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Body-Focused Repetitive Behaviors (BFRBs)
Body-focused repetitive behaviors (BFRBs) are a cluster of common but often misunderstood conditions involving repetitive behaviors focused on the body that can lead to physical damage. Think of them as intense urges to bite, pick, pull, or scrape at oneself, often resulting in unintentional harm that can be difficult to stop.
What are Body-Focused Repetitive Behaviors (BFRBs)?
Body-Focused Repetitive Behaviors are repetitive actions that damage the skin, hair, or nails. They include a variety of specific conditions, the most common being:
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Trichotillomania: This is the compulsive pulling out of one's own hair, often from the scalp, eyebrows, or eyelashes.
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Dermatillomania (Skin Picking Disorder): This involves repeated picking at the skin, often resulting in sores, scabs, or scars.
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Onychophagia: Chronic nail-biting, which can lead to damaged nails and surrounding skin.
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Excoriation: Constant scratching or picking at the skin, often leading to infection or scarring.
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Lip or Cheek Biting: Repetitive biting of the inner lips or cheeks, causing sores or damage to the mouth lining.
These behaviors are often triggered by feelings of anxiety, stress, or discomfort, and the action itself provides a sense of relief, even if the individual doesn’t consciously realize why they are doing it. BFRBs are classified under the larger category of obsessive-compulsive and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Who is Affected by BFRBs?
BFRBs affect an estimated 2-4% of the population, but these numbers may be higher due to underreporting. Many individuals with BFRBs feel embarrassed or ashamed and may try to hide their condition. The onset of BFRBs often occurs in adolescence, though they can develop at any stage of life.
Both men and women experience BFRBs, though certain behaviors like trichotillomania tend to be more common in women. These conditions may persist into adulthood and can have a significant impact on a person’s quality of life, affecting their self-esteem, relationships, and even career.
What Causes BFRBs?
The exact cause of BFRBs is still unknown, but researchers believe that a combination of genetic, environmental, and psychological factors contributes to the development of these behaviors.
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Genetics: Studies suggest that BFRBs may run in families. People with a family history of obsessive-compulsive disorder (OCD) or other anxiety disorders may be more likely to develop BFRBs. Specific gene mutations have also been linked to an increased risk of BFRBs.
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Neurological Factors: Some researchers believe that BFRBs may be related to how the brain processes habits and impulse control. There is evidence suggesting that individuals with BFRBs may have differences in brain regions associated with decision-making, emotional regulation, and motor control.
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Stress and Emotional Regulation: BFRBs are often a response to emotional stress or discomfort. For many individuals, these behaviors provide a coping mechanism for dealing with anxiety, boredom, or emotional numbness. Unfortunately, while the behavior may offer temporary relief, it often leads to feelings of guilt or shame afterward.
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Environmental Triggers: Certain environmental factors, such as trauma, significant life changes, or ongoing stress, can increase the likelihood of developing BFRBs. For instance, skin picking may become more frequent during periods of heightened stress or anxiety.
Symptoms of BFRBs
The symptoms of BFRBs vary depending on the specific condition, but common signs include:
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Noticeable damage to hair, skin, or nails: This can include bald patches, wounds, scabs, scars, or calluses.
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Inability to stop or control the behavior: Even when the person recognizes the harm being caused, they feel powerless to stop.
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Time spent engaging in the behavior: Individuals with BFRBs may spend hours each day pulling, picking, or biting.
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Embarrassment or shame: Many people with BFRBs go to great lengths to hide their behaviors, wearing hats, wigs, or long sleeves, or avoiding social situations.
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Emotional distress: The compulsive nature of the behavior, combined with the physical damage it causes, can lead to feelings of guilt, frustration, and low self-esteem.
The Impact of BFRBs on Daily Life
Body-Focused Repetitive Behaviors can severely impact an individual’s physical and mental health. The visible physical damage, such as bald spots from hair pulling or scars from skin picking, can lead to feelings of embarrassment and isolation. Many individuals avoid social situations, romantic relationships, or even work opportunities due to the condition.
In addition to physical harm, BFRBs can cause emotional distress. The compulsion to engage in the behavior, despite knowing it’s harmful, can lead to feelings of shame and frustration. Over time, the individual may experience low self-esteem, depression, or anxiety, exacerbating the cycle of compulsive behavior.
Treatment Options for BFRBs
The good news is that treatment options are available, and with the right support, individuals with BFRBs can manage their behaviors and improve their quality of life.
1. Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy is one of the most effective treatments for BFRBs. A specific type of CBT, called Habit Reversal Training (HRT), is commonly used. HRT involves several components:
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Awareness Training: Helping the individual become more aware of when and where the behavior occurs.
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Competing Response Training: Teaching alternative behaviors that are incompatible with the BFRB, such as clenching fists or using a fidget toy.
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Motivation: Encouraging the person to stay motivated and track their progress.
2. Medication
In some cases, medication may be prescribed to help manage underlying anxiety, depression, or obsessive-compulsive tendencies that contribute to BFRBs. Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, are sometimes used.
3. Mindfulness and Acceptance-Based Therapies
Mindfulness-based approaches help individuals become more aware of their urges and create space between the urge and the action. Acceptance and Commitment Therapy (ACT), for example, focuses on accepting the presence of urges while committing to actions that align with one’s values and goals.
5. Support Groups
Many individuals with BFRBs find it helpful to join support groups, either in person or online, where they can connect with others who understand their struggles. These groups provide a sense of community and reduce the feelings of isolation that often accompany BFRBs.
Conclusion
Body-Focused Repetitive Behaviors are complex and can be challenging to manage, but with the right combination of therapy, support, and self-care, individuals can reduce their symptoms and regain control over their lives. If you or someone you know is struggling with a BFRB, it’s important to seek professional help. At Night Owl Psychotherapy, we specialize in providing compassionate, expert care for those dealing with BFRBs, helping individuals understand the root causes of their behaviors and guiding them toward healthier coping strategies.
By increasing awareness and reducing the stigma around BFRBs, we can ensure that those affected feel understood, supported, and empowered to seek help.
If you’d like to learn more about our approach to treating Body-Focused Repetitive Behaviors or to book a consultation, please contact us at Night Owl Psychotherapy today.
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