Understanding Body-Focused Repetitive Behaviors (BFRBs): Symptoms, Causes, and Treatment Options 

Many people have habits like biting their nails or picking at their skin, but for some, these actions become hard to control and can cause real problems. These are called body-focused repetitive behaviors (BFRBs). BFRBs are repetitive body-focused behaviors such as hair pulling (trichotillomania), skin picking (dermatillomania or excoriation disorder), and nail biting (onychophagia). People with BFRBs often feel a strong urge to engage in these behaviors, even if they want to stop or know it’s causing harm. BFRBs can lead to physical damage, embarrassment, and emotional distress, making everyday life more difficult. In this blog, we’ll explore what body-focused repetitive behaviors are, everyday examples, why they happen, and the best treatment options for those who want help managing these challenging habits.  

What Are Body-Focused Repetitive Behaviors (BFRBs)?  

Body focused repetitive behaviors (BFRBs) are repeated actions where a person damages or alters their body, often without fully realizing it. These behaviors include things like pulling out hair (trichotillomania), picking at skin (dermatillomania or excoriation disorder), and biting nails (onychophagia). While many people might occasionally bite their nails or pick at their skin, BFRBs become a problem when they happen so often that they cause physical harm, distress, or interfere with daily life. People with BFRBs may feel tension or anxiety before the behavior and relief afterward, but they often struggle to stop, even if they want to. BFRBs are not just bad habits; they are considered related to obsessive-compulsive disorders and can seriously impact self-esteem and well-being.  

Examples of Body-Focused Repetitive Behaviors (BFRBs) 

There are several types of body-focused repetitive behaviors (BFRBs), each with its own unique challenges. Some of the most common examples include hair pulling, skin picking, and nail biting. These repetitive body focused behaviors can cause both physical harm and emotional distress, but understanding each one can help people recognize the signs and seek support. 

• Trichotillomania: Trichotillomania is when a person cannot resist the urge to pull out their hair, often from the scalp, eyebrows, or eyelashes. This hair pulling can lead to bald patches and feelings of shame or low self-esteem. People with trichotillomania may pull hair in response to stress or without even realizing it, and they often feel relief after pulling.  

• Dermatillomania: Dermatillomania, also known as excoriation disorder or skin picking disorder, involves repeatedly picking at the skin, sometimes until it bleeds or causes scarring. People may pick at healthy skin, scabs, or pimples, usually on the face, arms, or hands. This behavior can result in infections, scars, and emotional distress, and it can be difficult to control. 

• Onychophagia: Onychophagia is the clinical term for chronic nail biting. People with onychophagia bite their nails so often that it can cause damage to the nails, surrounding skin, and sometimes even teeth or mouth. This repetitive behavior is hard to stop, even when it causes embarrassment or physical harm, and may happen when someone feels stressed or anxious.  

What Causes BFRBs?  

Body focused repetitive behaviors (BFRBs) can affect people of all ages and backgrounds. They often start in childhood or adolescence and may be triggered by stress, anxiety, or emotional challenges. Genetics, brain chemistry, and environmental factors also play a role in why these repetitive body focused behaviors develop. Some people use BFRBs to cope with difficult feelings, while others do them without realizing, especially during boredom or tension. BFRBs are not rare and can last for years if not addressed.   

Signs and Symptoms of Body-Focused Repetitive Behaviors (BFRBs)     

Body-focused repetitive behaviors (BFRBs) can show up in many different ways, and the signs and symptoms are not the same for everyone. Some people may notice physical changes, while others experience emotional or behavioral struggles. Recognizing the symptoms is important because BFRBs can cause harm and lead to feelings of shame or distress. Below are some common signs to look for, grouped by physical, emotional, and behavioral changes.  

Physical Signs of BFRBs 

• Scarring, sores, or bald patches from picking or pulling 

• Damaged nails or cuticles 

• Infections or frequent skin irritation 

• Bleeding or bruising on fingers, skin, or scalp 

Emotional Signs of BFRBs 

• Feeling ashamed or embarrassed about the behavior 

• Anxiety or tension before doing the behavior 

• Relief or satisfaction after the behavior 

• Guilt or sadness about not being able to stop 

Behavioral Signs of BFRBs 

• Repeatedly picking, pulling, or biting despite wanting to stop 

• Trying to hide the physical damage (wearing hats, long sleeves, or makeup) 

• Avoiding social situations due to embarrassment 

• Engaging in the behavior more during stress, boredom, or anxiety