Body-Focused Repetitive Behaviors

What are body-focused repetitive behaviors?

Body-focused repetitive behaviors, or BFRBs, are a group of related conditions in which a person repeatedly touches their body in a way that causes damage, often without fully realizing they are doing it. The behaviors are hard to stop despite repeated efforts. The two most common are hair-pulling and skin-picking.

Trichotillomania is recurrent pulling out of your own hair, leading to hair loss, while dermatillomania, or excoriation, is recurrent picking at your skin, causing sores or scarring. Other BFRBs include nail-biting and cheek-biting. These behaviors are related to obsessive-compulsive disorder.

BFRBs are not habits you can simply break through willpower, and they are not self-harm in the way that term is usually meant. They often serve to release tension or provide a sense of relief, and they can bring real shame and distress. They are common, more so than many people realize, and they are treatable with the right approach.

What are the symptoms of body-focused repetitive behaviors?

BFRBs involve the repetitive behavior itself along with the feelings and consequences around it. The symptoms tend to fall into two groups.

The behavior and its triggers follow a recognizable pattern.

• Repeatedly pulling hair, picking skin, or biting nails
• A rising sense of tension before, and relief or release during
• Doing it automatically, or when anxious, bored, or stressed
• Repeated attempts to stop or cut back without success

The effects show up on the body and in daily life.

• Noticeable hair loss, sores, scarring, or skin damage
• Shame, embarrassment, or trying to hide the damage
• Spending significant time on the behavior
• Avoiding activities like swimming or haircuts

When a repetitive behavior is causing physical damage, taking up significant time, or bringing distress and shame, that is a sign it may be time to reach out for support.

Who is at increased risk of body-focused repetitive behaviors?

BFRBs are thought to arise from a mix of genetics, brain structure, and emotion. Several factors can raise the likelihood. Knowing the common ones can help you understand your own experience, even though having them does not mean a BFRB will develop.

Biological and personal factors

• A family history of BFRBs or obsessive-compulsive conditions
• Another mental health condition, such as anxiety or depression
• Being in adolescence, when these behaviors often begin

Emotional and situational factors

• High stress, anxiety, or boredom
• Using the behavior to release tension or self-soothe
• Situations that leave hands idle, like reading or screen time

BFRBs affect people of every background and often begin around puberty. Because so many factors are involved, having them does not mean the condition will develop.

How are body-focused repetitive behaviors treated?

BFRBs are treatable, and behavioral therapy is the most effective approach. Treatment focuses on building awareness and replacing the behavior with healthier responses.

Habit reversal training, a form of cognitive behavioral therapy, is the leading treatment. It helps you become aware of when and why the behavior happens and practice a competing response that is incompatible with pulling or picking.

Acceptance and commitment therapy (ACT) helps you make room for the urges and uncomfortable feelings that drive the behavior without acting on them, which can reduce its hold over time.

Awareness and practical tools support the work. Tracking triggers, keeping hands busy with fidget items, and adjusting your environment can all make the behavior easier to interrupt.

Treating what is underneath helps too. Because BFRBs often occur alongside anxiety or depression, addressing a related condition frequently eases the behavior as well.

Progress often comes gradually, with setbacks along the way, and that is normal. With support and practice, many people significantly reduce the behavior and the distress it causes.

When should you seek help?

It is a good idea to reach out to a professional if a repetitive behavior is causing physical damage, taking up significant time, or bringing distress, or if you have tried to stop on your own without success. These behaviors respond well to the right kind of support.

BFRBs often occur alongside anxiety and depression, so if you are struggling with your mental health or having thoughts of self-harm, reach out for support and call or text 988, the Suicide and Crisis Lifeline, or call 911. These behaviors are common and treatable, and they are not a personal failing. Whenever you feel ready, help will be there for you.