Body Focused Repetitive Behaviors (BFRBs)

Up to 20% of Adults are impacted by Anxiety Disorders Each Year

Miner, S., Takov, V., 2022

Almost 10% of Children Ages 3-17 are Diagnosed with Anxiety

CDC

What are BFRBs?

Body-Focused Repetitive Behaviors are repetitive, self-grooming behaviors that cause damage to the hair, nails, or skin; it can cause infection, scarring, bald patches, soreness, bleeding, etc. Some people find that engaging in the behavior feels impulsive and may not even be aware of what they are doing. For others it feels compulsive and like something they must do.

The most common BFRBs include:

  • Hair-pulling (Trichotillomania)

  • Skin-picking (Excoriation)

  • Nail biting (Onychophagia)

  • Cheek biting (Morsicatio Buccarum)

  • Other (anything that involves biting, scraping, picking, and/or pulling your own skin, nails or hair) 

Signs of BFRBs

  • You have tried to stop, but just can’t

  • Many people feel a sense of pleasure that is associated with with behavior 

  • You may feel like you have to hide parts of your body so others don’t see damage the BFRB caused

How I Treat BFRBs

Research indicates that a specific type of Cognitive Behavioral Therapy called the Comprehensive Behavioral Model (ComB) is especially effective in treating BFRBs. During ComB, individuals discover what needs are being met by engaging in the behaviors and then replacing unwanted behaviors with healthier ones. In my practice I have found that ComB takes Habit Reversal Training (another evidence based treatment) to another level. 


Depending on the needs being met by the behaviors it can be helpful to bring in other treatment modalities, such as Acceptance and Commitment Therapy, to help with living a full life with pain, or Dialectical Behavior Therapy, which helps people with big emotions.

Sources:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

  • Body-Focused Repetitive Behaviors (BFRBs) | Anxiety and Depression Association of America, ADAA. (n.d.). 

    https://adaa.org/understanding-anxiety/co-occurring-disorders/body-focused-repetitive-behaviors 

  • International OCD Foundation. (2020, March 10). International OCD Foundation | Comprehensive Behavioral (COMB) treatment for skin picking and hair pulling disorders. https://iocdf.org/expert-opinions/comprehensive-behavioral-comb-treatment-for-skin-picking-and-hair-pulling-disorders/

  • Mansueto, C. S., Vavrichek, S. M., & Golomb, R. G. (2020). Overcoming Body-Focused repetitive behaviors: A Comprehensive Behavioral Treatment for Hair Pulling and Skin Picking. New Harbinger  Publications.