Founded in 1991, The TLC Foundation for Body-Focused Repetitive Behaviors is a health-related human services organization dedicated to supporting the 1-in-20 individuals experiencing body-focused repetitive behaviors (BFRBs) through advocacy, awareness, connection, health education, celebration, and equitable access to effective evidence-based treatments.

Heart is at the center of everything we do – please join us to achieve our vision of a world where:

Body-Focused Repetitive Behaviors (BFRBs) are diagnosed quickly.
Body-Focused Repetitive Behaviors are widely known and understood in the general community.
BFRBs are not a source of shame.
Isolation is lessened.
Equitable, effective treatment is available to all people experiencing BFRBs.
Health education information and resources are readily available to people experiencing BFRBs and their families.

About the TLC Foundation for BFRBs

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What other behaviors are associated with BFRBs?

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.”

What is nail biting?

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.

What is cheek biting?

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).

What is skin picking or excoriation?

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.

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What treatment options are available for BFRBs?

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.

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