Are BFRBs Hereditary?

Blue DNA in front of black background

Family history may explain body-focused repetitive behaviors. Research suggests a genetic predisposition for nail biting, hair pulling, and lip biting behaviors. However, like most other mental health conditions, the genetic pattern is likely complex and involves the interaction of various genes with some environmental factors. The interaction is what exacerbates the condition. While family history may not solely determine these conditions, it provides essential insight into the origin of these BFRBs. The suggestion that BFRBS are hereditary emanates from the consistent studies that suggest that most mental health disorders are familial. This article reviews the deeper aspect of the hereditary nature of BFRBs.

Why are BFRBs Considered Familial?

Body-focused body-focused, repetitive behaviors are considered hereditary for several reasons that match genetic and social influences. Several studies have indicated that there is a genetic component to BFRBs. Twin studies have also supported these findings with a higher occurrence of BFRBs in identical twins than in fraternal twins. Additionally, growing evidence shows that particular genetic markers are associated with BFRBs. For example, the dynamics in specific genes in charge of neurotransmitter functions, like serotonin and dopamine systems, have been found in BFRBs. These neurotransmitters are crucial in determining one's moods, impulse control, and reward processing, all essential elements in adopting BFRBS. Some of the reasons why BFRBs are said to be in the family lineage include:

  • Genetic influences - trichotillomania often runs in the family, suggesting genetic predisposition. This means one is likely to develop a BFRB condition if one's parent or close relative has BFRB.
  • Observational learning- family members may subconsciously pick behaviors from each other through observation, especially for children who may imitate the behavior of their parents and siblings.
  • Shared environment - family members often share the same environment with similar stressors, which can, in turn, lead to the passing on of some BFRBs. High stress levels and various family dynamics increase the risk of BFRB occurrence.

What is the Interplay Between Gene-environment interaction in BFRBs

Gene and environment interactions include the combination of genetic predispositions and environmental effects or the risk of BFRB development. Specific genetic variants may increase the vulnerability to environmental factors. Instead, environmental factors may escalate the expression of genetic vulnerabilities. For example, an individual dealing with particular gene markers that cause impaired impulse control is more vulnerable to developing BFRBs as a coping mechanism when faced with various stress factors. Conversely, staying in a supportive environment can be an effective coping mechanism and psychological interventions also mitigate the genetic effects causing BFRBs or minimize their intensity. Therefore, there is a need to understand the correlation between genetic and environmental factors in the onset and consistency of BFRBs. The treatment process often involves an interpretation of the role these two factors play in the severity of BFRBs.

What Causes BFRBs?

Studies have indicated that skin picking or hair pulling may be hereditary predispositions. However, it is essential to note that despite the genetic factor involved in BFRBs, other factors, such as environmental stress elements and temperament issues, also escalate the condition. An individual may be genetically predisposed to BFRBs, but if the right stressor does not occur at a specific time, the BFRB may fail to manifest. Therefore, the interplay between genetic and environmental factors often leads to the onset and persistence of BFRBs. Some of the environmental factors that may contribute to the worsening of Body-focused repetitive behaviors include:


Stress is usually the core factor that escalates most BFRBs through emotional dysregulation, whereby one finds it hard to handle negative emotions such as anxiety and frustration. One may opt for BFRBs as a coping mechanism to get a hold of their feelings. BFRBs are, therefore, a self-soothing mechanism that helps alleviate stress and gives one a sense of control over their emotions. The stress response becomes habitual over time, and the behaviors become ingrained and consistent, reinforcing their association with stress. Stress and BFRBs are a vicious cycle whereby stress triggers habits such as skin picking, which leads to feelings of guilt and frustration that spikes one's stress levels once again, making it a perpetuating cycle.

Social or Environmental Triggers

Environmental triggers can occur anywhere and are usually a result of boredom, isolation, and being in places where BFRBs are more socially acceptable. Children tend to practice more BFRB when watching TV or using electronic gadgets since their hands are less occupied at that particular time. Furthermore, social situations that include performance pressure may escalate BFRBs since individuals may use these habits to handle the distressing emotions from these social pressures. Social anxieties such as new interactions and public speaking can alleviate stress, leading to adopting BFRBs as a coping mechanism. Other social aspects that exacerbate BFRBs are family dynamics and parental modeling. Children who grow up in homes where BFRBs are normalized are more likely to adopt these habits.

Body Dysmorphic Disorder

Body Dysmorphic Disorder and BFRBs have a direct relationship, seeing as the preoccupation with perceived body flaws often leads to the development of BFRBs as a way of trying to correct some of these perceived flaws. Body Dysmorphic Disorder primarily affects one’s confidence which can lead to stress and anxieties. Additionally, the anxiety that comes with body dysmorphic disorder may also make one adopt BFRBs as a coping mechanism. However, it is essential to note that the relationship between these two conditions varies for every individual. Individuals dealing with body dysmorphic disorders often engage in BFRBs as a way of trying to alleviate their perceived flaws. For example, an individual obsessed with their skin imperfection may pick their skin to try and remove any blemishes. Engaging in BFRBs may temporarily make one feel better about their BDD, resulting in a reinforcement loop whereby the behaviors are escalated by the relief they provide.

Access to Triggering Stimuli

There is usually a wide range of triggering stimuli around us that can exacerbate the adoption of BFRBs, from visual to tactile triggers. Access to these triggers increases the frequency, duration, and intensity in which one engages in these habits. Some tactile triggers that lead to the adoption of BFRBs involve physical sensations like the feeling rough, which can trigger one to pick their skin to try and even it out. Also, access to tweezers and mirrors may increase the urge to address tactile triggers. Visual triggers often occur when one is exposed to mirrors or other reflective objects that allow one to scrutinize their appearance.

Summing Up

The correlation between genetic and environmental factors in the onset and persistency of BFRBs offers a more significant explanation of how these habits occur. While the interplay between the two can be complex and multifaceted, it is essential to understand their effect on the development of BFRBs. Genetic predisposition has been an essential factor in explaining the origin of BFRBS, as some genetic components, specifically those in the neurotransmission system, have been associated with BFRBs. However, if there are no triggers, then one may not have to adopt behaviors such as skin-picking and lip-biting as coping mechanisms. Therefore, environmental triggers also play a vital role in developing these BFRBs. It is essential to acknowledge both of these elements when explaining the development of these behaviors.

Hair Pulling
Skin Picking