What are Body-Focused Repetitive Behaviors (BFRBs)?

Body-focused repetitive behaviors include skin picking (excoriation disorder), hair pulling (trichotillomania), and nail biting that are difficult to stop doing in the moment. These can be caused by specific triggers, such as seeing a pimple or hang nail, or can be experienced as “mindless,” meaning a person is unaware of how/why they started it, or a bit of both. While the behavior in and of itself is not necessary problematic, it is often the length of time or degree to which a person is engaging in the behavior that causes issues.

I pick at my pimples sometimes, do I have a problem?

The short answer is maybe, maybe not. Lots of people bite their nails, pick at their skin, or pull/pluck hair; however, people who engage in BFRBs find it very difficult to resist, stop, or control the behavior. It might not feel bad in the moment - in fact, it may feel soothing or satisfying - but there is typically a great deal of shame or embarrassment afterwards. For example, someone with compulsive hair pulling may pull our their hair to the point of having patches of thinning hair or even bald spots. Skin picking may result in bleeding, blemishes, or scarring. Often individuals who engage in BFRBs try to hide the affected parts of their bodies or even avoid being seen, due to the shame that can arise.

Stopping the Habit

While people want to stop, they often feel helpless to do so. The good news is that research shows that with Habit Reversal Training (HRT), many people learn the skills to significantly reduce or stop the behaviors. HRT is effective in changing behavioral patterns by first, understanding the circumstances under which the behavior occurs, including any known environmental or emotional triggers. Then, with the help of a trained clinician, a treatment plan is put in place to increase awareness to the thoughts and emotions surrounding the behavior and putting a plan in place to change. Therapy also typically includes skills for emotion regulation and distress tolerance to manage unpleasant emotions surrounding the habit.