Tips for Handling BFRBs (Body-Focused Repetitive Behaviors)
Body-focused repetitive behaviors (BFRBs) are a group of conditions involving repeated, self-directed actions that can cause physical harm. If you pull your hair, pick your skin, bite your nails, or chew the inside of your cheek, you may be dealing with repetitive behaviors that are harder to manage than typical habits.
BFRBs affect an estimated 1 in 20 people and often begin in late childhood or early adolescence. While they often cause shame and frustration, these behaviors can be managed. They are real, recognized conditions that respond well to the right support.
What Are BFRBs?
BFRBs fall under the obsessive-compulsive and related disorders category in the DSM-5. The most common include trichotillomania (hair pulling), excoriation disorder (skin picking), onychophagia (nail biting), and cheek biting.
These behaviors can be intentional or automatic. Some people engage in them during moments of stress or anxiety. Others do so out of habit while watching TV, reading, or sitting at a computer, barely aware it's happening. Either way, the urge to engage in the repetitive behavior can be very strong and hard to resist, even when you desperately want to stop.
Identifying Triggers
One of the most effective ways to manage repetitive behaviors is to learn the personal triggers that cause them. Triggers vary widely, but some of the more common ones include the following:
Stress, anxiety, or boredom
Specific environments or routines, such as sitting at a desk
Uncomfortable physical sensations, such as a bump on the skin or an uneven nail
Negative emotions, including frustration, loneliness, or shame
Try maintaining a straightforward record of when the behavior occurs and what happens beforehand. This can help you identify patterns over time.
Practical Symptom Management Strategies
Once you know your triggers, you can start putting barriers in place. These strategies won't eliminate a BFRB overnight, but they can help reduce the frequency and intensity:
Keep your hands occupied. Fidget tools, textured jewelry, or stress balls can redirect the urge.
Add physical barriers. Wearing gloves or bandages can make it harder to engage in the behavior automatically.
Modify your environment. Remove mirrors from areas where picking tends to happen, or keep nail files out of reach.
Practice self-compassion. Shame tends to intensify BFRBs rather than reduce them. Treating yourself with patience is a genuine part of symptom management.
Therapy Options That Work
Professional support makes a significant difference for most people with BFRBs. OCD therapy and BFRB-focused treatment share some overlap, but BFRBs benefit from specific approaches. Below are some effective, evidence-based options:
Habit reversal training (HRT): This helps you become aware of the behavior and teaches you how to replace it.
Comprehensive behavioral treatment (ComB): This approach examines all factors driving the behavior, including sensory input, emotional load, and cognitive and environmental factors. ComB is a method to build new habits around repetitive behaviors.
Acceptance and commitment therapy (ACT): ACT uses mindfulness techniques to change your relationship with urges. This helps to make them feel less urgent without requiring you to fight them directly.
Cognitive behavioral therapy (CBT): CBT is a well-researched treatment that helps you identify thought and behavioral patterns that fuel the cycle. It’s an effective complement to other approaches.
When therapy isn't quite enough, medication can also be a helpful support. It's all about finding what works best for you and making sure you feel comfortable with your treatment plan.
While no medication is formally FDA-approved for BFRBs, some options have shown promise in reducing urges and improving response to behavioral treatment. Speaking with a provider will help you determine which approach is best for you.
Want to Know More?
Call me to set up a free consultation, and we can explore options for BFRB-focused treatment. Working with someone who specializes in repetitive behaviors can truly help you create a personalized plan that meets your needs. Schedule an appointment and take a step toward less shame and more freedom.