For people who suffer with dermatillomania (compulsive skin picking) and trichotillomania (compulsive hair pulling) these urges come in overpowering waves. Triggered by stress, trauma, medication or just boredom, ‘derm’ and ‘trich’ are defined medical conditions that seriously affect people's lives for years. The visible symptoms, angry red marks, scarring and visible bald patches, can be the target of unwanted comments and attention, fuelling the cycle of shame, secrecy and isolation. 

Trich and derm are two examples of body focused repetitive behaviours (BFRBs), conditions that will affect one in 20 people in their lifetime. That’s 55m people across the US, UK and Europe alone; a figure so large that it’s hard to get your head around. But as a health care expert, what I find harder to get my head around is the widely disproportionate level of awareness, understanding and support available to anyone suffering with BFRBs.

When it comes to mental health visibility, acceptance and treatment, big leaps forward have been made over the past decade. As a result of the hard work of many champions, numerous high-profile advocates and refreshing media attention, it's no longer taboo to admit to having depression, anxiety, or several other mental health conditions. Across the US, UK and Europe, students learn about mental health in school and funding is allocated to research and treatment programmes.

But although I celebrate this progress, I am also frustrated about the fact that BFRBs seem to have been left behind. Why does it still feel so awkward to admit to having your life blighted by these compulsive behaviours? Why do people still confuse them with self harm or dismiss them as bad habits? Trich and derm sufferers are stigmatised and silenced: this needs to change. 

If we are ever going to see those 55m people escape their shame and access much-needed support, we must change the status quo. To do this, we must work together to take control of the narrative and confront BFRB stigma head-on. That means starting a conversation about these conditions in public spaces: in the press, on television and, crucially, on social media platforms. This might seem like a daunting challenge, but if we all play our part then it’s a challenge we can win. Get started by talking to your friends, educating them about the conditions and challenging dismissals of hair pulling and skin picking as ‘bad habits’ resulting from a lack of willpower or self control.  If you have personally experienced a BFRB, reach out to others to share your story - every person who speaks out makes another person feel less alone.

I co-founded the startup Nudge in 2020, with the goal of ending BFRB stigma and growing a supportive international community of people affected by these conditions. Our small but committed team has created the Nudge band, a wrist-worn, rechargeable device that - thanks to some inbuilt neural network programming and artificial intelligence - vibrates gently whenever the user lifts their hand towards their face or head.

The vibrations are designed to bring the wearer’s focus back to their hand movements.

According to our research, this usually stops a potential hair-pulling, skin-picking or nail-biting episode in its tracks and allows the wearer to distract their hands with another activity. 

Users can keep count of how often they attempt to touch their face or head thanks to small lights on the device that are activated whenever the band vibrates. Over time, the device helps wearers to rewire their brains and, combined with their own willpower, reduce the frequency of engaging in BFRBs.

I'm incredibly proud of the fact that we designed, built and launched the Nudge in under a year, and that we’ve now shipped thousands of bands to customers in over 30 countries. It almost brings me to (happy) tears to read the messages from customers who had almost given up hope of ever taking back control over their BFRBs before they started using Nudge. And as well as creating this product, we're also curating and creating education and recovery resources, sharing our customers' and ambassadors' unique BFRB experience stories on our blog, connecting the BFRB community on our Instagram page, and doing everything we can to raise public awareness.  

I firmly believe that we will soon see a day when we talk about all mental health conditions as openly as we might discuss a broken wrist or headache. But that day is only going to come if we all play our part in ushering it in. The challenges ahead demand a united front, but every person who chooses to be an active BFRB champion is pushing us closer to success.