What are Body-Focused Repetitive Behaviours?
BFRB for short, is an umbrella term for a group of repetitive self-grooming behaviours in which an individual damages* their appearance or causes physical injury through pulling, picking, biting or scraping of the hair, skin or nails. BFRBs are currently listed in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, as obsessive-compulsive related disorders. Over time these conditions can cause very significant distress, which can affect work, social and daily activities.
BFRBs affect 2-5% of the Canadian population, or approximately 2 million adults and children.
*These behaviours are NOT a form of self-harm.
Why are they not considered self-harm?
BFRBs are not considered self-harm because the intent of the behaviour is not to harm oneself, but rather to fix, correct or otherwise make better some aspect of physical appearance (for example, get rid of a blemish, or a hair that doesn’t seem to belong). BFRBs are also a coping mechanism for overwhelming emotions, but once again the intent is not to cause damage. When it comes to BFRBs, the physical damage done is just a by-product of the behaviour.
Common Types of BFRBs
Hair-Pulling Disorder (Trichotillomania/ Trich/ TTM) – The compulsive urge to pull out hair from various parts of the body resulting in noticeable hair loss. Areas where pulling usually occur include scalp, eyelashes, eyebrows, arms, legs, and pubic area.
Skin-Picking Disorder (Dermatillomania/Excoriation Disorder/ Derm) – The compulsive urge to pick at one’s skin resulting in noticeable damage (sores, scabs, infections). Common areas include face, head, cuticles, back, arms and legs, hands and feet.
Trichophagia – Coinciding with Trichotillomania, Trichophagia is the compulsive urge to eat or ingest the hair that has been pulled. In extreme cases, this can lead to a hair ball called a trichobezoar, which can cause significant health problems. Removal of the hair ball is usually done through surgery.
Onychophagia – Compulsive nail biting. The severity and extent of damage to the skin is variable, but can lead to infections, pain in the fingers and torn skin around the fingernails. Some signs include short nails, skin damage around nails, bleeding skin around nails, callouses.
Rhinotillexomania – Compulsive nose picking. Not to be confused with people picking thier nose from time to time for strictly hygienic purposes. Compulsive nose picking causes a greater risk of infection/damage to the lining of the nose.
Other BFRBs include:
- Trichotemnomania (compulsive hair cutting/shaving)
- Dermatophagia (compulsive skin biting ie. around nails, lips & inside of cheeks)
- Scab Eating Disorder (comparable to the way someone with trichotillomania may digest the hair after pulling it out)
Who is affected and when does it typically develop?
Most BFRBs begin in early puberty/adolescence and many continue into adulthood. In childhood both males and females are affected equally, but in adulthood more females are seemingly affected. Anyone can be affected by a BFRB.
Why do I pull or pick?
Research indicates these behaviours are possibly related to genetics/ environmental causes, but there is no concrete answer yet as to why people begin these behaviours. The symptoms are not personality traits or something that a person can just “snap out of” or stop.
I think my child has a BFRB, what should I do?
First and foremost, be there to support your child and NEVER punish them for the behaviour. Although it may seem like a good deterrent, BFRBs are a group of disorders, not just bad behaviour that can be solved by punishment. Keep in mind that your child very likely doesn’t want to pick or pull, and is probably ashamed of the behaviour. They probably want to stop just as badly as you want them to.
Knowledge is power! Educate yourself about BFRBs and if you take your child to the doctor for the behaviour(s), bring some printed materials/ information along with you. It will take some effort, but find what’s best for your child as they deal with their BFRB(s).
What help and/or treatments are available?
- Therapies (e.g. psychotherapy, Cognitive-Behaviour Therapy (CBT))
- Peer Support Groups (In person/Online)
- Online Resources
My doctor has never heard of BFRBs, now what do I do?
Many doctors still aren’t familiar with BFRBs and their specific needs when it comes to treatment. While there are specialists out there working to properly treat these disorders, if there isn’t one in your area or that you can reach out to, be sure to go prepared with BFRB information the next time you see your doctor.
Is there a cure?
At this time, there are NO cures. If you see a website or product claiming to be a cure, the chances are that it is a fraud and it should be avoided. With treatment, BFRBs can be reduced to a minimum (although even that isn’t guaranteed), but there is no cure-all to stop completely. With that being said, there ARE people who have been able to be pull/pick free for years.
The stigma associated with these conditions makes many feel embarrassed, frustrated, and shameful about the condition, making it difficult to seek help. Oftentimes other mental health conditions occur alongside the BFRB, such as anxiety and depression. Many people live in isolation or fear, not realizing there IS help. Help CBSN reach out to Canadians by spreading the word to break the stigma. Donate, Advocate, Educate.
For more information about BFRBs visit our RESOURCES page or The BFRB Blog