What are body-focused repetitive behaviors?
HOW TO MANAGE THE URGE TO PICK, PULL, AND BITE YOUR HAIR, SKIN, AND NAILS
By Alyssa Goldberg
(Kartik Gada / Unsplash)
Have you ever found yourself picking at your nail beds without being able to stop or felt the urge to bite your cheek uncontrollably, even if you’re not sure why? If this sounds familiar, you may be struggling with body-focused repetitive behaviors. Body-focused repetitive behaviors (BFRBs) are any kind of repetitive self-grooming behavior where you pick, pull, or bite your own hair, lips, skin, cheeks, or nails. These behaviors can cause physical damage to the body, and are usually met with multiple attempts to stop or limit the action.
Anyone can develop a BFRB, regardless of your ethnicity, gender, or age, but studies show that onset typically occurs in early-mid adolescence. People struggling with these disorders can suffer from physical impacts on their health, as well as isolating emotional effects. You may experience embarrassment, shame, or frustration due to your inability to stop the behavior, low self-esteem, and/or the fear of other people finding out about your condition. These symptoms may lead to keeping your distance from people, increased social anxiety, and a decrease in the ability to function in your daily life.
If you are struggling with BFRBs, you deserve care and support. Keep reading to learn about common BFRBs and their treatment.
What are some common BFRB’s?
HAIR PULLING DISORDER (TRICHOTILLOMANIA)
This causes you to forcefully pull out the hair from your scalp, eyelashes, eyebrows, and other parts of the body. About 5-20% of people struggling with this disorder will also swallow the hair.
SKIN PICKING DISORDER (EXCORIATION)
This causes you to repetitively touch, rub, scratch, pick at, or dig into your skin and can lead to skin discoloration, scarring, and potentially severe tissue damage from continued harm.
NAIL BITING DISORDER (ONYCHOPHAGIA)
This causes someone to bite their nails past the nail bed and chew on cuticles. This can result in soreness, bleeding, and infections.
CHEEK BITING (“CHEEK CHEWING”)
Ongoing cheek biting can result in redness, sores, and tearing in the inner lining of the the mouth.
There are other repetitive behaviors that interfere with a person’s physical and mental health. These can include — but aren’t limited to — lip biting, nail picking, and scab eating.
So, how do these behaviors relate to other mental health conditions?
Psychologists have associated BFRBs with anxiety disorders, impulse control disorders, ADHD, and obsessive compulsive disorder (OCD), and certain BFRBs are classified as “obsessive-compulsive and related disorders.” These disorders definitely share similarities in their symptoms, but they're not the same.
Other myths around BFRBs include that these behaviors are always noticeable to others. “Oftentimes, people can go Tourette's without knowing that repetitive behaviors can be even unnoticeable for people [engaging in them],” says therapist Shannon Vigil. “And, ADHD and autism are on a spectrum in the DSM, so people can be high functioning or low functioning. So sometimes somebody could have these disorders and others don’t know because they might be in the high functioning scale.”
How can you manage body-focused repetitive behaviors?
There are many types of evidence-based treatments that can help people manage BFRBs, so it’s all about finding one — or a combination of methods — that fits what you need.
COGNITIVE BEHAVIORAL THERAPY (CBT)
According to Vigil, CBT therapy is the gold standard for managing BFRBs. CBT therapy is a goal-oriented approach that helps you change negative thought patterns and behaviors by focusing on the present, reframing your negative thoughts, and developing healthy coping mechanisms. Existing studies have demonstrated that for BFRBs, CBT may be superior to medication in treatment outcome as it specifically addresses the harmful behaviors. This form of therapy can also help manage anxiety disorders, ADHD, and depression.
Dialectical Behavior Therapy (DBT)
DBT consists of four learning modules including mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. DBT can be helpful in behavior modification as well as managing other mental health conditions like bipolar disorder, major depressive disorder, personality disorders, and more.
HABIT REVERSAL TRAINING (HRT)
Includes awareness training and social support to help a person focus on the circumstances in which the behavior is most likely to occur, and by establishing a support network of loved ones to provide positive feedback during the treatment process. While this is effective for short-term treatment, it should be used alongside other treatment methods for long-term improvements.
COMPREHENSIVE BEHAVIORAL TREATMENT (COMB MODEL)
This involves self-monitoring to identify triggers and developing individualized strategies to resist triggers alongside a clinician.
MEDICATION
No drug is currently approved by the FDA for the specific treatment of BFRBs, but people may benefit from medication, which can be discussed with a clinician. Some medications that have been studied for BFRB treatment include Clomipramine, SRRIs and other antidepressants, Naltrexone, and Neuroleptics.
TREAT THE UNDERLYING CONDITION
You may also need to treat an underlying condition contributing to a BFRB. “It’s important for people to see a licensed therapist who specializes in treating disorders like OCD, ADHD, and autism,” says Vigil. “People can use search engines like Psychology Today to narrow down specific treatment types.”
Vigil also recommends applied behavior analysis therapy (ABA), which can be particularly helpful people who have autism, exposure therapy, support groups, and medication, especially for people struggling with OCD.
IDENTIFY AND COMBAT TRIGGERS
If therapy or medication is not accessible, there are still steps you can implement in your daily life to treat BFRBs. Identifying your triggers and developing healthy distractions can help you resist the urge to engage in BFRBs. These coping mechanisms can include journaling, exercising (even if that just means going for a walk), or practicing mindfulness.
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Taking action to manage BFRBs is not an easy feat, and requires resilience and dedication. But with the right support and treatment, you can regain control over these behaviors and improve your overall wellbeing. Remember, you are not alone on this journey, and there is hope for a healthier future.