What Are Body-Focused Repetitive Behaviors, And How Are They Controlled?

Body-focused repetitive behavior (BFRB) describes potentially unhealthy physical behaviors surrounding the body, such as skin picking. When this type of behavior is done repeatedly, it may lead to bodily damage and signify a health condition. Understanding the significance of BFRBs can be beneficial, as they may be a sign of an underlying compulsive challenge that could be treated. 

BFRBs may lead to bodily damage when engaged in on a repetitive basis. For example, brushing your teeth daily is a recommended habit, but brushing frequently might cause damage to your gums, such as bleeding or wear down the protective enamel of your teeth. 

Other examples of BFRBS include nail biting and pulling hair out due to stress. Some people partake in these behaviors due to nervousness or out of habit, which can be normal. However, if the behaviors become compulsive, frequent, and repetitive, they may be harmful. In some cases, BFRBs may be related to a mental illness like an anxiety disorder. 

Common BFRBs and how they might manifest 

BFRBs define a group of disorders, including nail biting, skin picking, and hair pulling. They are commonly related to actions tied to self-grooming, but some may engage in these actions when experiencing anxiety. 

BFRBs might be painful or pleasurable. Yet, the actions are considered chronic because some may not be aware they engage in them in a way that is causing physical damage. Others want to stop these behaviors but feel out of control. The most common of these conditions are as follows. 

Trichotillomania 

Trichotillomania is a hair-pulling disorder that includes pulling hair out from any part of the body where it exists, including the scalp, eyebrows, eyelashes, face, pubic region, arms, and legs. Bald patches and severe hair loss are common results. In addition, hair pulling may cause irritation, pain, and a lack of hair growth. 

Excoriation 

Also known as dermatillomania, excoriation is the repeated action of skin picking, which includes repetitive scratching, rubbing, digging, and touching of skin areas. Skin discoloration, scarring, and tissue damage may result from this concern. 

Onychophagia 

Also known as chronic nail biting or habitual finger or nail biting, onychophagia may become severe, resulting in permanent damage to skin and nails.

Other types of BFRBs 

There are other forms of BFRBs to be aware of that may not be recognized as often as the previous conditions, including the following:

• Trichophagia (hair nibbling)
• Rhinotillexomania (compulsive nose-picking)
• Morsicatio Linguarum (tongue biting)
• Morsicatio Buccarum (cheek biting)
• Bruxism (teeth grinding)

A person may not have a mental health condition if they sometimes pull their hair or pick at a scab. However, when such behaviors are done repetitively or lead to bodily damage or distress, reaching out to a mental health professional may be beneficial.

What causes BFRBs?

Studies continue to investigate potential causes for BFRBs, but some suggest it may be related to inciting events that cause distress or genetics. Some people may be bothered by a detail that others don't notice, such as the shape of their fingernails, how a pimple feels on their face, or how their hair feels or looks. 

People engaged in these behaviors may do so for minutes or hours. It may lead to damage, including scarring or irreversible skin marks. Some people experience loss of blood, mouth cuts, acne, bald spots, and skin scarring. Some develop stomach problems due to digesting their nails or hair. People experiencing these actions may isolate themselves and feel upset or disgusted upon recognizing the physical consequences.

People may think that those living with these habits should "just be able to stop." However, these compulsive behaviors can indicate an underlying mental health condition, like obsessive-compulsive disorder (OCD). Some experts also believe these conditions should be classified independently outside of OCD due to distinctive characteristics. 

What to know about BFRBs 

There are a few areas to consider when thinking of BFRBs and their impacts. 

These behaviors may cause impairment

Body-focused repetitive behaviors are considered more than a habit or normal grooming behavior. They are repeated, compulsive actions that may affect one's appearance. A person's ability to function in activities like work, school, or home responsibilities may experience impairment. In addition to social impacts, they can also cause physical impairments. 

Many of these behaviors can be unwanted

Many people living with these behaviors do not want them and make efforts to minimize or stop the activity. Although people might not want to partake in a BFRB, they might do so out of compulsion, habit, or stress. In some cases, they might not know they are partaking in the behavior and only notice when another person brings it up. 

BFRBs often start during puberty 

BFRBs commonly start around puberty. Therapy and prescribed medications may be effective in reducing the effect. Many clients of treatments like counseling find it helpful to understand their thoughts and emotions that may lead to repetitive behaviors. Medication may also help minimize compulsive behaviors and obsessive thinking. However, consult your doctor or primary care physician before considering any medication options.

When to seek support for body-focused repetitive behaviors

If your repetitive behaviors start to negatively impact you, those around you, or your daily responsibilities, it may be beneficial to seek support. In some cases, other mental health challenges like depression or anxiety may accompany BFRBs. You might look for the following indicators as well: 

• You suspect you have one or more BFRBs.
• Severe damage is noticeable to your hair, skin, or tissue areas.
• Stopping the behavior has been impossible or feels out of your control.
• You're experiencing problems at work or with relationships with friends and family. 
• The behavior is concealed by canceling plans or wearing certain clothes.
• Feelings of shame and hopelessness are arising for you. 

A person with BFRBs may think their actions are harmless, but such thoughts and behaviors can significantly affect mental health.

Tips for managing repetitive behaviors

While there are no one-size-fits-all solutions for coping with BFRBs, there are various effective methods you might try when seeking ways to control your behaviors, including the following. 

Use technology 

Use technology to track your behaviors by downloading a habit-tracking app. You can challenge yourself to go on a streak to see how many hours, days, weeks, or months you can go without engaging in the habit. Some apps make a game out of progress, awarding you digital currency, outfits, or items for completing a goal. Your app might also have a journaling feature to allow you to write expressively about what you're experiencing. 

Be aware of what incites your behaviors

Suppose you commonly perform repetitive behaviors after a specific event or experience. In that case, you might try to be aware of when these experiences occur so you can take steps to avoid the behavior afterward. For example, if you tend to pick your skin when stressed, consider trying to reduce stress by meeting with a therapist, practicing coping skills, or talking to someone you trust. 

Redirect your energy 

You might also try turning your obsessive energy into a positive habit. For example, if you get an urge to rub your skin, use a moisturizer, face mask, or lotion instead. If you have the urge to bite your nails, consider painting them or getting a set of nails so you cannot.

Use mindfulness 

Mindfulness techniques have been proven effective in reducing anxiety and improving mental health. There are many ways to practice mindfulness, and they might help you feel more grounded and in control of your body and behaviors. 

Research your condition 

Keep researching your forms of BFRBs and ways to manage them. It may take time to find out what works, but by researching, you may find coping skills others have used to cope with similar behavioral patterns. As you learn more about your form of BFRB, you may get closer to finding a solution that produces lasting results.

Use your hands in other ways 

Use your hands to get creative. When you have an urge, consider partaking in a form of art such as coloring, drawing, painting, or sculpting.

Seek professional support 

Cognitive behavioral therapy (CBT) is a popular form of therapy that may help you understand how your behaviors are related to your thoughts and beliefs. Habit reversal training (HRT) is another option that might help you identify the causes of your habits. BFRBs may be challenging to deal with, but support is available, and you're not alone. 

Get support with online therapy

If feelings of shame keep you from seeking in-person guidance, you can also consider online therapy. Evidence has shown that online therapy is effective in treating trichotillomania. In one study, 22 participants took part in treatment. Twelve were assigned online treatment, while ten were put on a waitlist. Those who received treatment immediately via online counseling showed a significant reduction in hair pulling. The results of all participants, even those who received treatment after being on a waitlist, showed a significant reduction in hair pulling at follow-up, including a decrease in feelings of shame.

With online therapy through a platform like BetterHelp, you can get started with a therapist within 48 hours with the expertise and training to help you manage your body-focused repetitive behaviors. Online therapy is also cost-effective, and you can choose between live phone, video, or chat sessions with your therapist match.