Have you ever found yourself lost in thought, only to realize you’ve been pulling out your hair? Or, maybe you frequently pick at your skin—fussing with scabs, biting your nails, or picking at pimples. These behaviors can be common bad habits, but if they start to cause physical damage—or feel impossible to stop, you may be dealing with a body-focused repetitive behavior (BFRB).
Read on to learn more about BFRBs, how to figure out if you’re dealing with more than a harmless bad habit, and how to get help.
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What are body-focused repetitive behaviors?
BFRBs are repetitive behaviors fixated on the body, such as hair-pulling, skin-picking, nail-biting or cheek-biting. If you’re dealing with a BFRB, know that you’re not alone; research shows that 1 in 20 people experience this condition. BFRBs often develop between the ages of 11 and 15, but can show up at any age—including in children as young as 2, or in older adults.
BFRBs often feel hard to control. According to licensed therapist April Kilduff, MA, LCPC, LMHC, LPCC, LPC, these behaviors can be a way to cope with boredom, stress, or anxiety. Sometimes, the behavior feels automatic—making it especially hard to identify and stop. For example, you may be watching TV absentmindedly only to find you’ve spent the past half hour picking at your face. Some people engage in BFRBs regularly, while others experience a spike in these behaviors during times of acute stress.
What are the impacts of BFRBs?
BFRBs like skin-picking and hair-pulling can cause physical damage, which is sometimes lasting. You may create open wounds, which can cause scarring or infections.
People who engage in BFRBs also often feel shame. “[People] feel like they should be able to stop. When they can’t, they feel defective, like there’s something wrong with them,” says Ruth Golomb, licensed therapist and author of The Hair Pulling “Habit” and You. This can result in worsened mental health, and/or social isolation. If the urge to pick at your skin or pull your hair feels uncontrollable, you may find yourself trying to get more time alone to “safely” engage in your BFRB.
How do I know if I have a BFRB?
It can be hard to tell the difference between a bad habit, and a BFRB, but there are some key signs to look out for:
- Does the behavior feel uncontrollable? BFRBs are characterized by a strong urge to engage in the behavior—whether it’s hair-pulling, nail-biting, cheek-biting, or something else. If it feels very difficult to stop, you might be dealing with a BFRB.
- Does the behavior feel automatic? Do you sometimes find yourself engaging in the behavior without realizing it? Some people with BFRBs aren’t even aware of when they’re picking their skin or pulling their hair. If you feel like you go into a kind of trance-like state, that could be a clue.
- Are you causing physical damage? If your behavior is causing repeated cuts, scabs, scars, or infections, it’s important to investigate what’s going on. These physical issues can cause short and long-term damage.
- Do you feel significant shame about the behavior? Do you feel like you need to hide your behavior? If so, that may indicate that it’s taking up more time than you think, or having a big impact on your life.
If your BFRB starts to impede your ability to lead the life you’d like—or is impacting your physical health—it’s worth investigating treatment options.
Are BFRBs a part of OCD?
The short answer is no. While both BFRBs and OCD involve compulsive behaviors, and they can appear similar for this reason, they are two distinct conditions. The main difference between these two conditions is the underlying reasons behind the behaviors.
OCD is a complex chronic mental health condition characterized by recurrent intrusive thoughts (obsessions) that prompt the people to engage in rituals meant to neutralize those thoughts (compulsions). “An OCD compulsion is always done in response to an unwanted thought, image or urge that provokes a high degree of distress and/or anxiety in a person,” Kilduff explains. “In short, a mental event triggers the compulsion.”
BFRBs, on the other hand, are not necessarily triggered by intrusive thoughts. You may not even be aware that you’re engaging in a BFRB, while it’s happening. BFRBs also tend to provide a sense of satisfaction or pleasure, even when they cause potential physical damage. It can feel satisfying to pick a scab, for example, even if you know it might cause you to bleed afterward.
An OCD compulsion, however, never really feels good—even if it provides temporary relief. According to Golomb, “there’s some sort of pleasure associated with some aspect of the BFRB that is typically not present for OCD.”
While OCD and BFRBs are different conditions, it’s easy to get them confused, and they can occur simultaneously. But, it’s important to know the difference, so you can access the appropriate treatment. OCD is treated using exposure and response prevention therapy (ERP)—which teaches you to face your fears and react differently—but BFRBs are approached using a different therapeutic method. Read on to learn more.
Treatment for BFRBs
- See a provider for your physical health: If you think you might be dealing with a BFRB, it’s important to address any potential physical damage, like repeated wounds or infections. A dermatologist can also help address potential triggers for the behavior, like acne or dry skin.
- Identify your triggers: BFRBs show up differently for everyone, and your triggers will be unique to you. Identifying these triggers is a first step to figuring out how to stop the behavior. For example, you may notice that you’re most prone to biting your nails, when you’re feeling anxious. Or, that you often find yourself picking your skin when your acne is flaring up. Understanding the situations and feelings that contribute to your BFRB will help you figure out where to turn to for help.
- Create an obstacle. Once you have a sense of your triggers and behaviors, you can try a few methods for reducing the amount of time you spend engaging with your BFRB.
- Keep your nails and/or hair short
- Try meditation, breathwork, or journaling to calm anxiety
- Use distractions, like fidget spinners
- Pick up a hobby that keeps your hands busy, like knitting
- Chew gum
- Seek therapy It can also be important to tackle the root causes of your behavior, by seeking support from a trained mental health professional. BFRBs are most effectively treated through a form of cognitive behavioral therapy (CBT) called habit-reversal training (HRT). HRT has two main components. “The first involves monitoring and tracking the specific details of when the problematic behavior, such as skin picking, occurs,” says Dr. Patrick McGrath, psychologist and Chief Clinical Officer at NOCD. “This process helps people become more aware of their patterns and triggers. By developing increased awareness, they can often reduce the frequency of the behavior itself.” The second component is known as competing response training. With greater awareness of your behavior and triggers, you can intentionally respond with other actions, such as crossing your arms, sitting on your hands, or reaching for a fidget spinner or gum.
- Consider medication. When therapy alone isn’t enough, medication may also be included in your treatment plan. While no medication has been formally approved to treat BFRBs, there is evidence to suggest that some antidepressants like SSRIs (selective serotonin reuptake inhibitors) and metamine, which is used to help with memory loss in Alzheimer’s patients, can be helpful in addressing underlying symptoms of impulse control disorder.
Bottom Line
BFRBs can look a lot like a bad habit, or a form of OCD, but they are their own distinct mental health condition that can benefit from specific treatment. If you’re repeatedly pulling your hair, picking your skin, biting your lips, or engaging in other body-focused repetitive behaviors that make it hard to engage in daily life or are causing physical damage, it’s important to seek help. You’re not alone, and you don’t have to live in shame.
