Many people have never heard the term “body-focused repetitive behaviors”, yet a surprising number of us suffer from them. Sometimes abbreviated to BFRBs, body-focused repetitive behaviors are a set of interrelated disorders that are categorized by routines that center around self-grooming. Sufferers may pick, pull, bite or scrape their nails, skin or hair. Around 3% of people are believed to be sufferers, and the problem affects adults and children alike.

BFRBs are thought to be connected to OCD (obsessive compulsive disorder), impulse control disorders and anxiety disorders. However, in general, experts believe that BFRBs are very different from all three. No matter how these types of behavior are categorized, there’s no doubt that they’re very hard to control. They may also result in physical injuries such as skin infections, bald spots, and scarring. They also often cause considerable emotional distress, especially when the disorder goes undiagnosed or is kept a secret. Body-focused repetitive behaviors can be difficult to treat and can make it difficult to socialize or function normally at work.

Why Do Body-Focused Repetitive Behaviors Occur?

At the moment, psychologists and medical professionals are still uncertain of why people begin to engage in body-focused repetitive behaviors. This is often because the majority of sufferers report that they have multiple triggers. Many people say that they pull or pick at their skin, nails or hair if they’re feeling anxious. They find that if they engage in such behaviors they experience temporary relief. This, therefore, has led to a theory that BFRBs could be linked to anxiety disorders.

However, other sufferers say that they scratch, pull or pick without even noticing it, or while they’re engaged in an activity such as watching TV or reading. In such cases, it’s thought that there is a closer relationship with impulse control disorders.

Gaining an understanding of the root cause of the disorder is vital in order to receive the right treatment, particularly since somebody who engages in this behavior because of anxiety will often need a different kind of treatment to someone who does it because they’re bored.

The Shame Of BFRBs

Although millions of people are affected by body-focused repetitive behaviors, they’re still poorly understood and are rarely seen or talked about in the media. This means that these behaviors all-too-often are viewed as just bad habits that sufferers could quit easily if they had enough willpower.

This misconception means that many people living with BFRBs experience shame about their disorder. They struggle to cope with not being able to stop. They may even go to huge lengths to try to hide any evidence of their disorder, even going so far as to use wigs and makeup, or covering up their entire bodies so no scars or scabs can be seen. This shame interferes with intimacy, daily function, and relationships, sometimes leading to further mental health problems and social difficulties.

Although sharing the feelings of shame with friends, family members or therapists may help, lots of people who have BFRBs derive a lot of comfort from talking to other sufferers. Support groups are extremely helpful for people who suffer from body-focused repetitive behaviors since they help to reduce the shame and embarrassment associated with these conditions.

Who Is Most Likely To Suffer From A Body-Focused Repetitive Behavior Disorder?

Experts are currently working on determining who is most likely to be a sufferer of a BFRB, however it’s known that genes are part of the problem. If somebody in your family suffers from a BFRB, you are more likely to suffer too. There are some other factors that are relevant too, including the stress you face in your everyday life, your personality, your sex, and your childhood. Women are more likely than men to be sufferers.

What Are The Types Of Body-Focused Repetitive Behavior Disorder?

There are several kinds of BFRB. They include:

• Dermatillomania – if you pick at bumps, scabs, pimples, and even healthy skin, the condition is known as dermatillomania (or excoriation disorder). It’s unknown what triggers it to occur, but people who suffer from OCD have a greater chance of developing it.
• Onychophagia – up to 30% of people suffer from onychophagia, which is simply a medical term for nail-biting. Many sufferers aren’t aware that they do it, but it doesn’t just damage the nails and skin, it can damage the teeth too and even cause infections.
• Morsicatio Buccarum – sufferers of this BFRB cannot quit biting the inside of their mouth. This results in swelling and sores. It can also cause the mouth’s inner lining to feel bumpy which only serves to encourage more chewing.
• Morsicatio Labiorum – this BFRB involves chewing, sucking or biting on the inner lip. Eventually, the lip skin cells will slough off to create a gray, yellow or white rough patch.
• Morsicatio Linguarum – sufferers of this BFRB chew the side of their tongue. This again causes sore patches and can cause difficulty in eating or speaking.
• Rhinotillexomania – Rhinotillexomania sufferers pick their nose so frequently that it impacts on their everyday life. They may even spend several hours each day trying to clean their nose. Sufferers of this disorder are also highly likely to have multiple body-focused repetitive behaviors such as nail-biting or skin picking.
• Trichotillomania – This disorder involves pulling hair from the eyebrows, head, eyelashes or other body parts and it could be triggered by boredom or anxiety. Some sufferers aren’t even aware that they’re pulling on their hair. This BFRB usually begins between the ages of 10 and 13, however, it can last for a lifetime.
• Trichophagia – up to a fifth of people who suffer from hair pulling disorders also eat their hair. While some nibble at the hair roots, others eat hair in bunches. In some rare cases, sufferers may eat hair from animals or other people. This problem can lead to hairballs in the stomach which could even be life-threatening.
• Trichodaganomania – biting the hair is the focus of this BFRB. It’s difficult to chew hair which is still attached to the scalp, so most sufferers bite hair on the other areas of their body.
• Dermatophagia – sufferers of this body-focused repetitive behavior chew their skin before eating it. Worry and tension often trigger this disorder, while other people are set off by feeling something on their skin such as a hangnail.
• Trichotemnomania – the name of this BFRB comes from the Greek words “temnein” which means “cut” and “trich” which means “hair”. Sufferers have strong urges to remove their hair from their bodies. They may remove hair from their scalp, eyebrows, pubic area, legs, and arms. Trichotemnomania is an obsessive compulsive disorder, and is often connected to a belief that cutting away hair gets rid of unpleasant or unwanted thoughts.

How Can Skin-Picking And Hair Pulling Be Managed?

People who suffer from body-focused repetitive behaviors may feel as if they will never be able to overcome their urges however, it is possible to quit pulling, biting, scratching and picking with the right approach and the right kind of help.

Some sufferers find that taking certain supplements like N-acetylcysteine (a form of amino acid) is helpful in managing their condition. However, there is little evidence to support this, and it’s unlikely that taking dietary supplements alone will have a long-term chance of success.

Currently, only limited research has been carried out into BFRBs, but recently the TLC Foundation For Body-Focused Repetitive Behaviors has launched a precision medicine initiative which is the biggest effort to date to try to gain a greater understanding of BFRBs’ neurobiology in order to pinpoint the most effective treatments.

Until more evidence has been gathered, self-help strategies could be beneficial in providing relief to sufferers of BFRBs.

Can Treatment At Home Help?

If you suffer from body-focused repetitive behaviors, there are a number of things you can do to try to overcome the problem. Each sufferer will need to find the best solution for them since BFRBs are personalized disorders. Here are some of the options which some people with these issues find helpful:

• Tracking their progress using an app. Some people use apps like coach.me to track their habit and to try to maintain a positive streak. It helps to empower sufferers to carry on trying to overcome their urges and reminds them of their successes if they relapse.
• Being mindful of thoughts. When sufferers are aware of their triggers they can employ mindfulness techniques at those challenging times to try to resist the urges they experience.
• Find an alternative. Some sufferers find that if they find a way to keep their hands or mouth busy they can avoid the temptations they experience to pull, pick, bite or scratch. People who chew their lips, tongues or mouths may benefit from chewing gum instead, while those who pull their hair or pick at their skin may benefit from adopting a hobby that uses their hands like knitting or embroidery.
• Using calming techniques. Some sufferers find that if they use relaxation or calming techniques such as meditation, acupressure or yoga they can ward off the urges they feel.
• Going to support groups. Many people with body-focused repetitive behaviors find that just spending time talking to other people really helps them to feel better about themselves. Knowing that they aren’t alone is reassuring and sufferers can exchange techniques for controlling these urges that have worked for them.
• Try art therapy. Some people with BFRBs find that artistic pursuits such as painting, sculpture or drawing help them to recover from their problem and avoid giving in to the urges they feel. Creating art can help sufferers to relax and to refocus as well as giving them something else to do with their hands instead of picking, pulling or scratching.
• Journaling. Writing down triggers, urges, thoughts and feelings can really help BFRB sufferers to understand their condition a little better and to find ways of controlling it.
• Using gadgets. For people who pull, scratch or pick at their skin, using something like a fidget spinner or fidget cube can help to refocus the mind while also keeping the hands busy.
• Seeking out online resources. There are groups and websites online which are dedicated to helping people with BFRBs to gain a better understanding of their problems and to share information and support with each other.

All of these options are something you can try yourself at home without having to go to see a doctor or therapist. Some sufferers find them extremely helpful and manage to control their urges effectively without ever needing to seek professional advice. It’s important to be aware, however, that these self-help strategies may not work for everyone or they may not work in the long-term. There is, however, always the option of getting professional counseling or therapy to treat the problem.

Cognitive Behavioral Therapy For Body-Focused Repetitive Behaviors

One of the most effective treatments available for body-focused repetitive behaviors is CBT or cognitive behavioral therapy. A CBT approach called HRT (habit reversal therapy) involves a number of components that help sufferers to focus on their repetitive behaviors, identify their triggers and then manage the urges that they experience.

While the suggestions above can be carried out outside of therapy and can be helpful in controlling the repetitive behaviors which are associated with BFRBs, seeking professional medical advice is always the best course of action. A trained therapist can help you to get to the root cause of your body-focused repetitive behaviors, work with you to identify the things that trigger your urges and enable you to find ways to cope more effectively with the boredom or anxiety that is causing you to carry out your destructive actions.

Although BFRBs can be difficult to live with, it’s important to remember that you aren’t alone. Millions of people all over the world are experiencing similar problems and many of them feel as if they are struggling to cope all by themselves. If you get the right professional support and help, you can eventually learn to overcome your urges and stop your body-focused repetitive behaviors.

Don’t hesitate: if you think you may benefit from inpatient treatment as a way to help you manage your struggles with body-focused repetitive behaviors, contact The Meadowglade today to see if we make a good fit.