A Journey into the World of Body-Focused Repetitive Behaviors (BFRBs)

By: Suzanne Feinstein, PhD

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Body-focused Repetitive Behaviors (BFRBs) are a group of disorders that involve repetitive self-grooming behaviors, leading to physical damage to the body. These behaviors persist despite multiple attempts to stop or decrease them. BFRBs are among the most poorly understood, underdiagnosed, and untreated groups of mental health disorders. It is estimated that BFRBs affect at least 3 percent of the population, impacting both children and adults.

Individuals with BFRBs can spend a lot of time thinking about and partaking in these behaviors, often in secret. The urge and impulse to engage in BFRBs can come on without warning, leading to interruptions in daily activities.

Despite the intensity of their behaviors, people with a BFRB disorder usually do not want to continue the behaviors. Most individuals want to stop the behaviors but often don’t know how.

People with active BFRBs can see the damage they do to their bodies. They often feel a great deal of shame and embarrassment about their lack of control and the effects their behaviors have on their appearance.

Treatment recommendations for BFRBs include cognitive behavioral therapy, medication, and select supplements.

Common Types of BFRBs

Hair Pulling Disorder (Trichotillomania)

This disorder causes people to pull out hair from their scalp, eyelashes, eyebrows, and other parts of the body, resulting in noticeable bald patches. Approximately 5-20% of people who have hair pulling disorder also swallow the hair. 

Skin Picking Disorder (Excoriation)

People with this disorder repetitively touch, rub, scratch, pick at, or dig into their skin, resulting in skin discoloration, scarring, and even severe tissue damage and disfigurement.

Nail Biting Disorder (Onychophagia)

This disorder causes people to bite their nails past the nail bed and chew on cuticles until they bleed, leading to soreness and infection.

Cheek Biting

Often referred to as “cheek chewing,” chronic cheek biting can result in a myriad of complications. Redness, painful sores, and tears can occur in the mucosa, which is the inner lining of the mouth.

Other BFRBs

Other BFRBs frequently include cheek and lip biting, nail picking, scab eating, and other self-grooming-related behaviors. Some less common BFRBs include compulsive nose picking (rhinotillexomania) and the compulsive urge to eat one’s own hair (trichophagia).

Causes of BFRBs

Research suggests that causes of BFRBs include improving or correcting an imperfection in physical appearance, in addition to self-regulation of intense emotions. Several studies have shown a higher number of BFRBs in immediate family members of persons with skin picking or hair pulling than would be expected in the general population.

Myths and Misperceptions About BFRBs

There are several myths and misperceptions about BFRBs. For instance, BFRBs are not OCD, they are not caused by trauma, they are not extremely rare, and they are not considered self-harm.

Creative Ways to Manage BFRBs

Managing Body-Focused Repetitive Behaviors (BFRBs) can be a journey of self-discovery and creativity. Here are some creative strategies that might help:

  1. Understand Your Triggers: Keep a journal to identify the situations or emotions that trigger your BFRBs. This understanding can help you develop strategies to manage, avoid, or minimize these triggers.
  2. Practice Mindfulness: Techniques like deep breathing, meditation, and yoga can help you stay present in the moment and resist the urge to engage in BFRBs.
  3. Engage in Alternative Activities: Find activities that you enjoy and can easily access, such as drawing, knitting, reading, or exercising. Engage in these activities whenever you feel the urge to perform a BFRB.
  4. Create a Supportive Environment: Seek out supportive friends and family members who can help you stay accountable for your behavior and offer encouragement.
  5. Develop a Self-Care Routine: Regular sleep, a healthy diet, and regular exercise are all forms of self-care that can help manage BFRBs.
  6. Use Fidget Toys: These can provide a physical outlet for your urges.
  7. Get Creative with Your Hands: Engage in art forms such as coloring, drawing, painting, or sculpting.
  8. Learn a New Skill: Practice origami, learn how to knit, crochet, quilt, or play a musical instrument. 

Remember, everyone is unique, so what works for one person might not work for another. It’s important to try different strategies and see what works best for you. Don’t be discouraged if progress is slow; managing BFRBs is a journey, not a destination.

Treatment for BFRBs

Treatment recommendations for BFRBs include cognitive behavioral therapy, medication, and select supplements. A specific form of behavioral therapy known as Habit Reversal Training may also be highly effective for recognizing behavior patterns and managing the negative emotions associated with BFRBs.

In conclusion, BFRBs are complex, multidimensional problems that require a multidimensional approach. Understanding the function of a BFRB, emotional and physical triggers to the behavior, and having a toolbox of strategies for working through triggers and urges are crucial components of success.


Advanced Behavioral Health, LLP helps people tackle their BFRBs using scientifically–proven CBT techniques. Call 646-345-3010 or email Dr. Suzanne Feinstein at drfeinstein@behaviortherapynyc.com for a free15 minute consultation to see if you qualify for treatment.

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