What are BFRBS?

Body-focused repetitive behaviors (BFRBs) include any repetitive self-grooming behavior that involves pulling, picking, biting or scraping one’s own hair, skin, lips, cheeks, or nails that can lead to physical damage to the body and have been met with multiple attempts to stop or decrease the behavior. BFRBs can be directed at anywhere on the body, especially the scalp, face, limbs and pubic areas. It can be difficult to stop these behaviors! Stress, although not causal, can exacerbate picking and pulling. The course of BFRBS often fluctuate across a lifetime with periods of greater or lesser preoccupation being reported. Although OCD and BFRBs have some overlapping features, these are considered different conditions. 

Causes of BFRBs:

The causes of BFRBs are still being understood and concretized. Research indicates that some people may have an inherited predisposition for BFRBs. Several studies have shown a higher number of BFRBs in immediate family members of individuals with skin picking or hair pulling disorders than would be expected in the general population. So BFRBs are thought to be inherited, to some degree, with other important contributory factors such as age of onset, temperament, and environment interacting with each other to maintain behaviors.

Impact of BFRBs:

The impact of BFRBs can range from mild frustration to significant distress, shame, and embarrassment. These effects can lead to isolation and withdrawal from other activities. There may be social, academic, or occupational impairment. Therefore, BFRBs place individuals at greater risk for co-occurring psychiatric disorders involving anxiety or depression. In addition, picking and pulling pose the potential for medical complications such as tissue damage, infection, and repetitive motion injuries.

• Amplify your personal reasons for tackling your BFRB and making meaningful change in your life.

• Assess for automatic versus focused behaviors which can help differentiate how aware you are of your picking and pulling.

• Identify the specific triggers and antecedents that precede picking or pulling as well as the sensory gains that are achieved. (ie: sensations, thoughts, feelings, physical positions and environments that cue you to pick or pull.)

• Explore urges to engage in your BFRB and how to become more confident in moving through them. 

• Employ elements of the ComB model to develop more accurate thinking, learn to relax, replace sensory experiences, and reduce triggers.

• Teach habit reversal strategies, which are behavioral actions that physically compete with a BFRB or are incompatible with the existing behavior. 

• Practice Harm Reduction to reduce or minimize physical harm to the body. This is especially important when an individual uses tools to pick or pull.

• Address anxiety or mood symptoms associated with a BFRB. 

• Stop the fighting against inner experiences that lead to the BFRB by learning cognitive defusion and acceptance.

• Emphasize compassion and self-care.

• Help you to reclaim time back that you have thus far dedicated to picking or pulling.

• Work consistently toward improving your quality of life so you can participate more fully in what is important to you!

• Incorporate CBT, ACT, MI, ERP, Behavior Change, Harm Reduction, and Mindfulness