Body-focused repetitive behaviors (BFRBs) are common repetitive actions, like hair pulling or skin picking, that can range in severity from mild to severe.

Do you find yourself repeatedly biting the inside of your cheek, picking at your skin, or cracking your knuckles? These behaviors could be signs of body-focused repetitive behaviors (BFRBs).

Although these habits are quite common and usually not a big deal, they can sometimes get out of hand, causing harm.

Let’s take a closer look at some of the most common types of BFRBs and the available treatments to address them.

Body-focused repetitive behaviors (BFRBs) are a group of conditions in which individuals repeatedly engage in self-grooming or self-destructive actions, such as:

  • hair pulling
  • skin picking
  • nail biting
  • lip or cheek biting

These behaviors are often linked to mental health conditions like anxiety, depression, and obsessive-compulsive disorder (OCD).

A study of 4,335 college students suggests that BFRBs are quite common. More than half of people surveyed said they sometimes engage in these behaviors but not enough to get diagnosed with a disorder.

About 12% had more serious BFRBs that met the diagnostic criteria.

Both the mild and more severe forms of BFRBs tended to be chronic, but few sought help despite experiencing distress.

Types of body-focused repetitive behaviors

  • Cheek or lip biting: Habitual biting of the cheeks or lips, sometimes causing sores or injuries. Cheek biting was found to be the most common BFRB in this research study.
  • Trichotillomania (hair pulling): Pulling hair from the scalp, eyebrows, or other parts of the body.
  • Dermatillomania (skin picking): Repeatedly picking at the skin, often to the point of causing wounds.
  • Onychophagia (nail biting): Biting or chewing nails, sometimes leading to bleeding or infection.
  • Bruxism (teeth grinding): Clenching or grinding teeth, usually during sleep but can also occur while awake.
  • Finger sucking: Sucking on one or more fingers, often for comfort.
  • Finger cracking: Intentionally causing a cracking sound in finger joints.

A 2022 review suggests that the following factors may contribute to the development and manifestation of BFRBs:

  • impulse control difficulties
  • compulsive behaviors to regulate anxiety or emotions
  • risk factors such as advanced age
  • female gender
  • family history of BFRBs
  • history of OCD
  • history of alcohol or substance misuse
  • impulsive personalities
  • high rates of neuroticism
  • high prevalence of OCD in individuals with BFRBs and their relatives

An association with OCD may also suggest a potential common genetic background between OCD and BFRBs.

A large study suggests that compulsivity significantly impacts disability and quality of life in individuals with BFRBs.

This suggests that addressing compulsivity may be key to improving outcomes for those affected by BFRBs.

Can BFRBs impact your life?

The impact of BFRBs on your life can vary widely. Research indicates that the following factors can contribute to how much these behaviors affect you:

  • the severity of picking
  • stress levels
  • other mental health disorders
  • impulsivity
  • family history

Seeking treatment that addresses these factors, not just the behaviors themselves, may lead to better outcomes.

Here are treatments commonly used for BFRBs:

  • Habit reversal training (HRT): A behavioral therapy that helps individuals become more aware of their BFRB habits and learn alternative behaviors to replace them.
  • Decoupling: This approach involves breaking the association between the trigger, such as a feeling or situation, and the behavior. It allows individuals to respond differently to the trigger.
  • Cognitive behavioral therapy (CBT): CBT helps individuals identify and change negative thought patterns and behaviors associated with BFRBs.
  • Acceptance and commitment therapy (ACT): ACT focuses on accepting urges and learning to live in the present moment without acting on BFRBs.
  • Medications: While no specific medication is approved for BFRBs, some individuals may benefit from antidepressants, such as selective serotonin reuptake inhibitors (SSRIs). Or N-acetylcysteine (NAC) may be prescribed as a glutamate modulator.
  • Comprehensive behavioral treatment for trichotillomania (CBTT): CBTT is a specialized form of CBT tailored specifically for trichotillomania.
  • Dialectical behavior therapy (DBT): DBT helps individuals regulate emotions and develop coping skills to manage urges associated with BFRBs.
  • Mindfulness-based therapies: Mindfulness techniques such as meditation and yoga can help individuals become more aware of their urges and learn to manage them.

A large 6-week study suggests that combining different behavioral treatments for BFRBs can be more effective than using a single technique.

The study found that starting with decoupling showed additional benefits for depressive symptoms and quality of life.

A 2022 review suggests that NAC shows promise in treating BFRB disorders like:

  • trichotillomania
  • excoriation disorder
  • onychophagia

But more extensive and longer-term studies are needed to establish its effectiveness conclusively.

BFRBs are a group of repetitive, self-induced behaviors that result in damage to the body. These behaviors often serve as coping mechanisms for stress, anxiety, or other negative emotions.

Examples include:

  • hair pulling
  • skin picking
  • nail biting
  • cheek biting

BFRBs are often challenging to control and can significantly impact a person’s physical and emotional well-being.

If you’re living with BFRBs, and it’s affecting your life, consider reaching out to a healthcare professional to discuss your treatment options.