BFRB: What are body-focused repetitive behaviours and how can we treat them?

by | Mar 23, 2023 | Adolescent Psychology, Anxiety, Body Image, Mental Health, Psychology, Stress | 0 comments

Skin-picking, hairpulling and nail biting are a few examples of body-focused repetitive behaviours (BFRB). These behaviours can create distress, shame and physical injury to those stuck in the grips of this sticky cycle. This is a fairly new area of research. However, clinicians and clients are learning new ways to manage the outcomes of BFRB. Here are a few simplified insights and examples of possible intervention strategies:

What are BFRBs?

Body-focused repetitive behaviours are actions such as skin-picking, nail biting and hair pulling. These habits become reinforced through both negative (relief) and positive reinforcement (stimulation). These habits can be self-destructive because they can cause injury to the person’s body. To a large extent we all use these behaviours at one time or another! However, if there are higher levels of distress and impairment as a result of these kinds of behaviours, it’s worth reaching out for help.

Focused vs. unfocused BFRB:

There are two types of BFRB: focused and/or unfocused. This means that sometimes the behaviour, such as skin picking, might be happening automatically, without you even knowing! At other times, the skin-picking might be done with more conscious awareness. Awareness training might be an important first step in therapy to figure out how an unfocused BFRB might be impacting you.

Emotional regulation:

Emotional regulation might be more difficult for someone using BFRB’s. For example, someone might use skin-picking or hair pulling as a way of regulating emotions of tension, boredom, or over-stimulation. Therapy can offer a safe space to learn alternative ways to tolerate difficult emotions.

Shame and guilt:

Quite often skin-picking, nail biting and hair pulling bring up intense feelings of shame. Individuals may try to cover up their scars, avoid seeking help. or avoid doing everyday activities like going to the hairdresser in attempts to hide this habit. However, therapy can provide a safe place to talk about these distressing behaviours to move towards acceptance, shame reduction and less avoidance.

Comorbid difficulties:

Sometimes BFRB do not occur by themselves. Generalised Anxiety Disorder, ADHD, OCD and depression are some mental health difficulties that might play a role in how a BFRB affects you. In order to tailor a unique intervention approach it is important for your psychologist to have a clear idea of the whole picture.

Interventions for BFRB:

These are a few interventions that can be used to address BFRB’s. Remember this is not an exhaustive list! You and your psychologist will co-construct the best approach to suit you.

  • Self-monitoring strategies, insight building and mindfulness-based activities can be used to build compassionate awareness.
  • Therapy can be used to help choose a more helpful competing response, such as clasping your hands. This creates a pause to allow the urge to pick, bite or pull to pass over.
  • Stimulus replacements can also be used to find something that offers a similar sensory experience. For example, a smooth stone might offer the same sensation as smoothed skin after picking.
  • Some therapy approaches might focus on reducing shame around the behaviours and building acceptance for difficult emotions.
  • Stress reduction and distress tolerance strategies can be helpful to learn alternatives to managing the discomfort of hard feelings.
Hand clasping as a competing response (CR) as intervention for BFRB.

If you or a loved one is struggling with a body-focused repetitive behaviour please reach out for support from a mental health professional. The clinicians at the Centre for Effective Living are able to help you manage these tricky behaviours to live in more effective and present ways.