Home > Dermatillomania (Skin-Picking Disorder) > An Overview of Toronto’s March 4th Peer Support Meeting with Dr. Sinyor

On March 4th, the Peer Support group based out of Toronto had the opportunity to have a guest: Dr. Mark Sinyor of Sunnybrook Health Sciences Centre. We had posted to our Facebook page asking if anyone had any questions for Dr. Sinyor along with the image to the right which invited people out to the meeting. During that meeting, many different things were discussed and many questions were asked; here is an overview of what was talked about.


  • False assumptions in the medical community about BFRBs (based on other mental health issues):
    • Doesn’t bother the person too much—based on a study that showed that a person with schizophrenia was no less happy than a regular person, suggesting that the mental health disorder has little to no impact on a person’s quality of life.
    • Treatment providers try to imagine the impact of the disorder on their patients and then think they know how to go about treatment.
  • No medications can target a specific behaviour.
    • All medications can do is target some triggers, such as anxiety or depression.
  • Therapy has proven better than medication.
    • Habit Reversal Therapy—very effective
    • HRT equips people with tools that they can continue to use even if they slip up, rather than just giving a medication that doesn’t really solve the problem.
    • These tools can be used to help a patient stop and stop again if relapse occurs.
  • Different treatments work for different people.
  • Journaling
    • Go back to basics and carefully catalogue what you’re doing when engaging in your BFRB to become more aware of your behaviour.
    • For some, awareness can be the biggest step in treatment.
    • List pros and cons of continuing versus quitting—can use that to help make your choice whether or not to stop at this point in your life.
  • Mindfulness Therapy
    • Breathing exercises
    • Progressive muscle relaxation

Heredity & Biology & Nature vs. Nurture

  • There is definitely evidence that BFRBs are hereditary.
  • The disorders, however, “don’t breed true”—if your parents have one BFRB, you won’t necessarily get that BFRB. Instead, you’re at risk for all BFRBs.
  • Modelling (“nurture”) also plays a part in the development of BFRBs.
  • It can also be a motor habit.
    • We can pick or pull in our sleep.
    • Use blockers for these kinds of instances—hats, gloves, tape on fingers, etc.
  • It is probably in your genes—“more nature, but nurture can kick it off.”
    • Studies suggest that a gland called the Putamen (which regulates these kinds of behaviours) is smaller and therefore can’t “shut off” the behaviours as it otherwise would.
  • Does not require a traumatic event to trigger the start of behaviours.
  • Genetic studies are being done at Sunnybrook Health Sciences Centre among the BFRB groups that take place there.
  • All babies self-soothe, and even adults do as well. BFRBs are an escalation of that to some extent.
  • Probably not wise to engage in normal grooming behaviours because of BFRBs.


  • It can be an automatic action (don’t think about it or have very little awareness) or a triggered event (such as an itching feeling).
  • Other mental health issues such as anxiety or depression can also act as triggers.


  • People with BFRBs are more predisposed to anxiety and depression.

Fidget Toys & Alternatives

  • Look for fidgets that suit you best
    • Are you sensory? (need to physically touch something)
    • Are you cognitive? (thoughts—such as something “having to come out”)
  • Substitute the habit for something that creates the same feeling in a healthier way.
    • Example: if you bite the root of the hair to get that “pop,” bite a seed instead.

OCD Spectrum

  • Fits into the OCD Spectrum because of the need to continue until it “feels right.”


  • We all “know better,” so why can’t we stop doing it?
    • We’ve all become experts at these behaviours—very difficult to break.
    • But, if you stop even for a little while, you lose some of that expertise—change is possible; break the ritual!
    • It can also be overwhelming trying to figure out where to start since there are so many different options—maybe instead think of it as many different opportunities or a lot of material with potential to work with.
  • Why do I pull at one spot, but not another? (A question asked.)
    • Got stuck in that program somehow.
    • Imprinted on that area but not another for some reason.
    • Can you move on from it? YES!
    • Mostly intuitive changes are what target a spot, but sometimes it’s a choice (although a not so good one).

Final Thoughts (with a Funny Quotation from Dr. Sinyor)

  • We must find what works best for us as individuals.
  • There is no “go to Wal-Mart and this is the thing!”