those with addictive family history as opposed to a picking family history.

-Dr. Jon Grant

Since skin picking is only in its infancy in terms of being recognized as a disorder, so too are the studies about derm infants. Researchers are currently conducting research that focuses on how the brain reacts during picking behaviour and comparing it to other areas of study, like addiction. Research is also being done on how well the different areas of the brain communicate which could maybe lead us to answers about that off switch we’re looking for.

Studies are also searching the differences between the trich brain and the derm brain, and there appears to be differences. Dr. Brian L. Odlaug highlighted a study done in South Africa that found derm has a greater volume of the ventral striatum in the brain, which is where the reward system is located. This led to a reduced ability to stop when that reward was activated. Derm brains in this study also had a reduced cortical thickness in the right hemisphere, which has to do with executive functions.

Another thing that has been noticed in studies is that dermafolk have a similar disconnectivity in white matter tracts (how the brain communicates) as people with addiction and OCD. Does that mean derm is an addiction or OCD? Not necessarily. So far all it suggests is they are related to those things, which may help us understand derm better in the end.

“One size does not fit all.”

-Dr. Jon Grant

All we know for sure is that BFRBs are not easy to understand, but for the sake of those who have them, we must try. The doctors mentioned above are only a few of those working hard to figure out these enigmatic disorders. There are many other doctors and many other researchers who do what they can to try to find the answers that we need.

Organizations like TLC and CBSN are here to support those who need it, and together with these doctors and researchers, we will continue to seek out the answers we need.