What are body-focused repetitive behaviors?
Body-focused repetitive behaviors (BFRBs) are repetitive, compulsive behaviors where a person pulls, picks, or manipulates parts of their own body in ways that feel difficult to control.
These behaviors are not simply habits, and they are not intentional self-harm. They are often urge-driven, repetitive behaviors that temporarily regulate internal discomfort.
Body-focused repetitive behaviors include:
- hair pulling
• skin picking
• nail biting
• scab picking
• repetitive grooming behaviors
Two of the most clinically recognized conditions include:
- Trichotillomania
• Excoriation disorder
Many people describe the same experience:
“I don’t want to do it – but it happens when I’m stressed, or even when I’m completely zoned out.”
Why do hair pulling and skin picking happen?
One of the most misunderstood aspects of BFRBs is that they are not triggered by a single emotional state.
Instead, they often occur when the nervous system is struggling to regulate internal experience.
This includes two opposite states:
- high activation (stress, anxiety, overwhelm)
• low activation (boredom, zoning out, fatigue, disengagement)
In both cases, the brain is seeking regulation.
The behavior becomes a fast, automatic way to change internal state.
Why BFRBs get worse under stress
During periods of stress, anxiety, or emotional overload, the nervous system becomes highly activated.
People may feel:
- tense
• overwhelmed
• emotionally flooded
• restless or “on edge”
• mentally overactive
In this state, BFRBs may temporarily reduce internal tension.
This is why people often experience:
- relief during the behavior
• automatic engagement
• difficulty stopping once it starts
Why BFRBs also happen when you’re bored or zoned out
While stress is a major trigger, many people also notice hair pulling or skin picking during boredom, distraction, or mental shutdown states.
This can feel confusing because boredom does not feel emotionally intense in the same way anxiety does.
However, boredom is not “nothing happening” in the nervous system – it is often a state of under-stimulation or disengagement.
In these moments, the brain may seek:
- sensory input
• stimulation
• self-soothing activity
• automatic engagement
People often notice BFRBs during:
- scrolling on their phone
• watching TV
• lying in bed
• studying or working on autopilot
• zoning out or fatigue
In these states, the behavior is less about reducing anxiety and more about regulating under-activation or filling internal “blank space.”
The core pattern: difficulty regulating internal states
The most accurate way to understand BFRBs is not as “stress behaviors” or “bad habits,” but as patterns of difficulty regulating internal states across a spectrum:
- too much activation (stress, anxiety, overwhelm)
• too little activation (boredom, disengagement, fatigue)
In both cases, the nervous system seeks rapid regulation.
BFRBs often become one of the most efficient learned strategies.
Why BFRBs are not just bad habits
Many people try to stop BFRBs through willpower alone, but find the behavior returns under stress or distraction.
This is because the behavior follows a reinforcement cycle:
- Internal state shifts
Stress, boredom, or fatigue increases internal discomfort or disengagement. - Urge emerges
The person becomes aware of sensations, tension, or an automatic pull toward the behavior. - Behavior occurs
Hair pulling or skin picking temporarily regulates internal state. - Relief occurs
There is a short-term shift toward calm, stimulation, or focus. - Emotional response follows
Shame, frustration, or regret increases internal stress again.
This cycle reinforces the behavior over time.
Why awareness is often missing in the moment
BFRBs often occur during:
- distraction
• zoning out
• emotional overload
• fatigue
Because of this, the behavior may begin before full awareness returns.
This is not a lack of discipline. It reflects how strongly the behavior has been reinforced through repetition and automaticity.
Emotional and physical impact
Over time, BFRBs may lead to:
- skin irritation or wounds
• hair thinning or loss
• emotional distress
• shame and avoidance
• increased anxiety about the behavior itself
But often the most significant impact is emotional:
the cycle of tension, relief, and shame that keeps the behavior going.
How CBT helps BFRBs
Cognitive Behavioral Therapy helps interrupt this cycle by targeting both triggers and behavioral responses.
Treatment often includes:
Awareness training
Learning to recognize:
- early urges
• body sensations
• high-risk states (stress, boredom, fatigue)
Habit reversal strategies
Replacing the behavior with competing responses.
Trigger mapping
Understanding emotional, cognitive, and environmental patterns.
Cognitive work
Addressing thoughts like:
- “just this one”
• “I need to fix this”
• “I’ll stop after this”
Emotion regulation skills
Developing alternative ways to manage:
- anxiety
• boredom
• overstimulation
• emotional tension
Reducing shame cycles
Reducing self-criticism, which often intensifies dysregulation and urges.
Learn more about CBT:
https://behaviortherapynyc.com/cbt-therapy/
Learn more about OCD and related treatment:
https://behaviortherapynyc.com/ocd-treatment/
Can BFRBs improve?
Yes. Many people experience significant improvement with evidence-based treatment.
Progress often includes:
- fewer episodes
• earlier awareness of urges
• shorter duration of behaviors
• improved ability to interrupt cycles
• reduced shame and distress
The goal is not perfection or elimination of all urges.
The goal is greater control, flexibility, and reduced suffering over time.
FAQ: Hair pulling and skin picking
Q: Why do I pull my hair or pick my skin when I’m stressed?
A: Stress increases nervous system activation, which can intensify urges to reduce internal tension through repetitive behaviors.
Q: Why do I also do it when I’m bored?
A: Boredom often reflects under-stimulation or disengagement. The behavior can serve as sensory input or automatic regulation during low activation states.
Q: Is Trichotillomania an anxiety disorder?
A: Trichotillomania is classified within the obsessive-compulsive and related disorders spectrum and is often influenced by stress and regulation patterns.
Q: Is skin picking related to anxiety?
A: Excoriation disorder is frequently associated with anxiety, stress, and emotion regulation difficulties.
Q: Why does it feel relieving but then upsetting afterward?
A: Because the behavior temporarily regulates internal state, but the longer-term emotional response includes shame and distress.
Q: Can CBT help BFRBs?
A: Yes. Cognitive Behavioral Therapy is one of the most effective treatments for reducing BFRB frequency and severity.
Final thought
Hair pulling and skin picking are often misunderstood as habits or willpower issues. In reality, they are frequently linked to how the nervous system regulates internal states across both high-stress and low-engagement conditions.
When the nervous system becomes dysregulated – whether through stress, overwhelm, boredom, or fatigue – the brain may turn to repetitive behaviors that temporarily shift internal experience.
Treatment is not about punishment or forcing control. It is about understanding the cycle, reducing shame, increasing awareness, and building healthier regulation strategies.
With evidence-based approaches such as CBT and habit reversal training, many people experience meaningful and lasting improvement.
About Dr. Suzanne Feinstein
Dr. Suzanne Feinstein is a Columbia University trained licensed clinical health psychologist specializing in anxiety disorders, OCD-spectrum conditions, body-focused repetitive behaviors, panic, and emotional regulation difficulties. She provides evidence-based treatment for individuals struggling with compulsive behaviors, chronic anxiety, and high-functioning emotional distress.
To learn more or schedule a consultation, call 646-345-3010 or visit https://behaviortherapynyc.com/.