BFRBs are often described as a cousin to OCD, but there are enough differences between the two that they are treated differently. Currently, hair pulling and skin picking are classified as Obsessive-Compulsive and Related Disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
Body-focused repetitive behaviors are distant cousins to OCD. Although individuals with BFRBs engage in repetitive, seemingly compulsive behaviors, there are enough differences between BFRBs and OCD to suggest that these are different disorders. First, BFRBs are treated with cognitive behavior therapy that is function-based, while OCD is treated with exposure and response prevention. Second, BFRB behaviors do not respond to the same medications that work well for OCD. Third, OCD involves obsessions that increase anxiety and compulsions that then reduce that anxiety, at least temporarily. People with BFRBs do not report having obsessions such as “If I don’t pull out this hair, something bad will happen/someone will die,” instead, they report that pulling/picking serves to reduce a number of negative sensations, cognitions, emotions, and serves a self-regulating function. Finally, people with BFRBs often like their pulling/picking and often do not want to let go of it, while people with OCD cannot stand their rituals, yet they feel compelled to perform them.