Body-Focused Repetitive Behaviors are complex for many reasons. There’s no simple motivator behind people performing these behaviors, even when they seem to be causing actual physical harm or emotional damage.
Little research is being done to better understand them. We don’t have an easy solution to stop them.
And at least an estimated 2% of the population may experience them, though the number may be higher due to inconsistencies in self-reporting.
What Are Body-Focused Repetitive Behaviors?
Body-Focused Repetitive Behaviors, or BFRBs for short, are self-directed behaviors that we often do unconsciously and sometimes to the point of obsession.
Common BFRBs include:
- Hair pulling, which includes hair on any part of the body (trichotillomania)
- Skin picking, often to the point of pulling blood (dermatillomania or excoriation)
- Nail biting, which also often leads to bleeding (onychophagia)
- Tooth grinding (bruxism)
- Skin biting (dermatophagia)
- Nose picking (rhinotillexomania)
- Check biting (morsicatio buccarum)
- Joint cracking
BFRBs are sometimes considered a subset of Obsessive Compulsive Disorder (OCD), but in reality many people without OCD can experience them as well.
What Causes These Behaviors?
As noted above, BFRBs are complex and there’s not much research available. They typically start in the early teens and don’t appear to affect any one gender more than others.
Some people may perform these behaviors as a way to alleviate anxiety. When they find themselves in a stressful situation, the BFRB can help them calm down and feel more relaxed.
Other people may perform these behaviors as a mechanism of control because they feel mixed up in chaos in other parts of their lives.
Still other people with BFRBs are looking for sensory stimulation. The minutes or hours they spend engaging in the behavior might just feel good, and it becomes difficult or near impossible to stop.
There also may be a genetic component at hand – if there’s a person with a BFRB in the family, a child or grandchild may be more likely to experience it as well.
How Do These Behaviors Relate to ADHD?
People with ADHD often seek out, sometimes unconsciously, behaviors that make them feel fulfilled, and BFRBs can offer that sensation. These behaviors may have a positive effect on dopamine production and stimulation.
Essentially, when someone with ADHD also experiences a BFRB, they do it because it feels good. Even if it’s causing pain, on some level it brings pleasure as well.
Many people with ADHD also have poor impulse control, and so they lack the ability to stop themselves from performing an action if it brings the smallest amount of satisfaction in the moment – even if the action is causing more harm in a larger sense.
ADHD medication may also cause a BFRB for some ADHDers. Some people with ADHD who take stimulants and nonstimulants alike have reported that they picked up a BFRB that they didn’t have pre-medication.
What’s so Bad About a BFRB?
Some BFRBs, like knuckle or joint cracking, may be overall insignificant if they don’t cause harm and aren’t a source of social embarrassment.
Other BFRBs do cause physical damage and are a source of deep shame.
Hair pulling can lead to bald spots that make the person experiencing the behavior unhappy with their appearance. Cheek biting can cause bleeding and inflammation that makes it difficult to eat. Nose picking can bring with it a stigma of immaturity or childishness.
The “badness” of a BFRB is essentially rooted in how much physical and emotional harm it causes to the person who experiences it. If someone with a BFRB isn’t in pain, doesn’t mind doing it, and it’s not exceptionally bothersome to the people around them, there may be no reason to change the behavior.
What Can We Do About Them?
There’s no specific medication that will stop all BFRBs, but there are some medications that may help curb the impulse based on the motives behind the behavior.
The TLC Foundation for Body-Focused Repetitive Behaviors offers this resource on medications for BFRBs. Some options, like Clomipramine, are typically approved for treatment of OCD. Other medications, like Selective Serotonin Reuptake Inhibitors (SSRIs), are typically used for treatment of depression.
Medication isn’t often an option for BFRBs. One clinical behavioral treatment that has been found effective is Habit Reversal Training (HRT). This type of therapy focuses on five components:
- Awareness of the behavior: When does it occur?
- Competing response: What can I do instead?
- Motivation and compliance: What is my motivation or reason for stopping?
- Relaxation: How do I calm myself down when I’m stressed?
- Generalization: How do I make my new behaviors automatic?
The most important first step to getting help is to know that you’re experiencing a BFRB and you want to stop. It can be emotionally painful to admit it to yourself, and even more difficult to tell another person. But you don’t have to suffer alone. Millions around the world – at least 1 in 50 people – have a BFRB.
If you’re interested in continuing to learn more, check out The TLC Foundation for Body-Focused Repetitive Behaviors. They provide education for clinicians; webinars for the people who experience BFRBs and their family members; outreach for support; and they design and fund research projects aimed at better understanding the root causes of the condition.
BFRBs are difficult to talk about. But my door is always open if you have more questions or want to share your experience!
In no particular order or citation style
- “Body-Focused Repetitive Behaviors (BFRBs)”, https://adaa.org/understanding-anxiety/co-occurring-disorders/body-focused-repetitive-behaviors
- “Hair Pulling! Skin Picking! Nail Biting! Oh, My!”, Roberto Olivardia, Ph.D., https://www.additudemag.com/body-focused-repetitive-behaviors-adhd-depression-anxiety/
- “HABIT REVERSAL TRAINING (HRT)”, https://manhattanpsychologygroup.com/habit-reversal-training-adults/
- “Learn About BFRBs”, https://www.bfrb.org/learn-about-bfrbs
- “Body Focused Repetitive Behaviours”, https://www.anxietycanada.com/disorders/body-focused-repetitive-behaviours/