Anne has a Master of Arts in Teaching and a Bachelor's in Language.
What are BFRBs?
BFRBs, or body-focused repetitive behaviors, are repeated behaviors often associated with the body, and can be a symptom of obsessive-compulsive disorder. However, these types of behaviors are not associated with OCD alone; individuals with anxiety disorders, bipolar disorder, depression, and other mental health diagnoses may also suffer from BFRBs. BFRBs are often frustrating and hard to quit. These behaviors often follow patterns similar to addiction, and they tend to affect many aspects of a person’s life. In this article, I will outline the most common body-focused repetitive behaviors. I hope this article will help you gain a sense of clarity and understanding if you yourself suffer from a BFRB, or it may help you to better understand the people that do have this.
Types of Body-Focused Repetitive Behaviors
There are several different types of body-focused repetitive behaviors, and probably more that haven’t even been identified as of yet. However, the DSM-5, or the Diagnostic and Statistical Manual of Mental Disorders, often recognizes the following disorders under body-focused repetitive behaviors: hair pulling, skin picking, and nail biting.
Trichotillomania, or hair pulling, is a body-focused repetitive behavior that most often involves pulling out the hair. This is one of the most common BFRBs and the one that most people have heard of when they learn about BFRBs. The DSM-5 notes that the effects of trichotillomania if left untreated can include hair loss, distress, embarrassment, and an inability to function or participate in certain activities. For instance, a person with this disorder might feel a sense of shame and be embarrassed to show their hair, such as in social atmospheres. They might try to cover bald patches of hair with a hat or some other way to prevent others from seeing the damage they have done to their hair. Those closest to the person might recognize the behavior, but often don’t know what to do to help their loved ones stop pulling their hair. This can cause tensions among loved ones, often leading to strained relationships and a lack of socializing from the individual due to their fear of these strained relationships with others in the future. A person may be less outgoing and more introverted if they sense their BFRB is affecting this aspect of their life to a great degree. In addition to these psychological effects, hair pulling can cause many physical health problems, including injuries and infections at the scalp from pulling hair out, tissue damage depending on the prolonged engagement in this behavior, and possibly joint pains related to their repetitive motions and pulling of the hair. Trichotillomania is the most common and most often recognized BFRB, and as you can see, the behavior can quickly get out of control and create distress for the person.
Dermatillomania, or skin-picking disorder, is another body-focused repetitive behavior, associated with the compulsion to pick and pull at the skin, sometimes at scabs or perceived “imperfections” in the skin that need to be “fixed”. There is still not a lot known about this disorder specifically, and it often goes more unnoticed than other BFRBs. Because much is still not understood about this disorder, people suffering often feel scared, shameful, or even embarrassed to mention this to their psychiatrist or doctor, in fear that they might be stigmatized or ostracized for a behavior that they are largely not able to control. Someone may notice the behavior in a loved one and say: “stop picking”, but this is just not a simple enough remedy. Oftentimes, when sufferers of the disorder hear someone tell them to stop picking, it makes them feel more shameful, embarrassed, and depressed, leading to more skin picking as a result. Family members may start to notice lesions on the person’s arms, legs, or other noticeable parts of the body and ask what happened. The person suffering from this disorder then has to either come up with an excuse or brush it off, saying it is only a scrape or bruise, to get family members off their backs. The person with skin-picking disorder often goes through cycles that mirror patterns of addiction, in which they want to stop, try using Neosporin, band-aids, and other remedies to help prevent picking and promote healing of the skin, but these efforts are often short-lived. The person can relapse very quickly, depending on the triggers they may experience for their skin-picking. Dermatillomania often poses serious health risks to individuals, including lesions that won’t heal, infections, the possibility of skin cancer development due to rapid cell regrowth in the skin, and serious risks to disease transmission and illness from the open wounds and sores if they are not treated effectively. Despite all of those risks, persons with skin-picking disorder still often ignore this and continue participating in the behavior because they feel that they can’t stop. That’s why it is always important to remain understanding and supportive when persons with this disorder are struggling. Try to see things from their perspective and really listen to them when they have a problem.
Onychophagia, or nail biting, is the compulsion to continually bite your nails. This is a very common body-focused repetitive behavior, and it has shown up time and time again in pop-culture references, such as children’s cartoons. Anxious and scared characters in TV shows are often portrayed biting their nails, so there is some suggestion that children’s exposure to this may also be an influence on whether or not they develop nail biting in the future. While many people might bite their nails occasionally, that does not mean they have the disorder. The nail biting must be consistent, triggering, and a serious detriment to the person’s health and everyday functioning in order for it to be considered a disorder. Much like the other body-focused repetitive behaviors, there will be “triggers” that might induce this behavior in an individual, leading to a cycle of addictive patterns of nail biting. Additionally, sufferers will pose the risk of potentially infected nail beds as well as getting seriously ill from biting, especially dirty nails or nails that may be carrying bacteria on them. However, as familiar as the other BFRBs, despite these risks, persons often continue the behavior and have trouble quitting.
Is it a Symptom, or its Own Disorder?
I think this is something that is still being debated among many psychologists. While body-focused repetitive behavior seems to have its own set of triggers and symptoms, it can almost be considered a disorder itself, but oftentimes, it is a co-occurring disorder that is attached to another mental disorder someone may have, such as OCD, anxiety, bipolar disorder, or schizophrenia. Pinpointing the disorder that it is associated with may also help to explain the triggers of the behavior and what needs to be done to help it. For instance, if someone suffers from skin-picking that is often triggered by bad news and unfortunate life circumstances, it is most likely related to anxiety and should be treated with that in mind, whereas if someone picks their skin because they believe there are bugs living inside their skin, this might be a delusion associated with schizophrenia that needs to be addressed with therapy.
It's Not Easy
Firstly, I just want to start out by saying, having a body-focused repetitive behavior is not easy. Many people on the outside of the situation often believe that a person can just “stop” or quit the behavior just as easily as they can start it. Unfortunately, it is not that easy. Many BFRBs follow patterns similar to addiction, because the act of this behavior actually releases dopamine in the brain and provides a sense of relief to the person participating in the behavior. Because the behavior initiates these actions within the brain, I believe body-focused repetitive behaviors should be looked at much like addiction, and treatment systems should focus on reasonable, science-backed successful treatment programs similar to those that work for persons with addiction disorders. I believe then that people will be able to make much progress in this field of psychology, and can bring a lot of people with these behaviors into remission from this illness.
Body-focused repetitive behaviors are often difficult to recognize and diagnose, leaving the person suffering feeling a sense of shame and also the thought that they might never be able to quit. Almost like a silent addiction, those with BFRBs can feel completely alone in their suffering and afraid to speak up. That’s why it is so important now more than ever to raise awareness about these disorders, as well as encourage support to the community that deals with these issues on a daily basis. Together, we can end the stigma of body-focused repetitive behaviors and facilitate a loving, encouraging environment for people to find the treatment they need to help them live full and productive lives.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2022 Anne Marie Carr