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

By Tanisha Herrin

Updated October 03, 2019

Reviewer Lauren Guilbeault

There are some habits people do regularly that seem normal such as touching their hair or washing their hands after using the bathroom, but a body-focused repetitive behavior (BFRB) distinguishes differences between a healthy and unhealthy habit. When such behavior is done repeatedly, it may lead to bodily damage and signal an individual may suffer from this disorder. It is important to understand the significance of BFRBs since some may be seen as a good habit that's gone out of control.

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BFRBs may lead to bodily damage when engaged on a repetitive basis. For example, brushing your teeth daily is a recommended habit, but if you brush frequently, you're likely causing damage to your gums such as bleeding. Another example would be someone who bites their nails. Some may do this due to nervousness or out of habit, which is normal. But, if you bite them so frequently leading to skin damage, there could be an issue going on worth looking into. Sometimes BFRBs may be about Attention-deficit/hyperactivity disorder or ADHD or anxiety disorders.

Overview Of Common BFRBs

BFRB is defined as a group of disorders that include actions such as nail-biting, skin picking, and hair-pulling. The disorder is commonly related to actions related to self-grooming, but some may engage in these actions when experiencing anxiety. People report these actions bring pain or pleasure, but their actions are considered chronic since 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 forced to keep doing them. There are three common forms of BFRBs to know, and they include:

  • Trichotillomania - hair pulling disorder that includes pulling hair from any part of the body where it exists such as the scalp, eyebrows, eyelashes, facial hair, pubic, arms and legs, etc. Bald patches and severe hair loss is a common result.
  • Excoriation - also known as dermatillomania, it is the repeated action of skin picking, which includes repetitive scratching, rubbing, digging, and touching skin areas. Skin discoloration, scarring, and tissue damage is the result.
  • Onychophagia - also known as chronic nail-biting or habitual finger or nail-biting. It may become severe, resulting in permanent damage to skin and nails.

Hair pulling and nail-biting are common actions that start during childhood. Females are known to engage in certain disorders more often than males. There are other forms of this behavior to be aware of that may not be recognized as often as the previous disorders mentioned, including:

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

Remember, a person may not have a mental disorder if they pull their hair or pick at a scab. When such behaviors are done repetitively where it leads to bodily damage or changes the appearance of the area in question or leaves a person in great distress, there could be enough evidence to suggest a diagnosis.

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What Causes BFRBs?

Studies continue to look into potential causes for BFRBs, but some suggest it may have something to do with being bothered or being stimulated by something unwanted. Some people may be bothered by little detail other likely won't notice, such as the shape of their fingernail, how a pimple feels on their face, or how their hair feels or looks. Maybe a scab is on their knee from a fall, but they can't leave it alone.

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

People may think a person suffering from this disorder should be able to stop, but someone that suffers experiences mild to extreme urges and may binge giving the impression of an addiction. Earlier studies suggest these actions may be related obsessive-compulsive disorder (OCD), but experts suggest BFRBs could be a classification of disorders itself due to distinctive characteristics not know to OCD such as pleasure during certain BFRDs. It may be compared to self-harming behavior, but experts feel this is not the same thing, although there have been reports of digestive issues close to life-threatening when reviewing cases of ingested hair.

BFRBs may persist for years, even if a person is being treated. When left untreated, it may have serious effects on relationships and daily activities, especially since many behaviors may consume a great amount of time during the day. A person may realize something isn't right and try to hide their behavior from others. When they decide to get help, it is a relief to know they are not the only one suffering.

What You May Not Know About BFRBs

There are a few things to keep in mind about BFRBs to put them in perspective. These actions are considered to be more than just your typical habit of grooming. They are repeated, compulsive actions at one's appearance. A person's ability to function engaging in activities such as work, school, or home may experience some form of impairment. There is a wide range of these behaviors that may result in negative outcomes physically and socially.

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Many who suffer from these behaviors do not want them and make efforts to minimize or stop the activity. People suffering have a better chance of controlling them successfully with professional help. Some experience psychological consequences because they have less control of their behavior with the behavior itself demanding attention from the sufferer. A person with BFRBs may feel shameful, causing them to go to great lengths to keep it a secret from others. They don't want to be judged by others, but the shame they experience may be more hurtful than the actions they engage in.

BFRBs commonly starts around puberty. While experts are not sure why people experience them, some say it could be related to genetics. Therapy and prescribed medications are effective in reducing the effect of these behaviors. People have found it helpful to understand their thinking habits and thoughts that may lead to their repetitive behaviors. Medication may help minimize compulsive behaviors and obsessive thinking.

When Should Someone Seek Help?

When the behavior gets out of control by affecting relationships or daily activities, sufferers should seek help. Maybe several attempts to stop on their own have failed. Emotional problems such as depression may be noticeable, or other activities such as avoiding others or events, or engaging in substance abuse are warning signs. Disputes about the behavior from others that notice something different leading to arguments may indicate it is time to get help. Here are other signs to look for when suspecting BFRBs:

  • Some suspect they have one or more BFRBs
  • Serious damage is noticeable to hair, skin, or tissue areas
  • Stopping has been impossible, or some feel they can't
  • Experiencing problems at work or with relationships (friends, family, etc.)
  • The behavior is concealed by canceling plans or wearing certain clothes
  • Feelings of shame and hopelessness

A person with BFRBs may think their actions are harmless, but such thoughts and behaviors have a significant effect on mental health.

Tips For Managing Repetitive Behaviors

While there are no one-size-fits-all solution for coping with BFRBs, there are various effective methods people found helpful when seeking ways to control their behaviors. There are different options to consider, and you may get the best benefit by using more than one along with professional guidance and moral support from others. Here are suggestions for managing these behaviors:

  • Use technology to help 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. It is a great motivator, and you have something to help track your progress. Your app may coincide with a writing journal to keep track of your urges.
  • Be aware of what triggers the behavior and be watchful of your thoughts.
  • Turn your obsessive energy into a positive habit with a form of pampering. If you get an urge to rub your skin, use a moisturizer, face mask, or lotion. You encourage your skin to look and feel great while reducing the urge to touch it again.
  • Learn ways to relax and be calm such as thought mindfulness techniques, acupressure, or other relaxation exercises.
  • Keep researching your disorder and ways to manage it. Sometimes it takes time to understand what works and what doesn't. As you learn more about your form of BFRB, you may get closer to finding a solution that produces lasting results.
  • Connect with others through a support group or forum and share your feelings. You may learn additional coping techniques to try.
  • Use your hands to get creative. When you have an urge, to consider doing some form of art such as coloring, drawing, painting, sculpting, etc.
  • Seek therapy. Cognitive behavioral therapy or CBT has helped others understand how their behaviors affect them. Habit reversal training or HRT is another option that helps identify triggers.

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BFRBs may be difficult to deal with, but there is hope. There are many strategies and techniques for children and adults to reduce these behaviors. When you have a support system consisting of professional guidance and peer support, recovery is achievable.


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