Body-focused repetitive behaviors may include any repetitive self-grooming behavior that involves biting, pulling, picking, or scraping one’s own hair, skin, or nails that results in damage to the body. While most people engage in one or some of these behaviors to a certain degree, an individual may want to seek help and support if the behavior begins to limit their life in some way, feels out of control, causes physical damage, or is causing social impact. These repetitive behaviors are not uncommon, yet there is very little empirical data in the scientific literature.
Body-focused repetitive behaviors include any repetitive self-grooming behavior that involves biting, pulling, picking, or scraping one’s own hair, skin, or nails that results in damage to the body.
Some of the BFRBs listed below are not specifically indexed in the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5). They are classified as “other specified obsessive-compulsive and related disorders", with specification of “body-focused repetitive behaviors.”
Hair Cutting (Trichotemnomania)
Is characterized by the compulsive cutting of one's own hair to achieve some visual goal like evenness or visual improvement.
Hair Eating (Trichophagia)
Occurs in approximately 15% of patients with hair pulling disorder or trichotillomania. Eating hair may cause serious medical complications in the form of trichobezoars – hairballs that may form in the stomach or bowel. Bezoars can be life-threatening. If you or your child experiences the following symptoms, it is recommended you seek advice from a medical doctor: feeling sick, vomiting, stomach pain, foul breath, or other symptoms of gastrointestinal problems.
Lip Biting (Lip Bite Keratosis)
Involves the repetitive biting of the skin of one’s own lips.
Nail Picking (Onychotillomania)
Involves the destruction of the fingernails or toenails by means of chronic picking of the nails.
Skin Biting (Dermatophagia)
Often occurs among patients with onychophagia. Skin biting behaviors include biting the cuticles or fingers, and digesting scabs or skin (usually as a result of skin picking disorder). Oftentimes, lip, cheek, and tongue biting are also considered dermatophagia.
Chronic chewing on the tongue, most frequently the sides of the tongue, to the point of damage is a common oral problem and is considered to be a body-focused repetitive behavior (BFRB).
The impact of BFRBs on one's life may be significant. Individuals may experience shame and embarrassment, and as a result, may avoid certain social situations or activities (e.g., pools, gyms, beaches), and medical care. These behaviors can lead to painful isolation and result in a great deal of emotional distress, placing them at risk for a co-occurring psychiatric disorder, such as a mood or anxiety disorder. The most successful management strategies make use of a variety of therapeutic techniques that address actionable emotional and behavioral components. While learning how to manage the behavior, it is important to remember that emotional discomfort that influences the behavior is subjective rather than objective. This realization empowers you to choose how you experience these emotions and enables you to alter your behavior.
Individuals who experience BFRBs often go to great lengths to cover, hide, or camouflage damage to the scalp, skin, nails, and may have difficulty with time management due to the significant time involved in engaging in the behavior as well as efforts to conceal it.
Medical complications as a result of BFRBs are not uncommon and may include physical effects such as pruritus, tissue damage, infection, and repetitive motion injuries to the muscles or joints. Other medical complications can include scabbing, open wounds, discoloration, scarring, or disfigurement, damage to the cuticles and nails, bacterial and viral infection, cellulitis, abscess, injury to the soft tissue lining the mouth, dental problems, temporomandibular dysfunction, and osteomyelitis.
BFRBs can lead to strained relationships with family members and friends. Family members may need professional help to cope with their loved one's behaviors.
Research into treatments for BFRBs, particularly hair pulling and skin picking, has grown steadily over the past decade. Although no one treatment has been found to be effective for everyone, a number of evidence-based treatment options have shown promise for many people.
Choosing a therapeutic provider to support your BFRB journey is a process that takes time. Patience and persistence are key to finding your own level of success.
Medications used for OCD and other anxiety disorders have been tested on subjects with BFRBs with limited success. There has not yet been any single medication or combined medications approved by the Food and Drug Administration (FDA) for the treatment of BFRBs.
Body-focused repetitive behaviors (BFRBs) include any repetitive self-grooming behavior that involves biting, pulling, picking, or scraping one’s own hair, skin, lips, cheeks, or nails that can lead to physical damage to the body and have been met with multiple attempts to stop or decrease the behavior.
Common BFRBs include hair pulling, skin picking, nail biting, and cheek biting. Other body-focused repetitive behaviors include hair eating, nail picking, skin biting, lip biting, tongue chewing, and hair cutting.
For some, the BFRB journey can last a lifetime. For others, their BFRBs wax and wane, with periods of no picking, pulling, or biting. For some, they are able to regulate and stop their behaviors completely.
It's important to remember that this is a very personal, individual journey. No two BFRB journeys are alike. It's up to you to decide how to best manage your BFRBs. Finding space and grace to make good choices for yourself will help you gain clarity on what you want.
Getting connected to community and meeting others on the BFRB journey gives you a variety of perspectives from which to grow. Strive for progress over perfection. You've got this and we've got you!
Research indicates that some people may have an inherited predisposition for skin picking or hair pulling. Several studies have shown a higher number of BFRBs in immediate family members of persons with skin picking or hair pulling disorders than would be expected in the general population. In addition, a recent study examined hair pulling in both identical and fraternal twins and produced results consistent with a significant inherited component in hair pulling disorder. So we can safely say that BFRBs are more than likely inherited, at least to some degree.
Research into treatments for BFRBs, particularly hair pulling disorder and skin picking disorder, has grown steadily over the past decade. Although no one treatment has been found to be effective for everyone, a number of evidence-based treatment options have shown promise for many people.