Unraveling the Connection: Body-Focused Repetitive Behaviors and ADHD

By: Suzanne Feinstein, PhD

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Body-Focused Repetitive Behaviors (BFRBs) and Attention-Deficit/Hyperactivity Disorder (ADHD) are two conditions that often coexist, yet their relationship is not widely discussed. This article aims to shed light on the intricate connection between these two conditions and the implications it has on individuals who live with them. 

According to recent research, between 20 to 38 percent of children who have trichotillomania, a form of Body-Focused Repetitive Behavior (BFRB), also fulfill the criteria for ADHD. In a particular study examining individuals with trichotillomania, it was found that roughly 30% also had ADHD. Furthermore, data suggests that about 10 percent of children who engage in skin picking, another BFRB, have ADHD. These figures are approximations, and the actual prevalence may differ. It’s crucial to remember that only a qualified healthcare professional should diagnose these conditions and develop a treatment plan.

The Intricacies of BFRBs

BFRBs are a group of related disorders that involve a recurrent urge to touch or manipulate one’s own body in a way that leads to physical harm. These behaviors, which include hair-pulling (trichotillomania), skin-picking (excoriation), and nail-biting (onychophagia), among others, are often performed unconsciously, making them difficult to control. BFRBs are considered impulsive when people mindlessly engage in these excessive grooming behaviors. They may have a low level of awareness and only realize the behavior after the damage is done. The behaviors can also be compulsive in nature given that people may be aware of the behavior but do not feel they have the discipline to fight the urge.

The ADHD Connection

ADHD is a common neurodevelopmental disorder usually first diagnosed in childhood, and characterized by persistent patterns of inattention, hyperactivity, and impulsivity. Interestingly, research has shown a significant overlap between ADHD and BFRBs. The sensory stimulation provided by BFRBs can serve as a form of self-soothing for individuals with ADHD, helping them manage feelings of restlessness and maintain focus. In turn, individuals with ADHD have more difficulty controlling impulses and therefore, may be less inclined to consider the consequences of the self-destructive nature of BFRBs.

The Role of Dopamine

One of the key factors that link BFRBs and ADHD is dopamine, a neurotransmitter that plays a crucial role in regulating motor control, emotion, learning, reward and executive skills such as working memory, problem-solving and self-control. Individuals with ADHD often have lower levels of dopamine in their central nervous system, which can lead to a constant search for stimulation. BFRBs, in this context, can be seen as a self-stimulating behavior that provides temporary relief from the symptoms of ADHD.

Dopamine deficiency is a complex condition that can be influenced by a variety of factors, including diet, obesity, and certain medical conditions. More research is needed to fully understand the causes and effects of dopamine deficiency. 

The Impact on Quality of Life

Both BFRBs and ADHD can significantly impact an individual’s quality of life. The physical damage caused by BFRBs can lead to feelings of embarrassment and social isolation. Moreover, the constant struggle with inattention and impulsivity associated with ADHD can affect academic and occupational performance. However, with appropriate treatment and management strategies, individuals with these conditions can lead fulfilling lives. 

If you or someone you know is dealing with these conditions, it’s important to seek help from a healthcare professional. They can provide a proper diagnosis and guide you towards the most effective treatment options.

Therapeutic Approaches

Addressing the co-occurrence of BFRBs and ADHD requires a comprehensive therapeutic approach. Cognitive-behavioral therapy (CBT) and habit reversal training (HRT) as well as DBT (Dialectic Behavior Therapy) have shown promise in helping individuals recognize their impulsive triggers and develop healthier coping mechanisms. Certain stimulant and non-stimulant medication and N-acetylcysteine (NAC), an amino acid, may also be beneficial. 

Please consult with a healthcare professional for personalized advice. This information is intended to be educational and should not be used as a substitute for professional medical advice.


The intersection of BFRBs and ADHD is a complex one, warranting further exploration.

Although both disorders can coexist, they are distinct in their characteristics. ADHD is primarily characterized by attention deficit and hyperactivity, while BFRBs involve self-inflicted physical behaviors.

By deepening our understanding of these conditions, we can pave the way for more effective interventions and ultimately, improve the lives of those affected. 

It’s important to note that a professional healthcare provider should make a diagnosis and treatment plan for these conditions.

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

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

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