What are body-focused repetitive behaviors (BFRBs)?
Body-focused repetitive behaviors (BFRBs) are a group of repetitive, compulsive behaviors in which a person repeatedly touches, pulls, picks, or damages parts of their own body.
These behaviors are not done intentionally to cause harm. Instead, they often feel automatic, difficult to control, and temporarily relieving.
Body-focused repetitive behaviors commonly include:
- skin picking (excoriation)
- hair pulling (trichotillomania)
- nail biting
- lip or cheek biting
- scab picking
Two of the most commonly searched clinical presentations are:
- Trichotillomania
- Excoriation disorder
Many people searching for help describe the same experience:
“I don’t want to do it – but I can’t seem to stop.”
Learn more about BFRBs from the TLC Foundation for Body-Focused Repetitive Behaviors.
Are BFRBs just habits?
One of the most common misconceptions is that skin picking or hair pulling is “just a bad habit.”
In reality, BFRBs are better understood as compulsive regulation behaviors, meaning they often serve a function in the nervous system.
People may engage in these behaviors when they are:
- stressed
- bored
- anxious
- overwhelmed
- focused or zoning out
- emotionally dysregulated
The behavior may temporarily:
- reduce tension
- create a sense of control
- provide sensory stimulation
- interrupt emotional discomfort
This is why willpower alone is usually not effective. The behavior is not simply a choice—it is part of a self-regulation loop.
Evidence-based behavioral treatment approaches are supported by the American Psychological Association.
Why do I feel urges before I pick or pull?
Most people with BFRBs describe a buildup of internal tension or “urge” before the behavior happens.
This urge can feel like:
- pressure under the skin
- a sense that something “needs fixing”
- anxiety or restlessness
- a focused need for symmetry or smoothness
- automatic hand movement without awareness
The behavior often occurs in a cycle:
- internal tension builds
- attention shifts to the body
- picking or pulling begins
- temporary relief follows
- shame or regret appears
- the cycle repeats
Why is it so hard to stop skin picking or hair pulling?
Many people try to stop through:
- willpower
- avoidance
- punishment or self-criticism
- “just don’t do it” strategies
But these approaches often fail because they do not address the underlying nervous system cycle.
The brain is not simply choosing a behavior – it is responding to:
- sensory urges
- emotional tension
- habit loops
- attentional shifts (often during scrolling, thinking, or zoning out)
In many cases, the behavior becomes more likely during:
- high stress
- fatigue
- unstructured time
- emotional overload
- perfectionistic focus on appearance or “fixing” sensations
Why do I feel shame about BFRBs?
Shame is one of the most significant maintaining factors in BFRBs.
Many people feel:
- “I should be able to control this.”
- “What is wrong with me?”
- “No one else does this.”
- “I’m making it worse by doing it.”
But shame often increases the cycle because it:
- increases emotional distress
- increases nervous system activation
- leads to more attempts at suppression
- paradoxically increases urges
So the cycle becomes:
urge → behavior → relief → shame → more urge
Why does BFRB behavior feel automatic?
A key feature of BFRBs is that they often occur outside full conscious awareness.
This is especially common when someone is:
- scrolling on a phone
- watching TV
- reading or concentrating
- thinking deeply or dissociating
The behavior becomes learned because the brain associates it with short-term tension relief.
Can BFRBs cause physical damage?
Yes. Depending on severity, BFRBs can lead to:
- skin damage or scarring
- infections
- hair thinning or patchiness
- pain or irritation
- dermatological complications
Learn more about skin health from the American Academy of Dermatology.
Can body-focused repetitive behaviors be treated?
Yes. BFRBs are highly treatable with evidence-based approaches.
Research supports behavioral interventions such as Habit Reversal Training (HRT), summarized by the National Institute of Mental Health.
Effective treatment may include:
1. Habit Reversal Training (HRT)
A structured behavioral approach that includes:
- awareness training (noticing early cues)
- competing response training (alternative behaviors)
- pattern interruption strategies
Learn more about BFRBs and HRT from the TLC Foundation for BFRBs.
2. Cognitive Behavioral Therapy (CBT)
Helps address:
- triggers
- thought patterns (“I need to fix this”)
- emotional regulation difficulties
Learn more: CBT Therapy at Advanced Behavioral Health.
3. Urge surfing and nervous system regulation
Learning to:
- notice urges without acting on them
- tolerate rising and falling tension
- reduce automatic response loops
4. Reducing environmental triggers
Including:
- modifying high-risk situations (mirror time, idle time, etc.)
- increasing structure during vulnerable periods
- reducing unconscious “checking” behaviors
Why treatment is not just about stopping the behavior
A key misunderstanding is that treatment = “stop picking or pulling.”
In reality, effective treatment focuses on:
- reducing urge intensity
- increasing awareness of triggers
- building alternative regulation strategies
- decreasing shame cycles
- improving nervous system flexibility
FAQ: Body-Focused Repetitive Behaviors (BFRBs)
Q: What are body-focused repetitive behaviors?
A: BFRBs are compulsive behaviors like skin picking or hair pulling that are used to regulate tension or sensory discomfort.
Q: Why can’t I stop picking my skin or pulling my hair?
A: Because BFRBs are driven by urge cycles and nervous system regulation, not just habits or willpower.
Q: Is trichotillomania a mental health disorder?
A: Yes. Trichotillomania is a recognized clinical condition often treated with behavioral therapy.
Q: Is skin picking a form of OCD?
A: It can overlap with obsessive-compulsive features, but excoriation disorder is classified as a related but distinct condition.
Q: Can BFRBs go away on their own?
A: They may fluctuate, but without targeted treatment they often persist or become more entrenched over time.
Q: What is the most effective treatment for BFRBs?
A: Evidence-based treatments such as Habit Reversal Training (HRT) and CBT-informed interventions are considered first-line approaches.
Final thought
Body-focused repetitive behaviors are not simply habits or lack of self-control. They are learned nervous system responses that develop over time as ways of managing internal tension, sensory urges, and emotional overload.
While they can feel automatic and difficult to interrupt, they are also highly responsive to structured, evidence-based treatment.
With the right approach, it is possible to reduce urges, interrupt cycles, and regain a sense of control without relying on constant willpower.
About Dr. Suzanne Feinstein
Dr. Suzanne Feinstein is a Columbia University trained licensed clinical health psychologist specializing in anxiety disorders, OCD-spectrum conditions, ADHD-related executive dysfunction, and body-focused repetitive behaviors including skin picking and hair pulling. She works with individuals struggling with compulsive behaviors, shame cycles, and nervous system regulation difficulties.
To learn more or schedule a consultation, call 646-345-3010 or visit Advanced Behavioral Health.