What Are BFRBs?
Body-Focused Repetitive Behaviors (BFRBs) are self-grooming behaviors—like pulling, picking, biting, or scraping—that can cause physical damage. These behaviors often target areas like the hair, skin, lips, nails, or cheeks and tend to be repeated despite attempts to stop. You may have heard of Trichotillomania (hair-pulling) and Excoriation Disorder (skin-picking).
BFRBs may be triggered by emotional states (like anxiety or boredom), attempts to fix perceived flaws, or the need for sensory stimulation. Around 3% of people experience them. Though they cause harm, BFRBs are not self-harm—they serve to soothe or regulate, not to cause pain.
People may engage in BFRBs consciously (“focused”) or unconsciously (“unfocused”). Focused BFRBs happen with awareness and intent, often tied to an urge. Unfocused BFRBs happen more automatically, like biting nails or picking skin while distracted.
How Therapy Helps
BFRBs are chronic but treatable. Therapy can help increase awareness, manage emotional triggers, and replace behaviors with healthier coping strategies. The most effective treatments are evidence-based and include:
- Habit Reversal Training (HRT)
- Comprehensive Behavioral Treatment (ComB)
- Acceptance and Commitment Therapy (ACT)
- Dialectical Behavioral Therapy (DBT)
Integrative Behavioral Therapy (IBT) utilizes the essential elements from the treatments listed above and the Transtheoretical Model.
Key therapy components include:
- Self-monitoring: Tracking when, where, and why behaviors happen to identify patterns.
- Functional analysis: Exploring emotional, physical, or situational triggers.
- Cognitive strategies: Challenging unhelpful thoughts and experimenting with new coping tools.
- Mindfulness: Building awareness of urges before acting.
- Stimulus control: Changing environments or using tools like fidget items or the HabitAware bracelet to interrupt the behavior cycle.
BFRBs and OCD
Though related to OCD, BFRBs are different. OCD involves obsessions and compulsions done to avoid feared outcomes. BFRBs typically don’t involve obsessive thoughts and often feel soothing in the moment rather than distressing.
Finding the Right Support
Look for a therapist trained in treating BFRBs using CBT, ACT, ComB, or HRT. Ask:
- What’s your experience with BFRBs?
- Do you use evidence-based approaches like HRT or IBT?
We recommend The BFRB Recovery Workbook: Effective Recovery from Hair Pulling, Skin Picking, Nail Biting and Other Body-Focused Repetitive Behaviors by Marla Deibler, PsyD & Renae Reinardy, PsyD as a self-directed guide or to use with therapist assistance.
Support groups can also be helpful:
You’re not alone—BFRBs are more common than you think, and support is available. With the right tools, change is possible.
Ashley Rush is a provisionally licensed professional counselor in Lafayette, Louisiana who is currently serving as Vice President of OCD Louisiana and has been a member of the affiliate’s board of directors since 2021. In her free time, Ashley enjoys collecting mid-century decor and hanging out with her greyhound.