理解拔毛癖（拔毛发）及其他身体聚焦重复行为，与Clare Mackay博士和Suzanne Mouton-Odum博士共同探讨

身体聚焦重复行为，如拔毛癖或慢性拔毛，以及皮肤搔抓、咬指甲等，可能影响高达二十分之一的人群。然而尽管这些行为相当普遍，被称为BFRBs的它们仍被污名化、误解且诊断不足。今天我们将与两位专家探讨这一现象的原因，以及近年来我们对BFRBs认知的演变。那么什么是身体聚焦重复行为？它们与普通习惯有何不同？

Body focused repetitive behaviors like trichotillomania or chronic hair pulling, as well as skin picking, nail biting and others may affect up to one in twenty people. Yet despite how common they are, BFRBs, as they're called, remain stigmatized, misunderstood and underdiagnosed. Today, we're going to talk with two experts about why that is and about how our understanding of BFRBs has evolved in recent years. So what are body focused repetitive behaviors? How do they differ from ordinary habits?

这些行为何时开始？为何开始？又为何难以停止？与拔毛癖或其他BFRBs共处如何影响人们的生活和心理健康？哪些治疗方式可能有所帮助？欢迎收听《心理学漫谈》——美国心理学会旗舰播客节目，探索心理科学与日常生活的联系。我是金·米尔斯。

When and why do they start and why are they so hard to stop? How does living with trichotillomania or another BFRB affect people's lives and their mental health? What kinds of treatments and therapies can help? Welcome to Speaking of Psychology, flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life. I'm Kim Mills.

今天我们邀请到两位嘉宾。首先是贝勒医学院临床心理学助理教授、休斯顿心理认知行为治疗中心创始人兼主任苏珊娜·莫顿·奥德姆博士。她专长于治疗身体聚焦重复行为、强迫症、抽动障碍及其他焦虑障碍。

We have two guests today. First is Doctor. Suzanne Mouton Odum, a clinical assistant professor of psychology at the Baylor College of Medicine and the founder and director of Psychology Houston, the Center for Cognitive Behavioral Treatment. She specializes in treating people with body focused repetitive behaviors, as well as obsessive compulsive disorder, tic disorders and other anxiety disorders. Doctor.

穆坦·奥德姆博士是身体聚焦重复行为TLC基金会的董事会与科学顾问委员会联合主席。她发表过大量科学期刊论文，合著过六本书籍，包括《家长拔毛障碍指南》和《克服身体聚焦重复行为练习手册》。我们的第二位嘉宾是英国牛津大学神经科学教授克莱尔·麦凯博士，她领导转化神经影像研究组。

Muthan Odom is co chair of the board of Directors and the Scientific Advisory Board of the TLC Foundation for Body Focused Repetitive Behaviors. She has published many scientific journal articles and has coauthored six books, including A Parent Guide to Hair Pulling Disorder and The BFRB A Workbook for Overcoming Body Focused Repetitive Behaviors. Our second guest is Doctor. Claire Mackay, a professor of neuroscience at Oxford University in The UK, where she heads the Translational Neuroimaging Group. Most of Doctor.

麦凯博士的研究主要运用神经影像技术解析帕金森症与阿尔茨海默症等疾病风险。近年来她开始研究身体聚焦重复行为的神经科学，这项研究源于她自幼与拔毛癖抗争的个人经历。她即将出版的新书《保持冷静：理解抓挠拔咬冲动》将于2026年4月发行。莫顿·奥德姆博士、麦凯博士，感谢二位今天的参与。

McKay's research focuses on using neuroimaging to understand risk for diseases such as Parkinson's and Alzheimer's. In recent years, she's begun studying the neuroscience of body focused repetitive behaviors, works spurred by her own experience dealing with trichotillomania since childhood. She's author of the forthcoming book, Keep Your Hair On Understanding Urges to Pick, Pull or Bite, which will be published in April 2026. Doctor Mutinodom, doctor McKay, thank you both for joining me today.

谢谢邀请。

Thank you for having us.

非常感谢。

Thank you so much.

让我们先详细解释一下身体聚焦重复行为。它们究竟是什么？有多少种不同类型？这个术语涵盖哪些内容？

Let's start by explaining in a little more detail body focused repetitive behaviors. What exactly are they? How many different types are they? What does the term encompass?

这是个很好的问题。根据《精神疾病诊断与统计手册》，BFRBs被描述为拔毛或抠皮行为。正如你提到的，拔毛癖是拔毛障碍的专业术语，而抠皮障碍则是抠皮行为的专业术语。拔毛障碍可以涉及身体任何部位的毛发。

That's a great question. So the Diagnostic and Statistical Manual of Mental Disorders describes BFRBs as hair pulling or skin picking. You know, as you pointed out, trichotillomania is the technical word for hair pulling disorder. Excoriation disorder is the technical term for skin picking disorder. Hair pulling disorder can encompass any hair on the body.

包括睫毛、眉毛、阴毛、手臂毛发、面部毛发、腿毛等任何毛发，最常见的是头皮、睫毛和眉毛。关键在于你试图停止却无法停止，并且这种行为给你的生活带来了困扰。所以这是个相当宽泛的定义。我们过去还有一些其他需要满足的标准，但在最新版本中基本就是这些。它不能归因于脱发症或某些皮肤疾病。

Know, eyelashes, eyebrows, pubic hair, arm hair, facial hair, leg hair, any hair, most commonly it's scalp, eyelashes and eyebrows. And really it's that you've tried to stop and you're not able to stop and it causes some problem for you in your life. So it's a pretty general definition. And we used to have some other qualifications or criteria that were needing to be met, but in the latest iteration, that's pretty much it. It's not accounted for by say alopecia or some dermatological disorder.

抠皮障碍也基本相同。它涉及反复抠皮到造成问题的程度，患者感觉无法停止。同样，它不能归因于皮肤疾病或其他精神科诊断。

Skin picking disorder is pretty much the same. It involves repetitive picking of one's skin to the point where it causes a problem, and a person feels like they're not able to stop. And again, it's not accounted for by a dermatological condition or some other psychiatric diagnosis.

这些行为与我们可能认为的坏习惯（如咬指甲）有什么区别？McKay医生，您对此有什么看法？

How do these behaviors differ from what we might just consider a bad habit like nail biting? Doctor. McKay, what are your thoughts on that?

我认为它们与咬指甲完全没有区别。咬指甲是另一种身体聚焦重复行为，实际上是社会接受度最高的一种。我认为BFRBs包括所有对毛发、皮肤和指甲的抠、拔、咬行为。当然我们都会做这些事，因为它们本是正常的整理行为。正如Suzanne所说，目前只有拔毛和抠皮被列入DSM，但在我看来，任何因此类行为承受巨大痛苦并影响正常生活的人都属于同一类别。

Well, don't think they're different at all from nail biting. Nail biting is another type of body focused repetitive behavior and it's actually the one that's kind of most socially acceptable. So the way that I think about BFRBs is that they are all of the picking and pulling and biting of hair and skin and nails. And of course we all do these things a bit because they are normal grooming behaviours. And as Suzanne said, it's only hair pulling and skin picking that have made it into the DSM, but really anybody who has BFRBs that cause them significant amounts of distress and are impacting the way that people can live their normal lives are in the same category as far as I understand it.

这些行为本质上没有区别。我也咬指甲，既拔头发又咬指甲，在我看来它们是一回事。

The behaviours are not really different. I bite my nails too. I pull my hair and I bite my nails, and as far as I'm concerned, they're the same.

是的。这和自残行为有关联吗？

Yeah. Is there any relationship to cutting?

这是个很好的问题，经常被提及。你知道，故意伤害自己身体的行为。表面上看这些行为可能像是自我伤害，但实际上完全不同。我们认为BFRB（身体聚焦重复行为）的功能更多是自我调节、自我安抚，或对个体有某种功能意义，而非自我伤害。人们通常甚至试图通过拔除某种毛发或去除皮肤凸起来解决问题或改善状况。

So that's a great question, and it comes up a lot. You know, intentional harm to one's body. I guess one could think about these because on the surface they kind of look like there might be self damaging, self harming behaviors, but really it's quite different. We see the function of a BFRB as more self regulation, self soothing, or serving some sort of a function to the person, the function not being self harm. People oftentimes are even trying to fix a problem or to improve a situation by removing all of a certain type of hair or removing a bump.

因此其功能与自残或自我伤害行为截然不同。所以我们对待方式也完全不同，思考角度也完全不同。

And so the function is quite different than in a self mutilation or self harming type behavior. So so we treat them very differently, and we think about them very differently.

我在开场提到了患病率，但研究对BFRB的普遍性有何说法？我们有准确数据吗？

I talked in my intro about prevalence, but what does the research say about how common BFRBs are? Do we have good numbers?

我们没有很完善的数据。只有部分数据。遗憾的是由于BFRB的污名化，很多情况下这个问题根本不会被问及。在标准心理健康筛查工具中，'你是否会抓扯或啃咬头发、皮肤或指甲？'这类问题通常不存在。所以我们缺乏大规模流行病学证据。

We don't have great numbers. We have some numbers. But unfortunately, because of the stigma around BFRBs, in many cases the question doesn't get asked. In standard screening instruments for mental health problems, the question do you sometimes pick or pull or bite at your hair, skin or nails?' doesn't tend to exist. So we don't have large scale epidemiological evidence.

目前最好的数据来自一些较小规模的研究。这类研究通常在学生群体中进行。但现有最佳证据表明，约5%或二十分之一的人存在达到问题程度的抓扯啃咬行为。而有过此类行为（如咬指甲、拔头发、抠皮肤）但未达问题程度的人群比例要高得多——可能我们中半数人甚至所有人都会...

So the best we've got is some relatively small scale studies. And often, these sorts of studies are carried out in school populations or college populations. But nevertheless, the best evidence suggests that about five percent or one in twenty people struggle with problematic levels of picking and pulling and biting. But the numbers of people who actually engage in the behavior at all nail biting, hair pulling, skin picking at a level that isn't problematic is much higher. It's probably maybe half of us or maybe even all of us to

在某种程度上如此。当然。那么McKay博士，您从童年起就患有拔毛癖，几年前才开始研究并公开谈论它。能否谈谈您的经历，以及为何现在决定公开讨论？

a certain extent. Sure. Well, Doctor. McKay, you've lived with trichotillomania since childhood, you only began studying it and speaking about it a few years ago. Can you tell us about your experience and why you decided to start talking about it now?

是的，谢谢。对我来说，与身体聚焦重复行为共存的经历就是不断隐藏自己。四十年来，我深受拔毛症的困扰，最大的痛苦就是对这些行为怀有强烈的羞耻感。不幸的是，由于这些行为很少被理解且备受污名化，普遍认知认为我们应该能控制它们，人们只会简单粗暴地要求我们停止——包括家人、爱人，甚至本该照顾我们的医生。

Yeah, thank you. The experience of living with a body focused repetitive behaviour for me was one of hiding. And the biggest problem that I experienced for forty years of living with hair pulling disorder was the amount of shame that I carried around about these behaviours. Unfortunately, because they're so little understood and so stigmatised, the general understanding of these behaviours is that we should be able to control them, and we're just told to stop it. And that's by our families and our loved ones, but also by our doctors and the people who are there to care for us.

当所有人都对这些行为缺乏正确认知，而你自己又无法控制时，就会陷入一种长期的羞耻循环，让你觉得自己本质上有缺陷。尽管表面上我是个成功人士，能对各种疾病障碍开展科学研究，但我从未想过把这些知识用在自己终身携带的病症上——因为羞耻感会严重抑制我们的思考能力。直到五十岁更年期时，我才欣喜地发现：你终于不再那么在意他人看法了。这时我才意识到，可以把三十年的神经科学研究和四十年的病症经历结合起来做些有意义的事。

And so when nobody has any good understanding or knowledge of these behaviours and you can't control it, unfortunately that can set up a kind of chronic shame spiral where you just think that you're fundamentally flawed. And even though I was on the surface a successful person, I managed to do some good science around all sorts of different diseases and disorders. It literally didn't cross my mind that I could apply some of this knowledge to the the disorder that I'd been carrying around all my life because shame has such a powerful dampening effect on the way that we think. And so I got to, you know, menopause and the age of 50 where joyfully the great news is that you stop caring as much about what other people think of you and it started to emerge for me that I could put these thirty years of neuroscience and forty years of this disorder together and maybe do something useful with that.

BFRB（身体聚焦重复行为）过去被归类为冲动控制障碍，但现在DSM（《精神疾病诊断与统计手册》）将其归入强迫症范畴。那么这些行为属于强迫症吗？它们与其他障碍有何异同？比如与图雷特综合症有关联吗？

BFRBs used to be classified as impulse control disorders, but they're now grouped under obsessive compulsive disorders in DSM, the Diagnostic and Statistical Manual used by psychologists and physicians. So are these behaviors a form of OCD? How do they differ from and overlap with other disorders? I mean, they related to things like Tourette's syndrome, for example?

很好的问题。其实我们很希望BFRB能有独立分类——在上次DSM修订时我们极力主张过，但很遗憾未能实现。它确实不适合归入冲动控制障碍，虽然对部分患者而言有这个特点。

Sure, great question. You know, it's tough because I wish we could have a separate category for BFRBs. It would be so nice and we really advocated for that in the last iteration of the DSM and unfortunately that didn't happen. It really didn't fit in impulse control disorders. For some people it does.

对某些人来说这种行为带有冲动性，但它与手册里列出的其他障碍都不完全吻合。虽然BFRB是种不自主的重复行为，但它与强迫症最多算远亲——可很多BFRB患者会误以为自己得的是强迫症，我们必须解释这两者的本质区别。除了都是非自愿的重复行为外，它们的相似点就到此为止了。

For some people it feels quite impulsive, but it didn't really fit with some of the other disorders that are listed in there. It doesn't 100% fit with OCD, although it is a repetitive behavior that is unwanted. They're very different. They're more like distant cousins, I think, but a lot of people assume they have OCD when they have a BFRB, and so we have to explain that they are quite different. So other than the fact that they are repetitive unwanted behaviors, and then it it the this the kind of ends the similarities.

强迫症患者进行重复行为是害怕坏事发生，而BFRB行为更多是自我和谐的——就像人们对巧克力的喜爱，适量时很愉悦，过量才成问题。

OCD people engage in repetitive behaviors because they feel like something bad will happen if they don't. This is very different from a BFRB where people the BFRBs are really more egocentonic, which means that someone wants to engage in them. I liken it more to if you have a love of chocolate. You know, chocolate is really good until you have too much. Right?

因此BFRB更偏向自我和谐行为，是人们主动想做的；而洗手这类行为是患者厌恶却被迫进行的。治疗强迫症的药物对BFRB普遍无效，这是重大区别。此外在治疗方案上，两者虽有部分重叠，但存在显著差异。

And and so so it's more of a ego syntonic. It kind of something that people want to do, whereas handwashing is something people hate doing, but they feel compelled to do it. The medications for OCD do not across the board work for BFRBs, so that's a big difference. And then another difference is the treatments. You know, there's some overlap, but there's also some real big differences.

我们最不希望看到的是人们觉得药物无效、治疗无效。

And what we don't want is for people to feel like medication doesn't work and treatment doesn't work.

作为相对近期才进入这个领域、且一生都与这些行为共处的人，我想补充的是，我观察到BFRB（身体集中重复行为）经常被归入其他障碍的范畴。我们讨论过强迫症，也稍微提及自伤行为，我经常被问及这两者之间的关系。但它们也常被视为焦虑的症状，如今越来越多地被当作神经多样性状况的症状。在ADHD和自闭症中，这些行为似乎更为普遍，且在这些障碍中有不同的理解。我认为这些行为本质上是一种广泛定义的痛苦运动症状，却被归入人们更熟悉的其他障碍类别中。

And maybe I could just add that as somebody who's sort of come into the field relatively recently and lived with these behaviours my whole life, what I observe is that BFRBs often get swept under the carpet of other disorders. So we've talked about OCD, we also talked a little bit about self harm, and I regularly get asked about the relationship with those two. But they're also assumed to be a symptom of anxiety, and these days more and more they're assumed to be a symptom of neurodivergent conditions. So They seem to be more prevalent in ADHD and in autism, and they're thought of differently in those disorders. So what I observe is that these behaviours, which I think of as being a kind of motor symptom of distress quite broadly defined, gets swept under the carpet of other disorders that people happen to know a bit more about.

这正是我们需要通过明确区分它们与其他问题来减少的污名化现象，这样才能找到最有效帮助人们管理的方法。

And it's kind of part of the stigma that we need to reduce by thinking of them as quite distinct, really, from these other things, so that we can find the ways to help people manage most effectively.

BFRB有家族遗传性吗？我们是否知道这其中存在某种遗传因素？

Do BFRBs run-in families? Do we know whether there's any kind of a genetic component here?

我们研究过双胞胎案例，确实发现双胞胎间的同病率更高。在BFRB患者的家族中，我们也观察到更高的同病率。不过母亲拔头发并不意味着孩子必然更可能拔头发——他们可能会咬指甲、抠咬伤或挤痘痘。临床数据显示BFRB确有家族聚集倾向，但尚缺乏足够的临床数据支撑。

We have looked at twin studies, and we do see that there is a higher concordance rate among twins. And we do see a higher concordance rate in families of people with BFRBs. Now, if a mother pulls her hair, it doesn't mean the child is necessarily more likely to pull hair. They might bite their nails or pick their bites or excoriate their acne. But we do see that BFRBs tend to run-in families, but we don't have clinical data.

我们掌握部分遗传学数据，但样本量不足。需要数十万人的基因数据库才能从实证角度确认是否存在可预测的遗传标记。不过家族遗传现象确实相当常见。

We have some genetics data, but not enough. You need hundreds of thousands of people in a genetic database in order to make to really understand from an empirical standpoint, yes, there is a genetic marker that will predict this, but we do see it run-in families quite often.

我们是否了解当人们出现BFRB时，他们大脑中发生了什么？

Do we know what's happening in the brains of people when they're engaging in BFRBs?

当人们进行BFRBs（身体聚焦重复行为）时，大脑中会发生各种变化。我喜欢从基本原理来思考这些行为，它们其实是正常的梳理行为。作为灵长类动物，梳理是我们与生俱来的正常功能。这种行为在进化过程中发展成我们护理体表的方式，帮助我们保持清洁、远离寄生虫等。

Well, there's all sorts of things happening in the brain of people while they're engaging in BFRBs. The way that I like to think about these behaviors from first principles is that these are normal grooming behaviors. So grooming is a normal it's a normal function of being a primate. Grooming evolved as a way to take care of our body surface. It's a way to keep ourselves clean and free of parasites, etcetera.

但在许多动物中，经过数十万年的进化，这类梳理行为获得了附加功能。灵长类动物（当然包括我们人类）最有趣的是，这些行为似乎承担起了情绪调节的功能。当我们试图从过度兴奋状态（如焦虑或过度激动）中平复神经时，会更频繁地触摸面部、缠绕头发或进行各种身体重复行为。任何过度兴奋状态都会增强我们通过抓挠、撕咬来安抚自己的冲动。但当我们处于刺激不足状态时，同样会产生这些冲动。

But in many animals, these grooming type behaviors, over hundreds of thousands of years of evolution acquired additional functions. And the interesting thing about primates and of course we are primates is that the additional function that these grooming behaviours seem to have taken on is emotion regulation. So we we pick we we are more likely to touch our faces or or twirl our hair or do all sorts of body focused repetitive things when we are trying to either calm our nerves down from being in a state of over arousal, like being anxious, but also being overexcited. So any kind of state of over arousal increases urges to pick and pull and bite to sort of calm ourselves down. But we can also find ourselves experiencing urges when we're understimulated.

因此，BFRBs患者常提到在无聊时会进行这些行为。他们并非在做其他事，也未必感到特别焦虑，这只是他们在感觉刺激不足时为身体提供输入的方式。这种情绪调节功能是灵长类共有的特征，我们人类也不例外。

So often people with BFRBs talk about doing it when they're bored. They're not doing anything else. They're certainly not feeling particularly anxious. But it's a way of giving our body some input when we're feeling under stimulated. So this emotion regulation function is something that primates acquired, and of course, we're no different.

所以我倾向于认为我们不是在寻找大脑中某个出错区域，而是需要理解大脑多个系统的互动如何催生这些行为。正如我所说，动物研究文献中对此已有大量记载，只是我们尚未将这些认知完全转化到对人类行为的理解中。

So I tend to think that we're not looking for an area of brain that's kind of gone wrong. We're needing to understand multiple systems in the brain and how they interact with each other that gives rise to these behaviours. And I think that that's as I say, there's actually a lot known about this in in the animal literature that we haven't quite translated over into our understanding of these behaviours in humans.

我们将短暂休息。回来后我们将讨论拔毛癖和其他BFRBs的治疗方法。现在让我们谈谈治疗，因为我知道确实存在帮助BFRBs患者的有效方法。那么Mutton Odem医生，当患者前来求诊时，您会从哪里入手？

We're going to take a short break. When we return, we'll talk about treatments for trichotillomania and other BFRBs. Well, let's talk about treatment, because I know that there are some ways of helping people who have BFRBs. So Doctor. Mutton Odem, when someone comes to you for treatment, where do you start?

这个问题很好。我认为关键在于认识到这些行为的复杂性。面对患者时，我们必须保持这种认知——不能仅仅因为他们有拔头发或抠皮肤的行为就妄下结论。我们应当避免任何先入为主的判断。

So great question. I think it's important to think about these behaviors as very complex. And so when we approach a person, we have to think about that. We can't make any assumptions just because they're pulling hair or picking skin. We don't wanna assume anything.

真正需要关注的是他们的内心世界：如何调节情绪系统？痛苦承受力如何？冲动程度怎样？是追求奖励型（受正强化驱动）还是逃避痛苦型（受负强化驱动）？是否有完美主义倾向？比如是否总想让两边眉毛对称？这种认知有时会带有强迫色彩。因此我们需要全面了解他们的信念、预设和目标体系。

So really looking at their internal world, how they regulate their emotional system, how is their distress tolerance, how impulsive are they, are they reward seeking, are they more driven by positive reinforcement or negative reinforcement, which means are they seeking a reward or are they kind of going away from a negative? Are they perfectionistic? Are they trying to get this eyebrow to match that eyebrow? Which sometimes the cognitive has a little more of an obsessional feel to it. So we want to understand their beliefs and their assumptions and their goals.

有时他们的目标，我感觉自己的行为非常高效且目标明确，想要达成特定结果。因此我们要关注认知层面。同时也要关注感官系统，看这个人能在多大程度上调节或尝试调节他们的感官神经系统。此外，我们还需要观察外部因素——这种行为发生在什么场合？

Sometimes their goals, I feel very efficient and goal directed in my behavior, and I want to achieve a certain outcome. And so we want to look at cognitive. We also want to look at the sensory system and how much is this person regulated or attempting to regulate their sensory nervous system. And so, we also want to look at external things. Where is it happening?

它发生在什么时候？环境中或那个人外部世界是否存在某些因素，会促使这种行为在特定时刻更可能发生。例如，如果我早晨去洗手间时灯光昏暗，我可能顺利进去刷牙再出来。但晚上灯光更亮时，经过漫长一天后我情绪失调或感官超负荷，周围又没人在场。

When is it happening? Are there things in the environment or in that person's external world that would make the behavior more likely to happen in a given moment. For example, if I go into the restroom, but it's in the morning and the lights are low, I may be able to get in, brush my teeth, get out. But in the evening when the lights are brighter, I've had a long day, I'm I'm emotionally dysregulated, or I'm I'm sensory overwhelmed. No one's around.

我有更多时间。同时还有各种外部因素在起作用。因此好的方法是提出大量问题：在这个人的内外世界中，是什么让该行为更可能或更不可能发生？然后我们据此制定治疗方案。重点也不是让冲动消失。

I have more time. And there's a variety of external factors that also play in. So a good approach is to ask a lot of questions about what in this person's internal and external world make that behavior more or less likely to happen. And then we start to build a treatment plan based on that. It's also not about making urges disappear.

如果我能消除人的冲动，我现在早成富婆了，对吧？但目前我们还没有这种能力。所以关键在于当冲动来临时如何管理——甚至不是所有人都会经历冲动。但无论促使行为发生的环境因素、内在因素或外部因素是什么，当这些因素起作用时，我要如何应对？正如克莱尔精彩阐述的，我们初期会花大量时间真正消除羞耻感。

If I could take away a person's urges, I would be a rich woman, you know? But so far we don't have anything that will do that. So it's about how are we gonna manage urges when they come and not even everyone experiences urges, but whatever the precipitating environment events, internal events, external events are that make this behavior more likely to happen. When those things are at play, how am I gonna manage that? We we spend a lot of time in the beginning as Claire talked so brilliantly about is really undoing shame.

因此要教育当事人，帮助他们认识到这些并非怪异行为，而是人类正常行为。开始这个消除羞耻感的过程是持续性的，不仅限于某次治疗，而是贯穿整个治疗过程。有时还需要帮助他们与他人建立联系，让他们明白'我并不孤单'——这是治疗中至关重要的一环。

So educating a person, helping them realize these are not strange, weird, odd behaviors. These are human behaviors. And it's and and starting that process of undoing shame, which is a constant process. It's not just a session. It is throughout the entire entire treatment process and sometimes involves helping them connect with other people, which is such an important piece of treatment is to know I am not alone.

其他非常优秀的人也会有这种行为。这就是克莱尔工作如此重要的原因。眼前这位成就斐然、智慧超群、美丽动人的女性，她也会拔自己的头发，这有什么可羞耻的呢？所以这是个过程，是段旅程，我们共同前行。

Other really amazing people engage in this behavior. That's why Claire's work is so important. Here is a very accomplished, highly intelligent, beautiful human being and she pulls out her hair, you know? And so what's the shame in that, right? So it's a process, it's a journey, we're on it together.

这是协作的过程。我常用饮食锻炼来比喻BFRBs（身体聚焦重复行为），因为我们都有过想改变习惯的时刻。比如想减肥、想更健康、想戒掉垃圾食品，但依然会犯戒，对吧？我可以买运动鞋，买全套装备，甚至办健身卡，但这不意味着我就会去锻炼。

It's collaborative and it's sort of, I use diet and exercise a lot to, as an example with BFRBs, because we all have been at the point where we wanted to change our habits. We wanted to lose weight, say, we wanna get healthier, we wanna stop eating junk food, but we still do it, you know? And I can buy the tennis shoes and I can buy all the outfits. I can even join the gym, but it doesn't mean I'm going to go. It doesn't mean I'm going to engage.

因此，关键在于帮助一个人参与这个过程并准备好做出改变。这就是为什么我们要对专业人士进行大量培训，因为如果他们不理解这一点，只是读了一篇关于如何治疗的文章就去照做，那肯定会失败。结果就是患者沮丧，治疗师也沮丧，所有人都认为治疗没用。但事实并非如此。如果方法得当，治疗确实有效。

And so really it's about helping a person engage in the process and be ready to make those changes. That's why we do so much training with professionals, because if they don't understand that and they read an article about how to do treatment and they go in and use this and do this, it will fail. And then, you know, patients are frustrated, therapists are frustrated, everybody walks away and says treatment doesn't work. And that is not true. Treatment does work if it's done right.

麦凯，我想问问你，你是怎么控制自己不去拔头发的？你有什么技巧吗？有没有尽量避免的触发因素？你接受过治疗吗？你是怎么应对的？

Well, McKay, let me ask you, what do you do to keep your hair pulling at bay? I mean, do you have techniques? Are there triggers you try to avoid? Have you undergone therapy? How have you managed?

我确实接受过治疗。年轻时，在我30多岁时，我接受过更偏向行为疗法的治疗。就像苏珊描述的那些元素，比如思考情境和意识等等。但当时缺少了我现在知道对我至关重要的东西——那就是慈悲心。所以，长期生活在羞耻中，我首先要说的是，我甚至没有真正意识到自己生活在多大的羞耻中，因为对我来说那已经习以为常了。

I have. I've had when I was younger, when I was in my 30s, I had therapy which was much more behavioural. So some of those elements that Suzanne described, so thinking about the situation and the awareness, etc. But it was kind of missing the thing that I now know was critical for me, which was compassion. So living with chronic shame, I should first say that I didn't even really know the extent of the shame that I was living in, because it was just normal for me.

所以，经过一些治疗和苏珊提到的准备工作，我才意识到，实际上我生活中最大的问题不是拔头发，而是我背负的羞耻感。而治愈羞耻感的良方，对我来说就是慈悲心。慈悲这个词听起来可能有点柔软、温和甚至轻飘飘的，我们在日常对话中也经常使用它。

And so it took a bit of therapy and that preparation work that Suzanne's talking about to get to the point where I even realize that actually the biggest problem I lived with is not pulling out my hair. It's the shame that I'm carrying around. And the antidote to shame, the thing that really works for me, is compassion. Now, compassion is a word that sounds kind of fluffy and gentle and easy. We use it in common parlance.

但实际上，慈悲是一项非常重要的技能，需要学习和练习才能掌握。学习慈悲，学习自我慈悲，是一个过程。我至今仍在学习中。但对我来说，这意味着要用我的大脑，用我神经科学的思维方式。过去两年我一直在从多个角度努力理解那些想要抓挠、撕咬的冲动。

It's actually a really important skill that you need to learn and you need to practice in order to be good at it. And so learning compassion, learning self compassion, is a process. I'm still in it. But for me, what that means is using my brain, using my neuroscience brain. I've just spent the last two years really trying to understand living with urges to pick and pull and bite from a number of different angles.

我探索了以前一无所知的科学领域，不断学习。对我来说，这就是慈悲——它就像驱散那些在你脑海中盘旋的羞耻摄魂怪（我这么称呼它们）。否则你就会不断对自己说：你真蠢、真软弱、真丑陋，你毫无自制力，毫无意志力。这些都是BFRB患者经常对自己说的话。学会降低这些声音的音量，才能温柔地问自己：为什么今天的冲动特别难控制呢？

And I've gone into areas of science I knew nothing about before, and I'm learning all the time. For me, that's what compassion is. It's kind of it's throwing away those awful I call them dementors of shame that are swirling around your head otherwise. You're stupid, you're weak, you're ugly, you've got no self control, you've got no willpower. These are things that people with BFRBs say to themselves all the time, and learning how to dial those down so that you can ask yourself, well, I wonder why my urges are particularly tricky today.

用更温柔、好奇、慈悲的方式提问，而不是'天啊我真蠢，又犯病了'之类的。所以，对我来说，慈悲绝对是改变我生活的首要因素。

And and asking in a much more gentle, curious, compassionate way rather than a oh god, I'm so stupid. I've done it again, etcetera. So, compassion is absolutely the top of the list of things for me that made the difference.

我想询问社交媒体对BFRB（身体聚焦重复行为障碍）患者的影响。你知道，它对许多心理障碍都有影响。它是在帮助还是伤害BFRB患者？对此你有什么看法吗？

I want to ask about the influence of social media. You know, that's had an impact on a lot of disorders that people have. Is it helping or harming people with BFRBs? Do do you have any opinion around that?

我认为目前还没有明确的研究结论。我们都知道社交媒体确实造成了很多伤害，特别是对年轻女性的自我认知和自信心。但我也看到了很多积极面——我知道有不少意见领袖正以建设性方式利用社交媒体建立社群，在这个让患者常感孤独羞耻的领域发挥领导作用。

I don't think there's any research to say one way or the other. I think we all know that social media is doing a lot of harm, especially to young women and their sense of self and their confidence. But I also imagine a lot of good. I know there's some quite a few influencers and people who are utilizing social media in a positive way to establish community, to be a leader in this space where people feel alone, people feel ashamed.

作为BFRB患者，我可以告诉你：当我刚开始考虑公开自己的病情时，社交媒体是我迈出第一步的地方。虽然现在看这些平台都算老技术了，但Facebook支持小组对这类情况仍然非常有用——你可以匿名参与，找到理解你处境的群体，分享经验和技巧。当你还不敢向现实生活中的亲友倾诉时，这些社群能提供巨大帮助。

And as somebody who lives with a BFRB, I can tell you that as I started to think that maybe I could come out about my BFRB, social media was the first place I could take my baby steps. And actually, it's kind of now old tech. But nevertheless, Facebook support groups are fantastic for this sort of thing, because you can be anonymous. You can find your community, you can find community to people who know exactly what you're going through, and you can share hints and tips and things that you found. And actually, they are enormously helpful when you're, when you're still not feeling able to say anything out loud to the real people in your lives.

你完全可以通过网络社群开启去羞耻化进程。正如Suzanne所说，社交媒体确实利弊参半，但对于想要寻求同伴支持的人来说，没有比网络更安全便捷的途径了。我年轻时深受拔毛症困扰，但那时这个疾病甚至还没被列入精神疾病诊断手册，没有谷歌，

You can actually start to find community online and start to get that deshaming process underway by just being part of a community. And yeah, so I would say that exactly as Suzanne said, it's a bit of both, but for those of us who are wanting to reach out and find people, there isn't really a better, safer way to do it than through the internet. Of course, I'm old enough that when I started to struggle with my hair pulling problems, there was nowhere for me or my parents to go for any information. It was before trichotillomania was was in the DSM. There was no Google.

没有互联网。你完全孤立无援。所以作为过来人，我特别能体会到通过网络找到同伴的巨大价值。

There was no internet. And so you are completely alone with that. So I guess coming from that generation, I see huge benefits of being able to find other people through through the internet.

说得太对了。不过我想提醒听众中的家长注意：网络论坛里经常充斥着愤怒沮丧的言论。建议家长通过可靠渠道获取信息，因为网上经常流传着大量错误资讯。这只是个善意的提醒——家长们务必注意信息来源的可靠性。

That's so true. The the only caution I would have because I imagine there many parents as your listeners and often times, the people who post online and on Reddit and on these forums are people who are very frustrated and angry. And so I would encourage parents to go to reliable sources to get their information because a lot of times people will come in and they will have very, very, wrong information that they got on the Internet. So so that's just a caution to parents to be very careful where they're reading their information.

那么对于正在收听的家长，如果怀疑孩子可能有BFRB症状，他们应该怎么做？该去哪里寻求帮助呢？

So speaking of those parents who may be listening, I mean, if somebody thinks that their child is experiencing some kind of a BFRB, what should they do? Where should they go?

确实有很多资源可供参考。其中TLC基金会专注于BFRBs（身体集中重复行为障碍）就是一个例子。还有其他BFRB领域的变革者，以及像国际强迫症基金会这样的非营利组织。BFRB英国爱尔兰分会有一个代表欧洲的团体。

Well, there are a lot of resources out there. The TLC Foundation for BFRBs being one of them. There are some other BFRB changemakers. There are other nonprofit groups out there, the International OCD Foundation. BFRB UK Ireland has a group that's representing Europe.

克莱尔在牛津与那个团体关系密切。全球各地都有这样的社区，而且正在不断壮大。我们在墨西哥、欧洲其他地区、亚洲和加拿大都发现了这样的社区。我认为获取优质信息后，无论是参加线上小组还是线下活动都非常有帮助。但最重要的是从一开始就获取准确信息。

Claire is very involved in Oxford and with that group. So there are communities in the world and they're growing. We're finding communities in Mexico and and other parts of Europe and and Asia and Canada. So I think getting good information and then possibly attending an event, whether it's an online group or an in person event, is really helpful. But it's so important to get good information from the beginning.

家长们，我必须说他们和孩子一样需要支持，有时甚至更多。根据孩子年龄，他们可能还不太在意，但父母对待他们的方式至关重要。父母的反应直接影响孩子的羞耻感、身份认同发展、自尊和自信。我常告诉家长，我们要做的是从长远角度对孩子最有利的事，要关注孩子真正重要的特质，而不是纠结于他们的头发或皮肤状况。

And parents, I will have to say need as much support as the kiddos and sometimes more, Depending on the age of the child, they might not really care at this point yet, but how they are treated by their parents matters a lot. And so how parents respond is critical to the shame, the development of identity, self esteem, confidence. And I always tell parents, you know, what we wanna do is what is best for your child in the long run. And we wanna focus on the things that are important about your child. And their hair is and their skin is is not that.

这其实是帮助他们把注意力转移到真正重要的事情上。但对家长来说很难，因为他们的角色就是帮助孩子，而他们看到孩子在做这些令人恐惧的行为却无法理解（如果他们自己没有类似BFRB的话）。通常家长自己也有BFRB，但可能没那么困扰他们，或者只是觉得烦人但没到造成秃斑的程度。我们会看到有咬指甲等BFRB的家长，帮助他们培养对孩子的同理心对改变他们的教育方式至关重要。

And so it's helping them to sort of shift the focus to what's really important. It's hard for parents, though, because their role as a parent is to help their child, and they see their child doing this really scary thing that they don't understand if they did not engage in that particular BFRB. Now oftentimes, the parents will have a BFRB, but it maybe doesn't bother them as much or it's been annoying, but not to the point where it's caused bald spots. But we'll see parents who engage in nail biting or some other BFRB and helping them to develop that compassion for their child is critical for them to to change their approach.

我完全同意，正如你所说Suzanne，帮助家长理解他们对孩子BFRB的感受是强烈而复杂的情绪，这些情绪需要被理解、被认可，并且需要独立于帮助孩子应对BFRB之外获得支持。昨晚我和Suzanne的另一组同事举办活动时，有位家长问'我该如何帮助孩子摆脱羞耻感生活？'这个问题让我非常欣喜，因为我通常听到的问题是'怎么让孩子停止拔头发或抠皮肤？'这才是正确的问题。我们最不希望看到孩子带着长期羞耻感成长，这比他们是否有一头浓发或皮肤是否有损伤重要得多。

I completely agree and and exactly as you said, Suzanne, helping parents to understand that their feelings around their child's BFRB are big, strong, powerful feelings that need to be understood, they need to be validated, and they need to be supported separate from helping their child with their BFRB. And one more thing I would say about that is it came from an event that I did just last night with another group of Suzanne's colleagues, where a parent asked the question, how can I help my child live without shame? And I was absolutely delighted to hear that question instead of the question I usually hear, which is, how can I help my child stop pulling out their hair or picking at their skin? Because that's the right question. The thing that you don't want is for your child to grow up with chronic shame, and that's much more important than whether or not they've got a full head of hair and and some, lesions on their skin.

那么对你们两位来说，最想解答的核心问题是什么？目前正在研究什么？Mouton Odom医生，您想先说吗？

So for both of you, what are the big questions you wanna answer? What are you working on now? Doctor. Mouton, Odom, you wanna go first?

我正在研究TLC基金会在疫情前启动的一个大型项目。当时收集了大量数据，250人接受了各种检测——基因检测、脑部扫描等等。我们正在分析这些数据，但我已经深入研究了如何重新定义我们对人的认知方式，正在撰写一篇让我非常兴奋的论文。

Well, I'm working on there was a big initiative pre COVID by the TLC Foundation. A lot of, data were gathered. Two fifty people had lots and lots and lots of tests, genetic tests, brain scans, etcetera. And we're waiting through those data, but I have really done a deep dive and trying to re imagine how we think about people. And we're writing up a paper that I'm super, super excited about.

我认为每个人在对待BFRBs（身体集中重复行为）时都有些孤立，他们只看到大象的一部分，如果愿意这么说的话，每个人都只关注那一部分。我认为我们需要退一步看清全局。治疗的问题一直在于，人们总是试图将患者归类为这样或那样。而一旦这么做，总会有人走进门来，他们不属于任何既定分类。因此我们正努力后退一步，建立一个能涵盖所有表现形式的模型，从而能为每个人找到治疗路径。但即便如此，我们仍需完成消除羞耻感和为治疗做准备的基础工作。

I think everyone gets a little bit siloed with BFRBs and they only see, you know, one part of the elephant, if you will, and everyone just focuses on that part, and I think we all need to step back and see the whole picture. The issue with treatment has always been, everyone's trying to lump people into you're this or you're that, or you're this or you're that. And sure enough, as soon as you do that, someone walks in the door and they don't fit in either of those buckets. And so we're really trying to step back and create a model that accounts for all presentations so that we can then approach that person with a path to treatment. But all of that said, we still have to do the foundational work of undoing shame and preparing the person for treatment.

因此，建立一个包含所有这些要素的模型让我感到非常兴奋，更多内容即将呈现。

So coming up with a model that that involves all of that is what I'm super excited about and more to come.

McKay医生，您怎么看？

Doctor. McKay, what about you?

是的，我最近启动了不少新项目，今天想重点谈谈其中一个。关于羞耻感我已谈过很多，我们也在深入研究如何概念化羞耻感及应对方法。但今天我想讨论一个不同的方向——我对BFRBs现象学中常被描述的部分产生了浓厚兴趣：当我们进行抠抓咬等行为时，会进入一种类似恍惚的状态。这是一种意识改变状态，介于清醒与模糊之间，你会对目标（头发、皮肤等）产生高度专注。意识状态本就是许多人感兴趣的领域。

Yeah, so well, I've started quite a few new things off and I'm going to talk about one of them in particular. I've talked quite a bit about shame and we've got quite a bit of stuff going on about understanding how to conceptualize shame and how to help people with it. But actually, I'm going to talk about something a bit different, which is that I have developed a real interest in something which is regularly described as part of the phenomenology of BFRBs, which is that when we're picking and pulling and biting, we go into a kind of a trance like state. This is a kind of altered state of consciousness where you're not quite aware and not quite unaware, and you become hyper focused on whatever it is that's your target, the hair, the skin, whatever your target is. And states of consciousness, of course, are things that lots of people are interested in.

这种意识状态可能介于清醒与睡眠之间——你相当清醒但绝非睡着，却处于某种解离状态。你仿佛身在别处，虽然电视还开着，人也在房间里，但这不同于创伤相关的解离。

And this state of consciousness, which might be a kind of something that's in between awake and asleep, where you're quite awake and you're certainly not asleep, but you've gotten you're kind of dissociated. You're somewhere else. And the telly's still on. You're still in the room. It's not like a trauma related dissociation.

这是完全不同的现象。准确理解这种状态及其在Suzanne提到的整体框架中的位置至关重要。因为在那种恍惚状态下，认知策略根本无效——你无法调用认知策略，就像我在那种状态下也无法使用它们。

It's a different thing. And trying to understand exactly what that phenomenon is and how that then forms part of that package that Suzanne was talking about is really critical. Because in that trance like state, cognitive strategies don't stand a chance. They have no way in. You're not I don't have access to my cognitive strategies when I'm in that trance like state.

我有个初步想法：或许我们需要更多考虑感官策略和呼吸训练，来帮助人们摆脱这种状态。虽然这种状态被多次描述过，但尚未得到充分探索。这正是让我兴奋的研究方向之一。

So I have kind of very early ideas that actually we need to be thinking a little bit more about sensory strategies and breathing work to sort of help you snap out of that state that you get into. And so it's it's been described many times the state, but it's not really been explored. So that's what I'm that's one of the things I'm excited about.

哇，好的，我想感谢你们两位。这次对话非常精彩，我认为对我们的听众来说既学到了很多，也有助于消除对某些常见现象的污名化。所以非常感谢。

Wow. Well, I wanna thank you both. This has been absolutely fascinating, and I think it's been very helpful for our listeners to to learn and also to help destigmatize something that we know is is fairly common. So thank you.

谢谢。感谢邀请我们。很高兴能对BF RB's这个话题进行探讨。

Thank you. Thank you for having us. It's great to shed light on BF RB's.

您可以在我们的网站speakingofspeakingofpsychology.org，或在苹果、YouTube、Spotify等任何您获取播客的平台找到《Speaking of Psychology》往期节目。如果您喜欢我们的内容，请关注并留下评价。如果您有任何意见或未来节目的建议，可以发送邮件至speakingofpsychologyapa.org。《Speaking of Psychology》由Leigh Weinerman制作。感谢收听。

You can find previous episodes of Speaking of Psychology on our website at speakingofspeakingofpsychology.org or on Apple, YouTube, Spotify or wherever you get your podcasts. And if you like what you've heard, please follow us and leave a review. If you have comments or ideas for future episodes, you can email us at speakingofpsychologyapa dot org. Speaking of Psychology is produced by Leigh Weinerman. Thank you for listening.

这里是美国心理学会，我是Kim Mills。

For the American Psychological Association, I'm Kim Mills.