What Are Body-Focused Repetitive Behaviors (BFRBs)?
Many people have the fleeting urge to pick at their skin or bite their nails. They may do so until they feel satisfied, then stop. For others, these kinds of behaviors last hours, with urges feeling out of control. From skin-picking, to hair-pulling, to cheek-biting, Body-Focused Repetitive Behaviors can take over someone’s life. If you find that urges become more demanding and behaviors are time-consuming, you may be struggling with a BFRB. Let’s take a look at what they are and how therapy can help.
What Are Body-Focused Repetitive Behaviors?
Body-Focused Repetitive Behaviors (BFRB’s) are a group of compulsive behaviors related to the skin, hair, and body. They are often used to self-soothe or manage distress. Hair pulling (Trichotillomania) and Skin Picking (Dermatillomania) are more well-known, but there is a range of behaviors that can happen. They share a similar cycle of urges, behaviors, and relief. Oftentimes, people with BFRB’s don’t consider consequences like scarring or infection. They might experience damage to their skin, but continue to pick or pull.
When Does a BFRB Become a Problem?
Each BFRB involves its own set of symptoms. However, they have some things in common. If you have a BFRB, you might experience:
Strong urges to pick, pull, or bite skin or hair
Focusing on parts of skin or hair that feel uneven, bumpy, or out of place
Difficulty controlling urges
Spending long periods of time doing the behavior
Feeling relieved and satisfied after doing the behavior
Unsuccessful attempts to stop
Behaviors interfere with health, school, work, or relationships
There are many reasons why you might engage in a BFRB. It can be to achieve a satisfying feeling or reduce stress. It can also happen automatically without you realizing it. Maybe the behavior feels so familiar that it’s hard to function without it. Or, it could be that your environment triggers picking or pulling. For example, being near a mirror, bright lighting, or being alone.
What are Trichotillomania, Dermatillomania, and Other BFRBs?
Body-Focused Repetitive Behaviors show up in many forms. You might pick at bumps, blemishes, or scabs on the skin. This is known as Skin Picking. It can happen intentionally or be automatic, often leading to skin damage. While Skin Picking usually moves around to different areas of the body, urges can be more specific. You might experience Nail Picking - picking at your cuticles or nails. Picking is not always the only behavior involved. Sometimes people bite at cuticles on their nails or repeatedly engage in Nail Biting. Tongue Chewing or Cheek Biting are also common.
Trichotillomania, or Hair Pulling, is one of the more well-known BFRB’s, and it involves pulling out hair from the scalp, eyebrows, eyelashes, or body. Even if you experience hair loss due to pulling, urges feel strong and behaviors feel difficult to stop. Sometimes people with Trichotillomania feel compelled to bite or eat the hair they have just pulled. Others don’t pull their hair, but instead feel urges to cut it. Hair-Cutting is when someone repeatedly cuts their hair until it feels symmetrical or has a certain texture.
When is it a BFRB, not just a habit?
While many people occasionally pick at their skin or pull at a rogue hair, BFRB’s are different. If you feel like you have little control over the behavior, it might signal something more is going on. Maybe the behavior started as a brief habit, but now lasts hours. Urges can feel more demanding over time. Usually, a habit doesn’t create the kind of skin damage seen in BFRB’s. Due to the repetitive nature of picking and pulling, you likely experience scarring or hair loss. Something else to keep in mind is that BFRB’s come with difficult emotions. Behaviors often lead to feeling guilty, ashamed, embarrassed, or stressed. It can be hard when you feel satisfied in the moment, but out of control in the long-run. The emotional toll and time spent in compulsive rituals can interfere with personal and professional life.
How common are BFRB’s?
BFRB’s are more common than you might think. They are seen in people of all ages, though usually begin in adolescence. They impact around 2-5% of people, but rates may be higher due to those that are undiagnosed. One study showed that up to 24% of people had a diagnosed BFRB (NIH). Because of the stigma or shame about seeking support, many people may be managing their symptoms alone. Though having a BFRB might feel like a hidden experience, many people are struggling with the same things.
Are BFRBs a Form of OCD?
BFRB’s are in the category of Obsessive Compulsive and Related Disorders (OCRDs). They share some similarities to the OCD cycle, but also many differences.
BFRB Similarities with OCD
In both BFRB’s and OCD, it can be hard to control impulses. Urges to perform compulsive behaviors feel strong, creating the need to do something immediately. Sometimes the behavior relieves uncomfortable emotions, creating temporary relief. Though the behaviors are different, they are time-consuming. Those with BFRB’s and OCD may spend hours trapped in compulsive cycles. Urges can become more demanding or strong over time. Both disorders often get worse in times of stress; compulsive behaviors can become a coping mechanism.
BFRB Differences with OCD
One of the main differences is that those with BFRBs don’t usually fear the consequences of their actions like someone with OCD. Picking and pulling feels so satisfying that it overshadows any physical damage. Someone with OCD might have fears that override urges to pick or pull. This might look like intrusive images of themselves without hair or of having an infection. These scenarios create fear in ways that those with BFRB’s don’t experience. Something else to note is that in BFRB’s, pleasant and satisfying feelings are connected to behaviors. In OCD, compulsions can be exhaustive or disliked. The reasons behind doing compulsive behaviors are different as well. Picking and pulling provides relief from the urge to pick. Compulsions in OCD serve to protect someone from a feared outcome. The intrusive thoughts and obsessions in OCD are common and are not seen in those with BFRB’s.
Why do people develop BFRB’s?
There are many reasons why people develop Body-Focused Repetitive Behaviors. Just like many conditions, genetics are involved. If a family member has a BFRB, you are more likely to engage in these behaviors yourself. Those with OCD in their family line are also more likely to have BFRB’s or other Obsessive Compulsive and Related Disorders.
Brain differences are seen in those with BFRB’s. Parts of the brain involved in impulse control, habits, sensory processing, and movement control respond differently. This is why you might have a hard time stopping behaviors or fall into cycles more easily. It might feel very rewarding or satisfying due to sensory parts of the brain having high activity. Areas of the brain that are responsible for stopping movements have lower activity.
Sometimes life challenges or moments of stress can trigger these behaviors. Picking or pulling can feel soothing and reduce anxiety temporarily. Behaviors may also be used to cure boredom - you may be more likely to pick when you have less to do. Emotional triggers can be strong for many people. Although behaviors can provide relief, BFRB’s can have major long-term impacts.
Why is getting BFRB treatment important?
When you’re stuck in the cycles of a BFRB, it can be hard to know where to turn. You may have tried to stop many times, but find it hard to resist the urges. You might find that you’re not aware of when you pick or pull. Behaviors can feel automatic, making it hard to know where they begin and end. Over time, BFRB’s can have health impacts. Frequent skin-picking can lead to damage and scars. Wounds might not heal properly or lead to infections. The emotional toll may become overwhelming. Guilt, embarrassment, or feeling the need to cover up skin or hair can be challenging to manage.
Sometimes behaviors can happen on autopilot. Whether you’re at home or out with others, picking and pulling can begin without your awareness of it. Other times, you purposely pick at your skin or pull out certain hairs. Both of these situations can create distress. Building self-awareness so you can notice when behaviors happen is important. It can be challenging to develop this skill on your own, but proper treatment can help you build awareness. Building skills to respond differently and resist urges will increase self-control.
Oftentimes, BFRB’s impact different areas of your life. Maybe you spend more time picking or pulling than you spend with friends. Maybe you avoid social situations or procrastinate schoolwork. It can be hard to focus when your brain wants you to constantly pick. The shame or embarrassment that comes with behaviors can be hard to manage. Treatment can help you take steps to reclaim your life - whether that’s getting involved in something you enjoy again or having mental space to take care of responsibilities. Finding healthier ways to cope with distress can get you on a better path.
BFRB, Trichotillomania, and Dermatillomania Treatment in San Diego
Although it can be challenging to take the first step, effective treatments are available. Comprehensive Behavioral Model (ComB) and Habit Reversal Training (HRT) are most frequently used for BFRB’s. In Habit Reversal Training, the focus is on replacing picking, pulling, or biting with a competing behavior. This might be holding a fidget toy, wearing gloves, or chewing gum. Making changes to your environment are also used, like spending less time alone or dimming bright lighting. ComB is a more personalized version of this treatment. It takes into account the contexts that trigger behaviors for each individual. Working together with your therapist to understand how BFRB’s impact your life can help you both understand contributing factors. These factors might be emotional, sensory, environmental, thought-based, among others. Then, you will begin to target the behaviors. This might be a mix of using competing behaviors, managing stress, challenging thoughts, or changing your environment. Self-compassion and motivation-training can also be used.
Helping you connect with your values is also an important part of treatment. When BFRB’s have taken over, it can be so helpful to re-engage with things you enjoy. Spending time with family or friends or finding new healthy habits might become goals of yours. Maybe you have lost progress in school or work. With the right support, you may be able to put effort back in. Treatment can help you find new ways to occupy your time that was previously spent picking or pulling.
BFRB therapy near me
At Resilience Counseling, our team of BFRB therapists are committed to helping you overcome compulsive cycles. We specialize in treating BFRB’s using the Comprehensive Behavioral Model (ComB) and Habit Reversal Training (HRT). We understand the impacts BFRB’s can have on daily life and provide a collaborative space to build skills towards recovery. Body-Focused Repetitive Behaviors impact everyone differently, and we take the time to understand what symptoms look like for you. We create individualized treatment plans and go at your own pace. Whether you have had symptoms for years or started experiencing them more recently, we walk alongside you through the treatment process. Helping you regain control, revisit things you enjoy, and live fully are our top priorities.
Our team of compassionate BRFB therapists in San Diego, CA have worked with countless kids, teens, and adults. We also work with those who have many kinds of BFRB’s. Whether you have Trichotillomania, Nail Biting, Skin Picking, Cheek Biting, or other behaviors, we are here to provide support. Helping you understand the BFRB cycle and gain tools to respond differently can put you in control. Building skills that you can use between sessions gives you somewhere to turn when urges are strong. We provide a judgement-free, supportive environment where you can create lasting change. You don’t have to figure this out on your own. Reach out to us and we will figure out a treatment approach that is best for you. With the right treatment, life can feel calm and free from the demands of BFRB’s. Schedule a free consult call today!
Clinical Director: Katherine Pica OCD Therapist - San Diego, CA
Katherine Pica, LCSW, is the Founder and Clinical Director of Resilience Counseling and has been practicing since 2007. With more than 19 years of clinical experience, she provides supervision and training to the practice’s OCD & BFRB therapists with a focus on Exposure and Response Prevention (ERP) and EMDR for trauma. Katherine brings extensive experience treating OCD to both her clients and the clinicians she mentors.
Katherine also serves as the Training Director and board member for OCD SoCal, where she is actively involved in increasing OCD awareness, education, and community support throughout San Diego and Southern California.
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