Body-focused repetitive behavior (BFRB) is a general term for a group of related disorders, under the OCD and related disorders umbrella. BFRB refers to any repetitive self-grooming behavior that results in damage to the body. It affects 5% of the population, often co-occurring with OCD, anxiety, and neurodevelopmental related conditions. These behaviors are not habits or tics. They are complex disorders that cause people to repeatedly touch their hair and body in ways that result in physical damage.
Some people assume that hair pulling or skin picking is a sign of some unresolved issue or problem that needs to be addressed for the BFRB to get better. Current evidence suggests, however, that these behaviors are not generally an indication of deeper issues or unresolved trauma.
- Hair pulling (trichotillomania)
- Skin picking (excoriation or dermatillomania)
- Nail picking (onychophagia)
- Compulsive nose picking (rhinotexomania)
- Skin biting (dermatophagia)
- Compulsive urge to eat one’s own hair (trichopagia)
- Scab picking and scab eating
- Picking of nails and cuticles
- Lip or cheek biting
- Other compulsive self-grooming related behaviors
Management of these behaviors begins with education about the disorder, followed by evidence-based treatment.
- CBT technique of Habit Reversal Training (HRT)
- CBT technique of Comprehensive Behavioral Treatment (ComB)
Acceptance and Commitment Therapy (ACT) and Dialectical Behavioral Therapy (DBT) are often used on conjunction with these specific techniques.
Many alternative approaches such as diet, electric stimulation, massage, hypnosis and any “miracle cures” or devices lack adequate scientific research to be recommended by expert clinicians. They may be helpful on an individual basis when used as an augment to evidence-based treatments.
People (sometimes even clinicians not trained in treating BFRBs) often mistake these behaviors for self-harm or mutilation. It’s important to differentiate between intentional self-harm behaviors and BFRBs. Those who engage in BFRBs do so to relieve stress, or to experience gratification or other sensations. This is in contrast to those who self-mutilate to intentionally harm, punish, or attempt to distract themselves from intolerable emotions.
Finding the right help:
Shame, isolation, low self-esteem, and social anxiety often occur as a result of coping with chronic BFRBs. Many individuals have avoided establishing close relationships or have not pursued interests. It’s critically important to find a therapist who thoroughly understands BFRBs and is trained in the evidence-based treatment approaches for BFRBs.