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TreatBFRD

The Norwegian Study of Skin Picking Disorder, Hair Pulling Disorder, and other Body-focused Repetitive Behavior Disorders.

Background

Hair-pulling disorder and skin picking disorder are body-focused repetitive behavior disorders (BFRD), classified as obsessive-compulsive related disorders in DSM-5 and ICD-11. Hair-pulling disorder, or trichotillomania, and involves recurrent pulling out of one's hair, resulting in visible hair loss. Similarly, skin picking disorder, or excoriation disorder, involves repetitive skin picking, leading to skin damage. In order to be diagnosed with hair pulling disorder or skin picking disorder, the symptoms must result in significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning. The life time prevalence has been estimated to be around 1.4% for hair pulling disorder and 1.7% for skin picking disorder.

Habit reversal training (HRT) is a well-established treatment approach for hair pulling disorder that primarily addresses automatic pulling. Acceptance and Commitment Therapy (ACT) can complement HRT by addressing factors that are particularly relevant to focused pulling, in which hair pulling is often more deliberate and occurs in response to emotional or cognitive experiences. Several studies have shown that ACT-enhanced HRT is effective in reducing hair-pulling symptoms, and more recent research suggests that this treatment may also benefit patients with skin-picking disorder. However, these studies have generally been based on relatively small samples and have included short follow-up periods, limiting the robustness and generalizability of the findings.

Aims

The overall aim of The Norwegian Treatment Study of BFRDs (TreatBFRD) is to map the phenomenology and clinical course of BFRDs in order to improve assessment and treatment of these disorders. TreatBFRD is a research project with a broad defined aim, which implies that more specific research aims are presented in future research plans and require a separate approval of the Data Protection Officer at the Oslo University Hospital.

Methods

Patients

TreatBFRD is the  continuation of two previous studies: “The Norwegian Trichotillomania Project” which started in 2012, and “The Norwegian Skin Picking Project” which started in 2014.

Patients in the new project, i.e., TreatBFRD, will be included in the existing database. We aim at including 400 new patients in (200 with hair pulling disorder and 200 with skin picking disorder or other BFRDs). Thus, merging this database with the database of the former projects will imply that the final database will include about 650 patients.

Treatment

All patients who are referred for treatment of BFRD at the outpatient department for OCD-specter disorders are invited to participate in the study. Most patients are offered group-based ACT-enhanced Habit Reversal Training, using the Norwegian translation of the treatment guide by Woods and Twohig (Se Trikotillomani | Douglas W. Woods | ARK.no). The manual is written for patients with hair pulling disorder and works well for patients with skin picking disorder as well. Group treatment consists of ten group sessions lasting three hours (with a break of 15 minutes), and three booster sessions. Treatment also includes one meeting for relatives.

Measurements and storage of information

Treatment effects are assessed by digital self-report questionnaires during the entire treatment period, using “Nettskjema” at the University of Oslo. All research data are stored securely in the Services for Sensitive Data (TSD) at the University of Oslo. Personally identifiable information will not be stored in TSD but will be kept separately in MedInsight at Oslo University Hospital.

Participants                      

  • Project leader: Benjamin Hummelen
  • Toril Dammen
  • Torun Grøtte
  • Håkon Nordahl
  • Jonas Brown-Pedersen
  • Shirin Eskeland
  • Erna Moen
  • Karete Jacobsen Meland
  • Anniken Andersen
  • Thale Oftebro Skulberg
  • Diana Strand Johnsen
  • Sidsel Myhr
  • Douglas Woods, PhD, Wisconsin, USA.

Publications

Peer-reviewed journals

  1. Trikotillomani | Tidsskrift for Den norske legeforening (tidsskriftet.no)
  2. Hudplukkingslidelse | Tidsskrift for Den norske legeforening (tidsskriftet.no)
  3. Moen, A. B., Hummelen, B., Moen, E., Dammen, T., Melle, I., Strand, D., . . . Grøtte, T. (2026). Trichotillomania and skin-picking disorder: associations with childhood maltreatment and the mediating role of depressive symptoms. BMC psychology.
  4. Flagstad, E., Hummelen, B., Moen, E., Dammen, T., Haaland, Å., Sunde, T., Hansen, B., Johnsen, D. S., Woods, D., & Grøtte, T. (2025). Early maladaptive schemas in trichotillomania and skin-picking disorder: their relationships with symptom severity and subtypes. BMC psychology, 13(1), 1–15.https://doi.org/10.1186/s40359-025-03096-y
  5. Hummelen, B., Brovold, F., Moen, E., Meland, K. J., Andersen, A., Johnsen, D. S., Dammen, T., Woods, D., & Grøtte, T. (2025). Psychometric Properties of the Action and Acceptance Questionnaire for Trichotillomania in a Clinical Sample of Patients with Trichotillomania and Skin Picking Disorder. Journal of Obsessive-Compulsive and Related Disorders, 100972. https://doi.org/10.1016/j.jocrd.2025.100972
  6. Haaland, Å. T., Eskeland, S. O., Moen, E. M., Vogel, P. A., Haseth, S., Mellingen, K., Himle, J.A., Woods, D.W.,Hummelen, B. (2017). "ACT-enhanced behavior therapy in group format for Trichotillomania: An effectiveness study". Journal of Obsessive-Compulsive and Related Disorders, 12, 109-116. https://doi.org/10.1016/j.jocrd.2017.01.005

Other publications and contributions - in Norwegian

More information

Published Dec. 20, 2023 1:16 PM - Last modified Oct. 23, 2026 11:44 AM
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