Researchers have noticed that people who pick their skin and pull out their hair tend to be perfectionists and over-achievers . There is also clear evidence that picking and pulling arise from difficulties with emotional regulation, like having a harder time calming down when upset and lacking communication skills.

I have not yet seen a satisfying explanation of the commotion between how perfectionism, emotional regulation and BFRBs intersect. In my work of more than a decade with pickers and pullers, I have come to understand something about this intersection: the “good girl” or “good boy” has learned that the so-called negative feelings such as anger and sadness are not welcomed in the home.

In trying to please parents or trying to cause as little stress as possible in an otherwise stressful time, perfectionism can develop as a defensive maneuver. Emotions that are seen as undesirable aren’t fully felt or expressed; rather, they are suppressed and a false, happier front takes the stage. Pent-up energy is channeled toward achievements that earn praise and keep up the appearance that everything is OK.

The perfectionism defense is often very successful at keeping unwanted emotions at bay, and achieving successes and getting kudos along the way! The only problem is that emotions don’t just disappear. Emotional energy has to come out somewhere. Pulling out a hair or picking a pimple can be just the thing to release built-up tension bit by bit.

The problem becomes a cycle, then, because picking and pulling cause damage too, that now must be covered up, as the frustration with having caused imperfections is hard to tolerate and adds more fuel to the inner tension.

So, now that we understand a bit more about this dynamic, let’s see how psychodynamic therapy might play a role in untangling emotions, perfectionism, and picking and pulling behaviors. In particular, by taking the time to establish safety before trying to change picking and pulling behaviors, it makes room for a relational dive into the feelings that have been tucked away. These feelings are too overwhelming to experience alone, but with a trusted they can be felt, processed, and released.

Anna, a 30 year old mother of 2 small children explained in her 3 month post-therapy interview how our work on emotional regulation helped her drop her lifelong shield of perfection, “The perfectionism was part of the problem. With Stacy, I figured out that I didn’t have to have perfectly clear, wonderful skin that I never picked in order to be happy and to feel like I was in control of my life and of my picking.”

The process of learning to drop the “good girl” or “good boy” persona that has been so helpful in the past is often painful and difficult. The journey is worth it, as the ability to tolerate and express one’s most painful emotions can cut through the veil of isolation. Deeper connections can bring the very comfort and emotional support that can relieve pressure on the need to pick and pull.