WHAT ARE BODY-FOCUSED REPETITIVE BEHAVIORS?
Body-focused repetitive behaviors (BFRBs) refers to repetitive behaviors that result in damage to the body. They typically include pulling, scraping, biting, or picking of skin, hair, nails, lips or cheeks. These behaviors are usually compulsive, making them very difficult to resist, and can cause significant distress that interferes with daily functioning.
Though data shows that BFRBs are quite widespread (an estimated 2% – 5% of the general public engage in hair pulling and 5% from skin picking), BFRBs are often misunderstood as bad habits or tics. Individuals may engage in BFRBs to temporarily relieve stress and anxiety or to elicit sensory gratification.
Commonly, people will engage in picking, scraping, or pulling without noticing they are doing so in the moment and go to great lengths to conceal physical damage that is visible on their bodies.
HAIR PULLING
(TRICHOTILLOMANIA)
NAIL BITING
(ONYCHOPHAGIA)
• Compulsively pulling out hair from the scalp, eyelashes, eyebrows, or other areas.
• Results in hair loss, including bald patches on the scalp
• Can damage skin, cause inflammation
• Biting nails passed the nail bed
• Biting cuticles until they bleed
• Frequently causes pain or soreness
• High risk of infection
SKIN PICKING
(EXCORIATION)
OTHER COMMON
BFRBS
• Also known as dermatilomania
• Recurrent picking at the skin
• Sometimes results in severe lesions
• Can result in serious medical problems, including infection
• Cheek Biting (Morsicatio Buccarum)
• Lip Biting
• Scab Eating
• Nail Picking (Onychotillomania)
• Hair Eating (Trichophagia)
GETTING HELP: BFRB TREATMENTS
Body-damaging behaviors can effectively be managed using behavioral therapy.
Cognitive Behavioral Therapy (CBT) is an evidence-based intervention that can effective treat BFRBs. However, some individuals may benefit from medication in conjunction with CBT. There are a number of different treatment approaches for BFRBs that fall under the umbrella of CBT: Habit Reversal Training (HRT) and Comprehensive Behavioral Treatment (ComB).
Comprehensive Behavioral Treatment (ComB) is a process that includes identifying sensory and environmental cues leading to urges, assessing awareness and ease of engaging in the behavior, evaluating post-behavior consequences (physical sensations, emotional changes), and implementing strategies to make engaging in the behavior more difficult.
Habit Reversal Training (HRT) requires the individual to increase awareness of internal and environmental triggers and learn to self-monitor their urges to engage in body damaging behaviors. When urges arise, rather than engage in BFRBs, they engage in “competing behaviors” (neutral substitutes such as clenching fists). There are a variety of available sensory and fidget toys that can effectively provide sensations similar to those of BFRBs.
Because few professionals have current knowledge about effective treatment for BFRBs, clients or family members often have more accurate information about their disorder than their treatment provider. When seeking help, it is important to find a clinician with experience treating BFRBs.
• Anxiety and Depression Association of America (ADAA). (2020). Body Focused Repetitive Behavior (BFRBs). https://adaa.org/body focused-repetitive-behaviors
• Golomb, R., Franklin, M., Grant, J., Keuthen, N., Mansueto, C., Mouton Odum, S., Novak, C. & Woods, D. (2016). Expert Consensus Treatment Guidelines for Body Focused Repetitive Behaviors. TLC Foundation. https://www.bfrb.org/storage/documents/Expert_Consensus_Treatment_Guidelines_2016w.pdf
• Mouton-Odum, S. (2018, January 16). Comprehensive Model for Behavioral Treatment (ComB) of Trichotillomania and Other Body-Focused Repetitive Behaviors (BFRBs). Psychology Houston, PC. http://psychologyhoustonpc.com/2018/01/16/comprehensive-model-for-behavioral-treatment-comb-of-trichotillomania-andother-body-focused-repetitive-behaviors-bfrbs/
• Psychology Today. (2020). https://www.psychologytoday.com/us/basics/body-focused-repetitive-behaviors