Published On By Rachel Nall

BFRBsBody-focused repetitive behaviors (BFRBs) are compulsive behaviors like skin picking, hair pulling, or nail biting. These behaviors can persist despite several attempts to curb them.

Often associated with anxiety and mood disorders, BFRBs can significantly impact life, causing emotional distress and physical damage.

In this article, I explain the nature and causes of BFRBs, along with some treatment approaches that may help prevent BFRB severity.

What Is BFRBs?

BFRB, or Body-Focused Repetitive Behaviors, are a group of psychological disorders known by repetitive self-grooming behaviors that might cause damage to the body.

These behaviors could manifest in various forms, such as hair-pulling, skin-picking, and nail-biting.

While some people are conscious of these actions, others may engage in them unconsciously, such as watching television or browsing online.

Though people with BFRBs do not intend self-harm, these repetitive behaviors could result in skin damage or bald patches, leading to feelings of embarrassment and shame.

The cyclic nature of BFRBs may cause frustration due to the challenges in controlling or stopping these behaviors.

Types Of BFRBs

  • Trichotillomania (Hair-Pulling Disorder): This involves recurrent pulling out of one's hair, resulting in hair loss. People with trichotillomania may pull hair from the scalp, eyebrows, eyelashes, or other body parts.
  • Excoriation (Skin-Picking) Disorder: Also known as dermatillomania, this involves repeated picking of skin, leading to tissue damage, scarring, and sometimes infection. Skin-picking may be focused on acne, scabs, or other perceived imperfections.
  • Onychophagia (Nail-Biting): This is a common BFRB that includes repetitive biting or chewing of fingernails or toenails. In severe cases, it could lead to tissue damage, infections, and dental problems.
  • Dermatophagia (Skin-Eating): Biting or chewing of skin, often the skin around the fingers or lips. It could lead to tissue damage, bleeding, and infections.
  • Rhinotillexomania (Nose-Picking): It is a compulsive picking of the nose, which might lead to tissue damage and nosebleeds.
  • Trichophagia (Hair-Eating): This is a rare BFRB characterized by the consumption of hair that has been pulled out (trichotillomania). It could lead to gastrointestinal complications like hairballs (trichobezoars).
  • Mucophagy (Nose-Picking and Eating): This behavior includes picking the nose and eating the nasal mucus. It may cause excessive physical discomfort and health problems.
  • Cheek Chewing: Some people repetitively chew on the insides of their cheeks, causing tissue damage, mouth sores, and discomfort.

These behaviors may serve as a way to relieve tension, anxiety, or other negative emotions, but they could become compulsive and harmful.

Best Strategies To Treat BFRBs

  1. Identifying Triggers

    Triggers for body-focused repetitive behaviors (BFRBs) vary among people. They could encompass a range of factors, such as stress, fatigue, boredom, skin blemishes, negative emotions, and hormonal changes. Identifying these triggers is essential in breaking the cycle of BFRBs. Some strategies to effectively identify triggers include:

    • Journaling: Keeping a detailed record of when BFRBs occur and the circumstances surrounding them could help pinpoint common triggers.
    • Self-reflection: Reflecting on the emotions and activities before engaging in BFRBs may provide insights into potential triggers.
    • Utilizing trigger tracking apps: Technology could assist in tracking patterns and correlations between triggers and BFRB episodes.
    • Seeking professional guidance: Consulting with a therapist or healthcare provider experienced in treating BFRBs may offer a new perspective on identifying triggers.
  2. Consider CBT

    Cognitive behavioral therapy (CBT) is a psychotherapy technique that aims to find the relationship between thoughts, feelings, and behaviors, offering a structured approach to address and modify maladaptive patterns.

    • Habit reversal training (HRT): It is a core component of CBT for BFRBs, helping people identify triggers and develop alternative responses to the urge to engage in repetitive behaviors. It may help replace harmful behaviors with healthier alternatives.
    • Comprehensive behavioral treatment: It is another approach within CBT that works to target the main reason why people have BFRBs, such as hair pulling.
    • Dialectical behavior therapy (DBT): It integrates mindfulness techniques to help people regulate negative emotions that may drive BFRBs.
  3. Medications

    Certain antidepressants and antipsychotic drugs demonstrate potential efficacy, particularly in people with concurrent depression, obsessive-compulsive disorder, or anxiety.

    While these medications may help alleviate symptoms, it's essential to consult a doctor to know the most suitable option for individual needs.

    Some of the medications that have shown promise in managing BFRB symptoms include:

    • Clomipramine (Anafranil)
    • Naltrexone (Revia)
    • Olanzapine (Zyprexa)
  4. Increase Social Support

    Engaging with a supportive community significantly enhances the coping strategies for individuals experiencing Body-focused Repetitive Behaviors (BFRBs).

    Support groups offer a safe space for people to open up and share their experiences, challenges, and successes with others facing similar struggles.

    Educating loved ones about BFRBs may help create a supportive environment at home without judgment and criticism.

  5. Use Distraction

    Distraction could be a helpful tool to shift focus away from harmful behaviors, providing individuals with alternative ways to cope with urges.

    Here are some key points to consider:

    • Engage in Physical Activities: Exercise or physical movements like yoga, walking, or dancing may help redirect attention and release tension.
    • Practice Mindfulness: Focusing on the present moment through mindfulness practices like meditation or deep breathing could help calm the mind and reduce the urge to engage in BFRBs.
    • Creative Outlets: Engaging in creative activities like drawing, painting, or writing might channel the energy toward productive and expressive endeavors.
    • Use Sensory Toys or Tools: Stimulating the senses with sensory toys like stress balls, textured objects, or fidget cubes may provide sensory satisfaction and distract from BFRBs.
  6. Monitor Your Progress

    Tracking their progress could give people insight into what methods work best for managing stressors and triggers. It may help make adjustments where needed.

    Benefits of Monitoring Progress How to Implement
    Helps identify successful strategies Keep a diary or notebook to record progress
    Provides positive feedback Use online applications for tracking
    Motivates continued efforts Reflect on periods of success
    Reinforces the importance of small steps Celebrate milestones

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Can ACT Help with BFRBs?

Acceptance and Commitment Therapy (ACT) is psychotherapy that may help people accept thoughts instead of avoiding them and take concrete steps toward changes to lead a positive life.

Integrating Acceptance and Commitment Therapy (ACT) into behavioral treatments for Body-focused Repetitive Behaviors (BFRBs) may help address emotion-focused hair pulling, enhancing the effectiveness of therapeutic interventions.

ACT emphasizes accepting urges and unpleasant emotions as normal human experiences, encouraging people to respond in alignment with their personal values rather than engaging in BFRBs.

It could regulate emotions and tolerate urges through active skills, reducing emotion-focused hair pulling.

How Common Are BFRBs?

The prevalence of BFRBs may affect up to 60% of the population at some point in their lives. These behaviors, experienced by approximately 13% of people, are characterized by recurring patterns that are challenging to control, often leading to distress and potential health complications.

Typically starting in late childhood or adolescence, these behaviors could persist throughout life if not addressed. While equally common in both genders during childhood, they tend to be more prevalent in females during adulthood.

Frequently Asked Questions

  1. Are BFRBs Triggered by Specific Environments or Situations?
    BFRBs could be triggered by boredom, inactivity, anxiety, perceived imperfection, sensory stimulation, or social environments causing discomfort. Understanding the factors that induce BFRBs may help people develop effective coping strategies and interventions.
  2. Are There Any Alternative Therapies That Have Shown Success in Treating BFRBs?
    Alternative therapies and unconventional approaches for treating BFRBs may include mindfulness-based interventions, acupuncture, yoga, and art therapy.
  3. How Do BFRBs Impact Relationships?
    Body-focused Repetitive Behaviors (BFRBs) could strain relationships with family and friends due to the emotional and physical toll. Strategies like open communication, education on BFRBs, seeking professional help, and fostering understanding may help address these challenges effectively.
  4. Are There Any Specific Recommendations for Managing BFRBs in Children or Adolescents?
    When managing BFRBs in children or adolescents, consider tailored interventions like habit reversal therapy, increasing social support, employing blocking behaviors, addressing underlying mental health conditions, and collaborating with healthcare specialists to enhance overall functioning and well-being.
  5. What Role Does Stress Management Play in the Treatment and Control of BFRBs?
    Stress management is pivotal in treating and controlling BFRBs. It may help address stress triggers and implement coping strategies, improving management and treatment outcomes.


Body-focused repetitive behaviors may seem like bad habits, but they are serious problems that could lead to skin damage or bald spots on the head.

People with BFRBs might feel that they cannot control these behaviors despite their attempts at stopping or limiting them. Still, treatment approaches like CBT could help them find relief.

Increased awareness, education, and destigmatization of BFRBs are vital to ensure that people affected by these disorders receive the support and resources they need to manage their symptoms and improve well-being.

  • The information in this article is for informational purposes only and should not be considered medical advice.
  • It is not recommended to disregard/delay seeking professional medical advice or treatment because of what you read or accessed through this article.
  • The results may vary from individual to individual.
  • It is recommended to consult your doctor for any underlying medical conditions or if you are on any prescribed medicines before trying any tips or strategies.

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