It’s a Saturday in April, and I’m attending the 25th annual TLC conference for BFRBs. This year, it’s in San Francisco. The conference is just one of the ways that TLC aims to help people directly. I’m here with nearly 500 others, including individuals with BFRBs, their families, clinicians, and researchers. This session is an art class for kids aged 11 and under.
“What we’re going to do is make our marks,” says Atkin, after roughly a dozen kids have taken seats and introduced themselves. She holds up a stick of charcoal and explains it’s a piece of wood that’s been burned. “I have compulsive skin picking, and charcoal really helps me.”
Atkin distributes the charcoal and paper and asks the kids to make a dot.
“Paul Klee said, ‘A line is a dot taking a walk,’” she says, holding up her own sheet of paper and making a black spot. From there, she demonstrates various rubbing and smudging techniques, before bringing out pastels so the kids can add color.
“I think my drawing’s going to end up looking like my cat,” says the girl sitting next to me, wearing a Toronto Maple Leafs sweatshirt. Her picture does indeed resemble a calico cat with patches of black and orange.
Atkin asks if anyone wants music, and someone requests Prince.
Above the music, Atkin asks, “Is drawing a nice thing to do? Why do we like drawing?”
The group offers varying responses: Drawing calms your mind. You can express yourself. There’s no wrong way to do it.
“Why are we working with stuff that’s messy? Why is that useful? We’re using materials that have a texture to them.” Later, she’ll explain to me that for many, BFRBs are texture-based disorders. Art engages the body and mind, giving the person a focus other than the BFRB.
I’m sitting in a row with a boy and a girl. I overhear the boy ask, “What’s your thing? Mine’s skin picking.” The girl says matter-of-factly, “Mine’s trichotillomania.”
They fall back into silence, drawing on the black paper.
It’s taken science some time to catch up with what people with BFRBs have known for years: For many, there’s a strong sensory component to the disorder.
A pair of studies published in 2017 and 2018 were the first to report that individuals with BFRBs have higher rates of sensory overresponsivity to external sensations than the general population. In other words, they respond intensely to things like sounds and textures. The phenomenon—also sometimes referred to as “sensory-integration dysfunction” or “sensory-processing disorder”—was first described in the 1970s by the occupational therapist Jean Ayres. Since then, sensory overresponsivity has been most frequently studied in association with autism, and more recently in OCD.
In one of the studies, people with trich were twice as likely to have severe to extreme sensory overresponsivity to touch and sound. One study participant described her struggle with clothing: “My tactile discomfort lies in how I feel in clothes. They always feel too tight and uncomfortable as soon as I step out of the house. For this reason, I only go out when absolutely necessary—school or work.”