Body-Focused Repetitive Behaviors (BFRB’s)
What are body-focused repetitive behaviors (BFRB’s)?
They can include, but are not limited to:
- Hair pulling (can be from scalp, eyebrows, eyelashes, and pubic area)
- Chewing and swallowing hair
- Nail and cuticle biting
- Picking cuticles, acne, or other areas of skin
- Chewing or biting one’s lips or the inside of one’s cheeks
People who experience BFRB’s often feel alone in their experience. They may feel grief, shame, and frustration over their desire to stop the behavior. At the same time, they may find, in the moment, that the pulling or picking behavior feels satisfying on a sensory or emotional level. BFRB’s can be complex in this way. When loved ones notice the BFRB’s, they may attempt to help by trying to exert control or admonish the person’s pulling/picking. This can sometimes lead to interpersonal struggles. If loved ones don’t notice, it may be because of the sufferer's lengthy efforts to keep the BFRB’s secret, which is an extra stressor for the sufferer to manage.
Comprehensive behavioral treatment can successfully address the distress, social isolation, and/or physical consequences of BFRB’s. Some people with BFRB's feel self-conscious about their appearance, remain vigilant to monitor whether others notice, and may limit their interactions with others due to the distress. Physical consequences can include bleeding, infections, and bezoars, which might require medical intervention.
Cognitive behavioral treatement for BFRB's involves psychoeducation, assessment of the variables that lead to the BFRB, learning and practicing new behavioral strategies to bypass or replace the BFRB, and addressing the social, environmental, and emotional issues that are layered within the behavior. People can create meaningful change with these consistent approaches over time.
If you have more questions about treatment of BFRB's, feel free to contact me to discuss whether I can help.