Body-focused repetitive behaviors (BFRBs) are not well understood. These 8 little known facts about BFRBs explain more about these disorders.

Most people are unaware of how common body-focused repetitive behaviors (BFRB) are. These behaviors are usually hidden and can create significant emotional stress. BFRBs are among the least treated psychological disorders, despite their prevalence among people of all ages, genders and cultures. The following eight little known facts about BFRBs reveal more information about these conditions:

1. BFRBs Include a Variety of Behaviors

Some of the most easily recognized BFRBs are hair pulling (trichotillomania) and skin picking (excoriation disorder). However, these are just two of the many behaviors included in the group of disorders. BFRBs include a variety of actions involving the skin, hair, mouth and nails, including:

  • Onychotillomania (nail picking)
  • Onychophagia (nail biting)
  • Dermatophagia (skin eating)
  • Lip bite keratosis (lip biting)
  • Cheek keratosis (cheek biting)
  • Tongue chewing disorder

2. BFRBs Disrupt Daily Life

A person with a BFRB can spend a lot of time thinking about and partaking in these behaviors. The behaviors themselves are often done in secret, so people often need to interrupt normal activities and find privacy throughout the day to partake in them.

The time spent performing these behaviors is typically significant, but the mental toll they take may be even more overwhelming. The urge and impulse to engage in BFRBs can come on without warning. Many people with BFRBs deal with interruptions from impulsive feelings all day long. These individuals may be able to stall their behavior for a short time, but their minds often remain occupied until they partake in the behavior again.

3. BFRBs Are Unwanted

Despite the intensity of their behaviors, people with a BFRB disorder usually do not want to continue the behaviors. Some people consciously perform their behavior of choice. Others enter a distracted or in a trance-like state when they engage in BFRBs. Regardless of a person’s level of awareness, BFRBs are almost always unwanted. Most individuals want to stop the behaviors but often don’t know how.

4. BFRBs Can Cause Feelings of Shame and Embarrassment

People with active BFRBs can see the damage they do to their bodies. Bald patches can be difficult to hide during the workday, and some scabs and sores can’t be easily covered up with clothing. People with BFRBs feel a great deal of shame and embarrassment about their lack of control and the effects their behaviors have on their appearance. Paradoxically, these feelings often keep people from seeking the treatment they’d need to stop BFRBs.

5. Causes of BFRBs are Unknown

BFRBs are not well understood and only a relatively small number of studies have been conducted about them to date. Because of this lack of scientific study, the causes of body-focused repetitive behaviors are not known. However, some studies do suggest that individuals with BFRBs may have a genetic predisposition to them. The development of these behaviors also likely depends on a variety of other, including family stability, temperament and stress level. Additional research will help explore these and other contributing factors more fully.

6. BFRBs Aren’t Considered Self-Harm

Sometimes a person will intentionally hurt themselves to cause pain. A person may do this to remind themselves that they are alive or to break through a feeling of numbness. While an individual engaging in self-harm behaviors knows they are hurting themselves, they are not trying to end their life.

Body-focused repetitive behaviors are different from self-harm. A person with a BFRB responds to a compulsive urge to feel satisfaction and pleasure, and the act of engaging in these behaviors is soothing to them. While the individual does end up hurting body tissues, there is no desire for harm or mutilation. Bodily injury is an unintended consequence of partaking in BFRBs.  

7. People with BFRBs Can’t Just Stop

Body-focused repetitive behaviors are driven by irresistible urges related to emotional pain or discomfort. These urges have an incredibly strong pull on a person’s mind and emotional state when they arise. They can often be so overwhelming that the person cannot focus on anything but performing the behavior.

In the moment, the behavior creates a sense of pleasure and distraction. Because this sensation is desirable at the time, the person continues to engage in the behavior. However, it is a short-term and solution to negative emotion because the person must eventually stop performing the behavior. When this happens, the pleasurable feeling is replaced with a sense of shame and guilt. These painful emotions can fuel the destructive cycle and drive future urges to engage in BFRBs.

8. Treatment is Available

Body-focused repetitive behavior treatment is available for individuals ready to begin it. While treatment is not an easy choice because of the shame and stigma surrounding BFRBs, support from professionals can bring symptom relief. People who participate in therapy have a significantly higher chance of reducing their symptoms and urges and living a higher quality of life than those who don’t.

In some cases, body-focused repetitive behaviors develop alongside a substance use disorder. Fortunately, treatment is available for these co-occurring conditions. If you or a loved one struggle with a substance use disorder and body-focused repetitive behaviors, contact The Recovery Village. Help and support are available today.

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Editor – Megan Hull
Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more
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Medically Reviewed By – Erika Krull, LMHP
Erika Krull has a master’s degree in mental health counseling and has been a freelance writer since 2006. Read more
Sources “Causes of BFRBs.” Accessed on March 31, 2019. “FAQ for parents.” Accessed on March 31, 2019.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.