Under the Hurt Umbrella: Shame and Body-Focused Repetitive Disorders

Wall-of-ShameIn my work with clients who deal with Body-Focused Repetitive Disorders (BFRDs) I have gradually become convinced that in many individuals shame drives the behavior.  BFRDs manifest in compulsive pulling of one’s hair (Trichotillomania), picking at skin and scabs (Excoriation), cutting, carving, biting, and starving (Non-Suicidal Self-Injury NSSI). This shame results from an individual’s unrealistic(even grandiose) expectations of oneself. When expectations are not met perfectly and an individual cannot accept that the expectations were unrealistic in the first place, the system is overwhelmed with fear and anxiety that result in shame.

Shame is different from guilt.  Guilt can be explained – you did something wrong.  You can confess and be forgiven.  Shame – you are wrong.  You can only hide and conceal your weakness.  The result can be a combination of blurred boundaries, depression and defensive rage.

The cycle is vicious.  Unrealistic expectations set up anxiety and fear of failure.  When anxiety and fear become overwhelming, self-harm temporarily offers escape from the uncomfortable and finally intolerable state.  Engaging in the behavior results in shame and  negative self-talk.  When efforts to conceal are discovered, and individual defends the secret behavior with narcissistic rage.  Once the cycle is complete, the individual resolves to “do better,” “to quit,” and to be the perfect self that set them up for failure in the beginning.

Shame is a challenge for therapists because it causes clients to hide and conceal.  Clients will often admit to feelings of aggression-feelings that have power.  When you first suggest shameful feelings – clients will deny them and try to escape the discussion.


About drmary2003

I am a psychologist in Winter Park, FL. I come from an education background with a specialist degree in School Psychology plus a PhD in Human and Organizational Development. I love the social/cultural sides of psychology. My private practice is based on principles of positive psychology and "horse sense." I specialize in trichotillomania (hair pulling), skin picking, victims of bullies, anxiety and depression. As a school psychologist I am qualified to give all psychoeducational tests. I help students, parents, and teachers with learning differences, accommodation for college board tests, neuropsychological testing, ADHD, and do evaluations for giftedness. After testing I consult with parents and teachers to help optimize classroom performance. Throughout the school year, I monitor the progress of all students I have evaluated. I have a broadly based practice drawing on multiple streams of knowledge and interest. I bring my voracious appetite for books, my interest in herbs and gardens, my music minor in college, my storytelling classes, my yoga experience and love of movies to make my counseling individual and creative.
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3 Responses to Under the Hurt Umbrella: Shame and Body-Focused Repetitive Disorders

  1. This is so well written, and eerily accurate.

    • drmary2003 says:

      Thank you, I hope you enjoyed it !

    • drmary2003 says:

      It is so eerily accurate because I have personal experience with this. It seems it never completely goes away. I have to keep working on my “default negative” every single day. There was an old SNL skit that repeated “I’m good enough, I’m smart enough, and doggone it – people LIKE me!” Thanks for commenting. Dr. Mary…..

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