What is body-focused repetitive behavior?

BFRBs are compulsive behaviors focused on the body, such as nail biting or skin picking. A person usually engages in the same behavior repeatedly, sometimes despite pain or injury.

People with BFRBs do not engage in the behaviors due to concerns about their appearance. Instead, the behavior is a habit that can feel compulsory or unconscious. In most cases, a person uses the habit to relieve anxiety and tension.

People with BFRBs they find hard to stop may meet the criteria for BFRB disorder, which is a distinct mental health diagnosis. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) classifies it under the heading of “Other obsessive-compulsive disorders.”

However, milder forms of these behaviors are common and do not necessarily indicate a mental illness. Many people engage in BFRBs occasionally when they feel anxious. For instance, a person might bite their nails while waiting to give a speech or twirl their hair when they are anxious at the doctor’s office.

In a 2018 study, 59.55% of participants reported occasionally engaging in at least one BFRB, and 12.27% met the criteria for a BFRB disorder diagnosis.

Some BFRBs examples include:

• nail biting
• nose picking
• skin picking, such as pulling on scabs or popping pimples
• pulling out hair on the body, head, eyelashes, or eyebrows
• chewing the inside of the cheek or the tongue
• chewing or biting the skin

Some of these compulsive behaviors have clinical names in the DSM-5-TR. This includes trichotillomania, which is compulsive hair pulling, and excoriation disorder, which is compulsive skin picking.

However, BFRBs only become a medical diagnosis if they interfere with a person’s life or health.

BFRB disorder is a mental health condition in itself. However, it has links with other anxiety disorders, such as:

OCD

OCD is an anxiety disorder that causes a person to engage in compulsions or rituals to relieve anxiety from intrusive thoughts.

Intrusive thoughts are sudden and scary thoughts or images that seem to come from nowhere, causing fear and an urge to do something to ease the anxiety. This can include BFRBs.

For example, a person may worry that they have skin cancer. Skin checking or skin picking may be part of how they respond to this fear.

GAD

GAD causes chronic anxiety about a range of things, sometimes for no apparent reason. A person may develop compulsive behaviors to deal with anxiety, including BFRB.

Trichotillomania

Trichotillomania is a specific subtype of BFRB disorder that causes a person to compulsively pull out their hair. They may pluck hair from their head, eyelashes, eyebrows, or elsewhere on their body. Doing so may relieve anxiety but also cause pain and hair loss.

Excoriation disorder

Excoriation disorder is another subtype of BFRB. It causes people to pick at their skin, often to the point of serious injury or bleeding.

Treatment for BFRB focuses on treating the underlying anxiety that is causing the compulsive behavior. This may include talk therapy, such as cognitive behavioral therapy, to help someone reframe anxious thoughts and find healthier ways of managing emotions.

It may also include antidepressants, such as selective serotonin reuptake inhibitors, to reduce anxiety symptoms. However, the Food and Drug Administration (FDA) has not approved any specific drugs for BFRBs.

Another option is glutamatergic drugs. These are substances modulate glutamate and aspartate, which are chemicals that “excite” brain cells. This may play a role in anxiety, particularly OCD. N-acetyl cysteine (NAC) is an amino acid that doctors can prescribe to regulate glutamate.

Some self-help strategies that may help a person manage BFRB include:

• Behavior blocking: This involves creating barriers that reduce the risk of injury or cause a person to pause before engaging in the behavior. For example, a person might wear gloves to make it more difficult to bite their nails, tie their hair up to prevent hair pulling, or wear a mouth guard to prevent cheek chewing.
• Stimulation substitute: Next, consider replacing the habit with something else, such as playing with a fidget blanket, squeezing a stress toy, chewing gum, or ripping paper. People can also try hobbies that occupy the hands.
• Identifying triggers: Try to notice when and in what situations the urge to engage in the behavior arises. People may find it helpful to keep a journal to note any frequent triggers.
• Mindfulness: To manage BFRBs long term, becoming mindful of when the behavior happens is key. When the urge arises, pause and observe how it feels. People may find it helpful to ask themselves what their body wants and find an alternative way of meeting that need. For example, instead of picking skin due to anxiety, a person might hug a pillow.

People with BFRBs can feel embarrassment or shame about their behavior, which may deter them from speaking with a doctor or therapist. However, support is available.

Consider treatment for BFRB if the behaviors interfere with daily life or if they are hard to stop. A person should also seek medical care if they have injuries to prevent an infection.

BFRBs are a way to cope with psychological distress. They include behaviors such as skin picking, nail biting, and hair pulling.

Mild BFRBs are common, but when these behaviors interfere with a person’s daily life, they can become harmful. People can find them difficult to stop, and they can result in injuries or pain.

BFRBs are a sign of anxiety or stress, but support is available. Treatment can help a person to live a happier, healthier life. If a person is concerned about BFRB, they should contact a doctor or psychotherapist.