The Effects of Body-Focused Repetitive Behaviors on the Prefrontal Cortex

By: Suzanne Feinstein, PhD

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Body-Focused Repetitive Behaviors (BFRBs) are conditions in which individuals compulsively engage in repetitive activities centered around their own bodies. Examples of BFRBs include hair pulling, skin picking, nail biting, cuticle picking, and lip and cheek biting. These behaviors are recurrent and persist over an extended period of time. Despite wanting to stop these behaviors, affected individuals find it difficult to resist the impulses. 

In individuals with trichotillomania, MRI scans show increased thickness in a brain region called the inferior frontal gyrus (part of the PFC). This area is associated with habit suppression. 

The PFC’s intricate role in executive function and behavior regulation intersects with BFRBs, shedding light on their underlying mechanisms. Understanding these interactions can guide treatment approaches for individuals affected by BFRBs.

Important Facts about the Prefrontal Cortex

The prefrontal cortex (PFC) is a critical brain region responsible for orchestrating complex cognitive and emotional processes. It is a crucial part of the brain located at the front of the frontal lobe, just behind the forehead. Cross-species comparisons, neuroimaging, computational modeling, and therapeutic approaches contribute to our knowledge.

The prefrontal cortex plays a pivotal role in executive function. This encompasses several high-level cognitive processes, including self-regulation which is the ability to control behavior and impulses. It helps with planning, strategizing and setting long-term goals. The PFC is important for decision-making and the ability to weigh options in order to choose the best course of action. It is responsible for problem-solving and tackling complex issues. It plays an integral role in attention and the ability to focus on relevant information. The prefrontal cortex is also responsible for emotional regulation and the management of reactions. Furthermore, it significantly influences personality and behavior. 

The PFC has two main parts, the medial PFC and the lateral PFC. If the medial PFC (mPFC) is not functioning properly, it can affect self-reflection, memory, and emotional processing. If the lateral PFC (lPFC) is not functioning properly, it can affect sensory processing, motor control, and performance monitoring.

Damage to the prefrontal cortex can result from brain trauma, tumors, strokes, or other factors. Without a properly functioning prefrontal cortex, one can struggle with impulsivity, emotional regulation, attentional issues and problem-solving. 

Understanding the Prefrontal Cortex

  1. Function and Complexity:
  • The PFC is essential for developing action plans, driven by the coordination of cognitive and emotional processes. It relies on both current goals and future plans.
  • Behavioral flexibility, necessary for successfully reaching goals in a changing environment, is a hallmark of PFC function.
  • The PFC comprises several interconnected regions, each associated with various functions. These regions form networks that mediate different aspects of behavior.
  • Dysfunction between PFC regions and networks underlies many mental illnesses.

Effects of BFRBs on the Prefrontal Cortex

  1. BFRBs Defined:
  • BFRBs include conditions like trichotillomania (hair-pulling), dermatillomania (skin-picking), and nail-biting.
  • These behaviors are repetitive, ritualistic, and often serve as coping mechanisms.
  1. Prefrontal Dysfunction in BFRBs:
  • Research suggests that BFRBs involve altered PFC activity.
  • Decreased inhibitory control in the PFC may contribute to the persistence of these behaviors.
  • Dysregulation of emotional processing within the PFC could drive BFRBs.
  1. Specific Effects:
  • Decreased Empathy: PFC dysfunction may impair our ability to empathize with others. The PFC, which plays a crucial role in understanding and sharing emotions, may become dysregulated. Individuals with BFRBs might find it challenging to connect emotionally with others, affecting their social interactions and relationships.
  • Short-Term Memory Loss: Damage to the PFC can lead to memory deficits. The PFC is involved in working memory, which allows us to hold and manipulate information temporarily. BFRBs may disrupt this function, making it harder for individuals to retain and recall information over short periods.
  • Poor Decision-Making: BFRBs may interfere with rational decision-making. The PFC is essential for evaluating options, considering consequences, and selecting appropriate actions.Dysfunctional PFC regions due to BFRBs may impair this process, leading to impulsive or suboptimal choices.
  • Personality Changes: PFC dysfunction might alter personality traits. The PFC contributes to personality traits such as conscientiousness, openness, and agreeableness. BFRBs might alter these traits, potentially leading to shifts in behavior, preferences, and interpersonal dynamics.
  • Difficulty with Planning and Organization: BFRBs disrupt executive functions. The PFC is responsible for executive functions, including planning, organizing, and setting goals. BFRBs can disrupt these functions, making it challenging for individuals to structure their daily lives effectively.
  • Inflexibility and Stubbornness: Rigidity in thinking patterns may arise from PFC dysfunction. Individuals with BFRBs might exhibit inflexibility, resisting change or adapting poorly to new situations.

Clinical Implications

  1. Neuropsychiatric Disorders:
  • BFRBs often co-occur with conditions like obsessive-compulsive disorder (OCD) and anxiety disorders.
  • Understanding PFC dysfunction in BFRBs can inform therapeutic approaches.
  1. Treatment Approaches:
  • Cognitive-behavioral therapy (CBT) targeting the PFC can help manage BFRBs.
  • Mindfulness-based interventions may enhance PFC regulation.


The prefrontal cortex, with its intricate network of regions, plays a central role in our behavior. BFRBs disrupt this delicate balance, affecting decision-making, emotional regulation, and cognitive flexibility. By unraveling the complexities of PFC dysfunction in BFRBs, we pave the way for more effective treatments and improved mental health outcomes.

Advanced Behavioral Health, LLP helps people tackle their BFRB symptoms using scientifically–proven CBT and DBT techniques. 

Call 646-345-3010 or email Dr. Suzanne Feinstein at for a free 15 minute consultation to see if you qualify for treatment.

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