Your Guide to Body-Focused Repetitive Behaviors (BFRBs)

Nail biting, skin picking, and hair pulling. What do they all have in common? 

They’re all Body-Focused Repetitive Behaviors (BFRBs).

Up until the past few years, people weren’t talking about BFRBs. Hair pullers were in one corner and skin pickers were in another. This umbrella term has grouped people with similar self-grooming behaviors together. With this new classification system, it’s important for those of us who live with BFRBs or support people with BFRBs to understand what exactly is a “Body-Focused Repetitive Behavior.”

What is a Body-Focused Repetitive Behavior?

Body-Focused Repetitive Behaviors are any repetitive self-grooming behavior that involves biting, pulling, picking or scraping one’s own hair, skin or nails; thereby unintentionally causing damage to the body. Commonly misunderstood as “habits” or “tics,” BFRBS are among the most misdiagnosed and under-treated group of disorders. 

Here are a list of some common Body-Focused Repetitive Behaviors: 

  • Trichotillomania - Hair Pulling

  • Excoriation (formerly Dermatillomania) - Skin Picking

  • Onychophagia - Nail Biting

  • Trichophagia - Hair Eating

  • Dermatophagia - Skin Eating

  • Lip Bite Keratosis - Lip Biting

  • Cheek Keratosis - Cheek Biting 

While most of us have probably done one of these self-grooming acts at one point in our lives, for people with BFRBs, these acts become rituals that interfere with day-to-day life.

How Many People Have BFRBs?

According to the BFRB Precision Medicine Initiative, BFRBs affect more than 10 million people in North America. Numbers vary when it comes to the individual BFRBs. It is estimated that 2-4% of the population lives with Trichotillomania. 2-5% of the population lives with Excoriation. 20-30% of the population lives with some form of Onychophagia. 

What Causes BFRBs?

There hasn’t been much conclusive research done on BFRBs to date. Similar to the research done for Trichotillomania, the medical community believes that there is a large genetic component to BFRBs. It is also suspected that there are some environmental factors. 

Are BFRBs a Type of Self-Harm?

BFRBs are not a form of self-mutilation or self-harm. The intention when performing a BFRB is not to cause harm or punish oneself. Rather, those with a BFRB perform these acts because they feel pleasurable and/or to relieve stress.  

How are BFRBs Treated?

Unfortunately, there is not an effective form of treatment currently available for those with BFRBs. Cognitive-Behavioral Therapy (CBT) or Habit-Reversal Therapy (HRT) are both common treatment plans, but the success rates for these options are often very low. There is currently research being done by the BFRB Precision Medicine Initiative to find an effective treatment option for all of us with Body-Focused Repetitive Behaviors. 

What Does This Mean If I Have a BFRB?

If you or someone you support has a Body-Focused Repetitive Behavior, it’s important to understand the basics of this classification. Nothing about you disorder changes with this new umbrella term. However, you might hear it come up in conversation regarding your Trichotillomania, Excoriation, Onychophagia, etc.

When you hear another person’s disorder is being classified as similar to yours, it’s easy to think “They don’t understand what it’s like to have what I have” or “Yay! Finally someone who understands what I’m going through.” Both thoughts are valid. Everyone’s experience with a BFRB, even if it is the same BFRB, is unique.

For more information about Body-Focused Repetitive Behaviors, check out the following resources:

The TLC Foundation for Body-Focused Repetitive Behaviors
Canadian BFRB Support Network