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What are Body-Focused Repetitive Behaviors (BFRBs)?

September 30, 2020
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Posted by Kate Gibson, PsyD, ABPP

Ever heard of Trichotillomania or Excoriation? What are Body-Focused Repetitive Behaviors (BFRBs)? They are explained here in honor of BFRB Awareness Week October 1st-7th, 2020

You may have heard some of these terms before but been unsure what they are really about. Or maybe they are completely new to you and sound quite complicated. We have all seen someone bite their nails, twirl their hair, or maybe chew on their cheeks or lips… Although seeing this is common, for some people, it is harder for them to stop these behaviors and it may become more problematic.   

Here is an explanation of Body-Focused Repetitive Behaviors (BFRBs) adapted from the TLC Foundation for Body-Focused Repetitive Behaviors (https://www.bfrb.org/). Some children and adults engage in repetitive behaviors that fall under the category of self-grooming and involve doing something to their bodies that causes damage. These behaviors become habits and can be exacerbated by stress. Many times people are not aware they are doing it, and need help noticing when it occurs. There are often triggers happening inside the person or in the setting around the person that may not have been identified as triggers yet. The symptoms cause emotional distress and have physical effects. This can be a persistent condition that worsens and improves at various times throughout a person’s life.  

BFRBs occur in both boys and girls, but in adulthood are more common in women.  

For kids the MOST COMMON types of BFRBs are:
 
Skin Picking (Excoriation) Disorder: Involves repetitively touching, rubbing, scratching, picking at, or digging into their skin, resulting in skin discoloration or scarring.
 
Hair-Pulling Disorder (Trichotillomania): Involves pulling out the hair from their scalp, eyelashes, eyebrows, and other parts of the body, and may behind leave patches without hair.
 
Nail-biting Disorder (Onychophagia): Involves biting their nails past the nail bed and chewing on cuticles until they hurt themselves, which may lead to soreness and infection.
 
Some other BFRBs are: cheek and lip biting, nail picking, scab eating.
 
How do you know when it’s a problem?
 
Body-focused behaviors are considered problematic for children when they are happening repeatedly over time and they result in negative physical, social, or emotional consequences.
 
Good news, there is help!!
 
Treatments such as cognitive behavioral therapy (CBT) or a form of behavioral therapy called Habit Reversal Training (HRT) have been shown to be very helpful for children with body-focused repetitive behaviors! HRT involves building motivation to change the behavior and building substitute behaviors to replace the unhelpful BFRB. 

Often times kids need help bringing attention to when they are doing the behavior. This can be a gentle reminder from a parent at home or a teacher at school. Having something tactile to fidget with helps the child do something else with their hands, which allows them to work on changing the behavior. 
 
You can find more information and resources at:  

https://www.bfrb.org/ 

https://adaa.org/body-focused-repetitive-behaviors 

https://www.stoppulling.com/ 

https://www.stoppulling.com/ 

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Kate Gibson, PsyD, ABPP

Kate Gibson, PsyD, ABPP is a licensed clinical psychologist specializing in the treatment of anxiety, trauma, obsessive-compulsive disorder (OCD), body-focused repetitive behaviors (BFRBs), and behavioral problems. Dr. Gibson also has a subspeciality in Selective Mutism. Dr. Gibson is board certified in Clinical Child and Adolescent Psychology by the American Board of Professional Psychology. Dr. Gibson ... Read full bio
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What are Body-Focused Repetitive Behaviors (BFRBs)? | Kurtz Psychology