Habits: Body-Focused Repetitive Behaviors (BFRBs)

Body-Focused Repetitive Behaviors (BFRBs)

By Lauren Hernandez

            Body-focused repetitive behaviors (BFRBs) are a group of disorders composed of “self-grooming” behaviors in which a person might pull, pick, bite, or scrape one’s hair, skin, or nails. BFRBs can be considered “impulse disorders,” however; it is still undetermined whether they are either impulsive or compulsive behaviors. People suffering from BFRBs typically lack awareness towards engaging in the repetitive behavior. BFRBS are problematic when they occur repetitively and cause a person distress in their physical, social, and emotional lives. The cause of BFRBs is still being researched; however, for some, habitual behaviors such as biting nails, chewing on their cheeks, and pulling their hair may develop into an impairing pattern associated with other mental illnesses.

Most BFRBs are associated with anxiety disorders, impulse control disorders, and obsessive compulsive disorders because they are difficult for individuals for control. BFRBs not only have an emotionally distressing impact, as an individual may experience high levels of shame, but BFRBs can also cause physical injuries such as scarring, skin infections, or bald spots.

The most common BFRBs include:

  • Trichotillomania- compulsive hair pulling
  • Dermatillomania- Compulsive skin picking
  • Onychophagia- Compulsive nail biting

Treatment of BFRBs include cognitive behavioral therapy, medication, and supplements, however, there are lower rates of treatment success due to lack of research on the disorders and effective treatment methods. Treatment for BFRBs should be discussed with a psychologist or psychiatric nurse practitioner in order to tailor treatment for an individual.

If you or someone you know is struggling with a Body-focused repetitive behavior, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/ .





Image Source:


What is Trichotillomania?

By Stephanie Osuba

Trichotillomania is a hair pulling disorder categorized in the Obsessive Compulsive and Related Disorders section in the DSM-5. It is one of the other Body Focused Repetitive Behaviors (BFRBs) – along with excoriation (skin picking) and onychophagia (nail biting) – in which the individual will pull, pick or bite at various parts of the body resulting in damage.  Symptoms include recurring hair pulling, hair loss, and related stress and impairment because of the behavior. The disorder is not considered self-mutilation like cutting or burning because the behavior is not intentional and research suggests that there is no connection between the disorder and unresolved trauma. Often people are ashamed of the behavior and their resulting appearance because of it and try their hardest to stop. Comorbidities include, tic disorders, mood disorders, and anxiety disorders, although, trichotillomania can also occur in the absence of any other psychopathology.  The regular age of onset is between the ages of 11 and 13, however, baby trichotillomania is a rare phenomenon that seems to go away as the child grows older. Research also suggests that the disorder is primarily genetic as it appears in the first relatives of people with trichotillomania than it does in the general population.

Available treatments include cognitive behavioral therapy (CBT) and habit reversal training (HRT) with adjunctive dialectal behavioral therapy (DBT) and acceptance and commitment therapy (ACT). These therapies help the person to be aware of the pattern of the behavior and helps to identify triggers to pulling. It also teaches methods to redirect that urge to pull into a new healthy pattern of behavior in order to reduce or eliminate the urge. While there is no FDA-approved medication specifically for BFRBs, research is being conducted. OCD medication such as selective serotonin reuptake inhibitors (SSRIs) and anafranil can help alleviate symptoms as well.

Sources: Deibler, M. W., Psy. D. (n.d.). Trichotillomania (TTM) and related Body-Focused Repetitive Behaviors (BFRBs). Retrieved from http://www.thecenterforemotionalhealth.com/trichotillomania-and-related-disorders

Zwolinski, R., LMHC. (2013, October 03). Cause And Treatment Of Trichotillomania. Retrieved from https://blogs.psychcentral.com/therapy-soup/2012/04/cause-and-treatment-of-trichotillomania/

If you or someone you know appears to be suffering from trichotillomania, the licensed psychologists, psychiatrists, psychiatric nurse practitioners, and psychotherapists at Arista Counseling & Psychotherapy can assist you. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, visit http://www.counselingpsychotherapynjny.com/.