Body-Focused Repetitive Behaviors (BFRB)

Body-focused repetitive behaviors (BFRBs) is a set of disorders categorized by self-grooming routines that essentially go awry. It can include pulling, picking, biting, or scraping one’s hair, skin, or nails. These disorders include trichotillomania (compulsive hair-pulling), dermatillomania that is also called excoriation disorder (compulsive skin picking), and onychophagia (compulsive nail-biting). It affects at least 3 percent of children and adults.

BFRBs are theorized to be related to anxiety, impulse control, and obsessive-compulsive disorders, but most experts agree that they differ from all three. Some BFRBs are categorized as “obsessive-compulsive” and other related compulsive disorders and can be hard to control. People with BFRBs report that they have different triggers for their behaviors. Some pick and pull when they are anxious, and it provides temporary relief. Others say that they pull, pick, or scratch without noticing it, or while they are invested in another activity like reading or watching TV. It is believed that there may be genetic components and often run in families. It can also be influenced by early environment, stress, and temperament.

Treatment recommendations for BFRBs can include cognitive-behavioral therapy (CBT), Habit Reversal Training (helpful for recognizing behavior patterns and managing negative emotions regarding BFRBs), medication, and select supplements like N-acetylcysteine which is an amino acid. These can be highly effective for some people by having an overall long-term success rate of less than 20 percent. Medications are considered less effective than other behavioral treatments for BFRBs. Some drugs have shown to help individuals who also have co-occurring anxiety, depression, or OCD. This includes selective serotonin reuptake inhibitors (SSRIs), clomipramine, naltrexone, and olanzapine. You can also use a few self-help strategies for BFRBs to manage the behaviors yourself. Try using an object to occupy your hands during times when pulling occurs, wear gloves or mittens to make picking harder, or join a support group to connect with others who have BFRBs.

Because of misconceptions regarding BFRBs, many people report feeling shame surrounding the disorder. They may beat themselves up for their inability to stop or go to great lengths to hide the hair-pulling or skin picking evidence. They may use wigs or makeup or refuse to let people see the parts of their body where they pick or pull at. The intense shame can interfere with their relationships, intimacy, and daily functioning. Sometimes sharing their feelings of guilt and shame with a loved one or a trusted therapist, simply learning that they are not alone, going to support groups can help reduce shame. Most people who live with a BFRB disorder will have to manage and treat it for their entire life because there is no cure, but an improvement on the issue can significantly reduce or even eliminate the need to pick or pull.

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