Understanding and Treating Chronic Cheek Chewing

Body-Focused Repetitive Behaviors (BFRBs), such as chronic cheek chewing (morsicatio buccarum), can be challenging for those who experience them and for their loved ones who want to help. This behavior may be triggered by stress or boredom or stem from a need for sensory stimulation. Over time, it can result in physical discomfort and emotional frustration, along with a sense of helplessness.

If you or someone you care about is struggling with cheek chewing, know that you are not alone. Effective strategies exist to address this condition. While improvement requires patience, there is real hope in scientifically supported treatments.

Recognizing Cheek Chewing as a BFRB

Chronic cheek chewing is a subset of BFRBs—behaviors involving repetitive, self-directed physical actions that may result in harm or discomfort. Like nail biting or skin picking, cheek chewing is often an automatic response to emotional or situational triggers. While these behaviors are not uncommon, they can be challenging to manage without guidance and support.

Acknowledging the complexity of this behavior is the first step toward healing. Cheek chewing isn’t simply a bad habit or lack of willpower—it’s a complex interaction of neurological, psychological, and emotional factors. Recognizing this can help reduce the stigma and frustration surrounding the behavior, creating space for productive, evidence-based solutions.

Evidence-Based Treatments for Chronic Cheek Chewing

Successfully managing cheek chewing often involves exploring various BFRB treatment options, including therapeutic approaches and professional intervention. Here are the key strategies supported by research:

Cognitive Behavioral Therapy (CBT)

CBT is one of the most well-established treatments for BFRBs, including cheek chewing. This therapy identifies thought patterns and beliefs contributing to the behavior and replaces them with healthier alternatives. For example, individuals might learn to challenge automatic thoughts such as “I can’t stop” and develop a more constructive perspective like “I can try different strategies to reduce this behavior.”

Habit Reversal Training (HRT)

HRT is a structured approach that has proven highly effective for many BFRBs. It includes awareness training to recognize moments when cheek chewing occurs, competing response training to develop alternative behaviors (such as chewing sugar-free gum or holding an object for sensory focus), and motivation building to reinforce the importance of change.

The Role of Mental Health Professionals

Mental health professionals specializing in BFRBs are essential partners in managing chronic cheek chewing. Therapists with expertise in evidence-based approaches like CBT and HRT can provide tailored guidance and help individuals navigate challenges specific to their experience. In some cases, therapists may also integrate relaxation techniques or mindfulness strategies to address underlying stressors.

Seeking professional help can make a significant difference, particularly when the behavior feels overwhelming or difficult to manage alone. An experienced therapist can provide practical strategies and emotional support while fostering a sense of control and well-being.

Coping Strategies for Daily Life

Developing effective BFRB coping strategies is an important part of managing cheek chewing. These practical approaches can help address triggers and reduce the likelihood of engaging in the behavior. While these methods alone may not eliminate cheek chewing, they can be valuable tools in the broader treatment process.

For example, tracking patterns by keeping a small notebook or using an app can reveal common situations or emotions that lead to cheek chewing. Safe, sensory substitutes, such as sugar-free gum or crunchy vegetables, can satisfy the urge without causing harm. Stress management techniques, including deep breathing and progressive muscle relaxation, can help mitigate emotional triggers.

Setting specific goals, like creating “chewing-free zones” at work or in social settings, also encourages mindfulness and allows space to practice alternative responses.

When to Seek Professional Help

While self-guided strategies can be effective, there are times when professional support is essential. Consider reaching out to a mental health professional if:

1. The behavior causes physical harm or pain.

2. Attempts to reduce the behavior lead to frustration or feelings of failure.

3. Emotional or mental health challenges, such as anxiety or depression, accompany cheek chewing.

4. The behavior interferes with daily life, relationships, or self-esteem.

Early intervention can prevent escalation and provide the tools needed to regain control.

Finding Hope and Support

Whether you’re struggling with chronic cheek chewing yourself or supporting someone who is, it’s important to remember that effective help is available. BFRBs like cheek chewing can be managed with the right combination of strategies and professional guidance.

If you're ready to take the next step, consider joining a peer-led BFRB support group or connecting with a mental health professional specializing in BFRBs. Trusted organizations also offer additional resources and guidance. Recognizing the behavior and seeking support are signs of strength, not weakness.

For those supporting someone with BFRBs, your patience and encouragement can make a tremendous difference. Simply listening without judgment and offering support can create a foundation for change

Together, individuals and their support systems can work toward meaningful improvement—one small step at a time.