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Body-Focused Repetitive Behaviors (BFRBs)

Are you struggling with frustrating and embarrassing behaviors such as hair pulling or skin picking?  Do you feel the need to hide or cover up parts of your head or body due to marks or bald patches?   You might avoid going to certain places and enjoying special activities.  

At CFCE, we want you to know that you are not alone.

Perhaps you understand why and when you are likely to start pulling your hair or picking your skin or nails, or maybe it happens without thinking.  Both are common. You have likely tried to stop many times without success and feel exhausted. 

At CFCE, we understand that you just want some relief.

Trichotillomania (hair pulling), excoriation (skin picking), nail biting and other repetitive body-focused behaviors (BFRBs) are common sources of distress and embarrassment that affect people of all ages and backgrounds. These conditions are likely to become chronic without proper treatment.

At CFCE, we are trained to help you.

Many of our therapists have completed advanced trainings in BFRBs through the TLC Foundation Professional Training Institute.  Our client-centered, integrative treatment approach incorporates the latest evidence-based treatment for BFRBs, including Habit Reversal Training (HRT) and the Comprehensive Behavior Model (ComB), as well as additional Cognitive Behavior Therapies (CBT) with demonstrated efficacy.

More Information on BFRBs

Trichotillomania (trick-o-till-o-may-nee-uh) (TTM or “trich”), also known as hair pulling disorder, is characterized by the repetitive pulling out of one’s hair. Trichotillomania is a Body Focused Repetitive Behavior (BFRB) and part of a group of behaviors in which a person causes harm to the body through pulling, picking, scraping or biting hair, skin, or nails.

This disorder usually begins in late childhood or early adolescence and occurs equally in males and females, although by adulthood most of the persons affected are female.  The research indicates that 1-2 people in 50 may experience trichotillomania in their lifetime.   The severity of the condition varies, and it can come and go, but what we do know is that the situation may worsen with time without treatment.   It is often difficult for family members to cope as well, and sometimes the person is affected by other health issues related to the Trich or suffers with anxiety or other mental health issues.

Excoriation or Skin Picking, also know as dermatillomania, is another BFRB.  In this case, a person may pick, rub, scratch or dig into their skin repetitively in an attempt to improve perceived imperfections.  These behaviors usually result in damage to the skin such as scarring or discoloration. Although many people will pick at their skin or nails, a small percentage of the population (2-5%) pick to the extent that it causes significant distress, tissue damage and interferes with daily functioning. These behaviors usually begin in early adolescence although it can start at any age.  Without treatment, skin picking disorder tends to be a chronic condition that may wax and wane over time. 

There are other BFRBs that are also as equally distressing and interfere with daily life.   These include (but are not limited to):

  • Onychophagia – (nail biting) –involves repetitive biting to the point where nails and skin are damaged.
  • Onychotillomania – (nail picking) involves the destruction of the fingernails or toenails by means of chronic picking and manicuring of the nails. 
  • Trichophagia – (hair eating) occurs in approximately 15% of patients with trichotillomania. Eating hair may cause serious medical complications.
  • Dermatophagia – (skin eating) often occurs amongst patients with onychophagia.
  • Lip Biting – (lip bite keratosis) involves the repetitive biting of the skin of one’s own lips.
  • Cheek Biting – (cheek keratosis) involves the chronic biting of the inside cheek resulting in sores and other oral health issues.
  • Tongue Chewing – Chronic chewing on the tongue, most frequently the sides of the tongue, is a common oral problem.
  • Trichotemnomania – (hair cutting) is characterized by the compulsive cutting of one’s own hair. 

As with all BFRBs, there are difficult emotions that go along with these disorders including high levels of stress and anxiety.  If you struggle with one of these behaviors, you are likely feeling as if your life is out of control and that you cannot live your life the way you would like. It is exhausting when you feel you have to hide or minimize your situation or even explain it.   You may experience social isolation and a lack of understanding from peers and family members.

Since many of us have engaged in activities like nail biting, it can seem as if these behaviors would be easy to stop. However, for someone who suffers with one of these disorders, it is actually very difficult to stop the behavior.  

More research into the causes and types of BFRBs is needed.  We do know that professional support is necessary and helpful and that certain therapies (as outlined above) can help.

If you or a loved one recognizes these symptoms, please reach out to us for a consultation and more information about treatment options. 

At CFCE, we understand and we are here to support you to feel better!