Q: What are Body-Focused Repetitive Behaviors (BFRBs)?
BFRBs are a group of compulsive behaviors in which individuals repetitively damage or manipulate their body tissue. Many people think of BFRBs as limited to hair pulling (trichotillomania) or skin picking (excoriation disorder), but the category also includes:
- Lip biting
- Cheek chewing
- Tongue chewing
- Nail biting (onychophagia)
- Cuticle picking
These behaviors are typically unconscious or semi-conscious, often triggered by stress, boredom, tension, or sensory stimulation. They are not acts of self-harm – they are repetitive behaviors that feel difficult to control.
Learn more about BFRBs from the TLC Foundation for Body-Focused Repetitive Behaviors:
https://www.bfrb.org/
Q: Why do people bite their lips, cheeks, or tongue?
These behaviors often serve as an unconscious coping mechanism for:
- Anxiety or stress
- Emotional tension
- Perfectionism or over-responsibility
- Sensory-seeking (the physical sensation provides temporary relief)
For many, these habits start in childhood or adolescence and persist into adulthood, particularly in high-functioning, achievement-oriented individuals. They often occur in moments when attention drifts or stress increases, like during meetings, study, or prolonged focus tasks.
Q: Are BFRBs dangerous?
In most cases, BFRBs are not physically dangerous, but they can lead to:
- Pain, sores, or scarring
- Dental issues
- Bleeding or infection
- Social embarrassment or shame
The psychological impact, however, can be significant. Many adults report shame, guilt, and frustration at being unable to control the behavior – even when they understand it is “minor” physically.
Q: How are BFRBs related to stress and anxiety?
BFRBs are often stress-linked habits. Tension, overthinking, or high internal pressure can trigger these behaviors. The cycle looks like this:
- Stress or tension arises.
- You engage in a BFRB (lip, cheek, tongue biting, hair pulling, or skin picking).
- You feel temporary relief.
- Shame or frustration may increase.
- Anxiety rises, creating a feedback loop.
Over time, the behavior becomes more automatic and less conscious.
Q: What is the ComB model, and how does it help?
The ComB (Comprehensive Behavioral) model is an evidence-based framework for understanding and treating BFRBs. It identifies the different factors that maintain these behaviors:
- Biological factors: Genetics, nervous system reactivity, or stress sensitivity
- Environmental factors: Situations or triggers that make the behavior more likely
- Cognitive factors: Thoughts, beliefs, and attention patterns surrounding the behavior
- Sensory factors: The physical or sensory feedback that reinforces the habit
Using the ComB model, treatment is tailored to the individual. For example, lip biting might be triggered by stress and sensory craving, while skin picking might occur in boredom or during anxiety spikes. Identifying triggers allows targeted intervention.
Q: What treatments are effective for BFRBs?
Evidence-based treatments include:
1. Habit Reversal Training (HRT)
HRT is the core intervention for BFRBs. It teaches:
- Awareness of when the behavior occurs
- Alternative, competing behaviors
- Strategies for managing urges
Example: Replacing cheek biting with gentle tongue presses or chewing sugar-free gum.
2. Stimulus Control
Reducing environmental triggers can help prevent habitual behaviors.
Example: Keeping lips moisturized, avoiding specific textures that encourage biting, or creating reminders to stop.
3. Stress Management & Emotional Regulation
Because stress and tension often trigger BFRBs, integrating:
- Mindfulness
- Deep breathing
- Cognitive restructuring
…reduces overall vulnerability to habits.
4. Comprehensive CBT Approach
CBT integrates ComB insights, helping:
- Address perfectionism or over-responsibility patterns
- Break cycles of shame or rumination
- Improve tolerance for tension without relying on the habit
Learn more about Cognitive Behavioral Therapy (CBT):
https://behaviortherapynyc.com/cbt-therapy/
Q: Can BFRBs be fully treated?
Yes. While these habits are often chronic, many high-functioning adults experience significant improvement with structured, evidence-based treatment. Success depends on:
- Awareness of triggers
- Willingness to practice replacement strategies
- Managing underlying stress and anxiety
- Personalized ComB-informed interventions
The goal is not just stopping the behavior, but reducing compulsive tension and restoring confidence in your ability to cope with stress without the habit.
Q: Why do high-functioning adults continue BFRBs?
High-achieving adults often develop these behaviors as subtle stress-management tools. They may:
- Work long hours or under high pressure
- Feel an internal drive toward perfection
- Have histories of over-responsibility or anxiety
- Engage in compulsive self-monitoring
Because the behavior is often discreet, it can go unnoticed for years. But even minor BFRBs create ongoing stress, shame, and self-consciousness.
Q: How do I know if my BFRB needs professional help?
Seek therapy if:
- The behavior causes physical injury
- You feel chronic shame or distress
- You can’t stop even when highly motivated
- It interferes with social, professional, or personal life
High-functioning adults often hesitate to seek help because the behavior is “small” or hidden. Yet addressing it can dramatically improve focus, confidence, and overall well-being.
Learn more about treatment for OCD and related behaviors:
https://behaviortherapynyc.com/ocd-treatment/
Q: Can BFRB therapy be tailored to my lifestyle?
Absolutely. High-functioning adults benefit from tailored, flexible interventions, which may include:
- Evening or weekend sessions
- Telehealth for convenience
- Targeted ComB + HRT sessions
- Integration with stress management, mindfulness, and emotional regulation
This approach ensures therapy is effective without interfering with busy professional lives.
About Dr. Suzanne B. Feinstein
I am a licensed clinical health psychologist specializing in anxiety disorders, OCD, perfectionism, and body-focused repetitive behaviors (BFRBs), including hair pulling, skin picking, lip biting, cheek chewing, and tongue chewing.
My approach integrates the ComB model, Habit Reversal Training (HRT), Cognitive Behavioral Therapy (CBT), emotional regulation, and stress management strategies. I work with thoughtful, high-functioning adults seeking sophisticated, evidence-based treatment for anxiety, obsessive habits, and subtle stress-driven behaviors.
To learn more about therapy for BFRBs, anxiety disorders, and OCD in NYC, call Dr. Suzanne Feinstein at 646-345-3010 or visit https://behaviortherapynyc.com/.