Diagnosis and Treatment
Choosing a therapeutic provider to support your BFRB journey is critically important. Finding the right fit may take time, so knowing what you want to achieve from therapy is a good first start.
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 behavior.”
Hair pulling disorder or trichotillomania (trick-o-till-o-may-nee-uh) (TTM or “trich”) is characterized by the repetitive pulling out of one's hair. Hair pulling disorder is one of a group of behaviors known as body-focused repetitive behaviors (BFRBs) and are technically classified as Obsessive-Compulsive and Related Disorders. BFRBs can be thought of as self-grooming behaviors in which individuals pull, pick, scrape, or bite their hair, skin, or nails, resulting in damage to the hair or body. Hair pulling can occur on any part of the body that grows hair.
Research indicates that approximately 1 or 2 in 50 people experience hair pulling disorder in their lifetime. Hair pulling disorder usually begins in late childhood/early puberty, and occurs about equally in boys and girls. By adulthood, 80-90% of reported cases are women. Hair pulling varies greatly in its severity, location on the body, and response to treatment. Without treatment, hair pulling disorder tends to be a chronic condition; it may come and go throughout a lifetime.
Skin picking (excoriation), is characterized by the repetitive picking of one’s own skin. Individuals who struggle with this disorder touch, rub, scratch, pick at, or dig into their skin in an attempt to improve perceived imperfections, remove rough patches/scabs, smooth areas, or accomplish some goal. Skin picking often results in tissue damage, discoloration, or scarring.
Occasional picking at cuticles, acne, scabs, calluses, or other skin irregularities is a very common human behavior; however, research indicates that approximately 2%- 5% of the population picks their skin to the extent that it causes noticeable tissue damage and marked distress or impairment in daily functioning. An estimated 75% of people experiencing skin picking disorder are female. The behavior typically begins in early adolescence, although skin picking disorder can begin at any age. Without treatment, skin picking disorder tends to be a chronic condition that may wax and wane over time.
Nail biting or onychophagia involves damage to fingernails by means of habitual biting. Although not specifically indexed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), nail biting is currently classified under Obsessive-Compulsive and Related Disorders in the DSM-5 and is considered to be a body-focused repetitive behavior.
Chronic cheek biting (morsicatio buccarum) is a compulsive behavior whereby an individual repeatedly bites the inside of their cheek, causing damage to the tissue. This behavior may result in ulcerations, sores, and infections within the oral tissue.
Furthermore, repetitive biting in a target area typically leads to the development of white patches of keratosis– a callus-like formation. Cheek and lip biting are estimated to occur in approximately 3% of U.S. adults, with more than half of individuals reporting childhood onset. Similar to skin picking (excoriation) and hair pulling (trichotillomania), chronic cheek biting is classified as Other Obsessive-Compulsive and Related Disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).