
(Trichotillomania) causes people to pull out the hair from their scalp, eyelashes, eyebrows, and other parts of the body resulting in noticeable bald patches. Approximately 5-20% of people who have hair pulling disorder also swallow the hair.

(Excoriation) causes people to repetitively touch, rub, scratch, pick at, or dig into their skin, resulting in skin discoloration, scarring, and even severe tissue damage and disfigurement.

(Onychophagia) causes people to bite their nails past the nail bed and chew on cuticles until they bleed, leading to soreness and infection.

Often referred to as "cheek chewing," chronic cheek biting can result in a myriad of complications. Redness, painful sores, and tears can occur in the mucosa, which is the inner lining of the mouth.

Frequently include cheek and lip biting, nail picking, scab eating, and other self-grooming-related behaviors.

BFRBs are among the most poorly understood, underdiagnosed, and untreated group of mental health disorders. Research suggests that causes of BFRBs include improving or correcting an imperfection in physical appearance, in addition to self-regulation of intense emotions. Several studies have shown a higher number of BFRBs in immediate family members of persons with skin picking or hair pulling than would be expected in the general population. BFRBs are not self-harm.

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).
Some people assume that hair pulling, skin picking, nail biting, cheek biting, and associated behaviors are signs of some unresolved issue or problem that needs to be addressed, including past trauma. There is no evidence supporting the belief that BFRBs are associated with past trauma or are caused by past trauma. BFRBs are also not a form of self-harm.
BFRBs are common behaviors rarely discussed in the general public. It is estimated that 3% of the world’s population experience BFRBs. Due to the shame associated with hair pulling, skin picking, nail biting, cheek biting, and other associated behaviors, they often go unreported, undiagnosed, and misdiagnosed. If prevalence estimations are correct, if you put every person with a BFRB in one place, their population would be larger than the country of Brazil.
Although BFRBs can cause damage to the body, the goal is quite different than that of people who engage in self-harming behaviors. Self-harm (cutting, scratching, burning, etc.) is done with the goal of intentional harm to one’s body in an attempt to reduce the sensation of emotional pain or to manifest physical pain to drown out emotional pain. Alternately, BFRB behaviors are, for many people, self-regulating and serve some internal need. Many people who engage in BFRBs report that they are pleasurable, that they help them in some way, or that they help them to achieve some goal (symmetry or smoothness). When a person engages in their BFRB, physical damage is created as a result of their behavior but is an unintentional result of their repetitive behavior.
BFRBs are not self-harm. BFRBs are not caused by trauma.


Body-focused repetitive behaviors are complex, multidimensional problems that require a multidimensional approach. Learning to understand the function of a BFRB, emotional and physical triggers to the behavior, and having a toolbox of strategies for working through triggers and urges are crucial components of success. The articles below offer various approaches and tips to help you or your loved one on the path to recovery.