Body-focused repetitive behaviors (BFRBs) are compulsive behaviors or habits that an individual ritually performs on themselves. Some examples of BFRBs include: picking one’s lips, nails, skin or hair such that it can cause damage or injury to the affected tissue. Unfortunately, there is not a clear scientific understanding of BFRBs. As a result, there are several myths and misconceptions surrounding BFRBs. Many mental health conditions are closely related to or have overlapping symptoms with BFRBs, making it extremely difficult to diagnose or recognize in a person from a medical standpoint.
Myth #1: BFRBs Are Just Bad Habits
Fact: BFRBs are considered a group of mental health conditions.
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) is a tool that licensed medical professionals use to diagnose all currently known mental health conditions. The DSM-5 classifies BFRBs as mental health conditions that can impact a person’s physical and mental well-being. BFRBs are not just bad habits. One of the more common BFRBs, known as excoriation, or skin-picking disorder, has been described in medical literature since the 1800s but was not formally added to the DSM-5 until 2013. As more BFRBs are added to the DSM-5, additional research will help reveal new information about this group of mental health conditions.
Myth #2: Body-focused Repetitive Behaviors Are Rare
Fact: Many people exhibit BFRBs at some point in their lives
Chances are, most people engage in some form of a BFRB at least once in their lives. In a 2018 study, college students were asked to self-report if they engaged in different BFRBs. The BFRB statistics show that approximately 60% of students self-reported engaging in BFRBs on occasion but at the subclinical level. In other words, medical professionals would not recommend that people who engage in these behaviors on occasion receive treatment. In contrast, 12.3% of the students met the criteria for pathological BFRBs and would be recommended for treatment.
In another study conducted in 2018, 23% of study participants reported engaging in BFRBs and were deemed to have probable BFRBs. These studies suggest that BFRBs are not rare, but more research needs to be conducted in representative populations. Many studies conducted on BFRBs involve individuals self-reporting their BFRBs. Therefore, the true percentage of individuals with this disorder may be skewed, over-reported or under-reported on this basis.
Myth #3: There Are Only a Few Types of BFRBs
Fact: There are several different recognized types of BFRBs and likely more
Several types of BFRBs are recognized by the DSM-5 as their conditions, while others fall under the general BFRB umbrella. The lifetime prevalence, or how common these disorders are in the general population, falls between 0.5% and 4% and can be higher depending on the specific type of BFRB. A list of common BFRBs includes:
Both of these BFRBs are considered their own conditions in the DSM-5. Other conditions include:
- Onychotillomania (nail picking)
- Onychophagia (nail biting)
- Dermatophagia (skin eating)
- Lip biting (lip bite keratosis)
- Cheek biting (cheek keratosis)
- Tongue chewing
In the future, more pathological behaviors will likely be added to the list of BFRBs.
Myth #4: BFRBs Are Not a Big Deal
Fact: BFRBs can lead to severe tissue damage.
As BFRBs involve excessive grooming, more severe cases can lead to excessive tissue damage. In individuals that exhibit subclinical levels of BFRBs, damage to affected tissues may never reach a detrimental level. However, BFRBs can impact how an individual operates in society, including interactions in the workplace, school and family members. BFRBs can easily become a big deal if not managed properly. When individuals start exhibiting serious BFRB symptoms, it may be time to seek treatment. Serious symptoms include:
- The inability of affected tissue to properly heal
- Absence of hair in certain areas due to overgrooming
- Infections or developing another illness as a result of overgrooming
- Loss of the nail bed
- Development of calluses on the affected tissue
- Sores that never go away
Always consult with a doctor if severe symptoms appear, worsen or do not go away.
Myth #5: BFRBs Are a Choice
Fact: BFRBs are classified as impulse control disorders.
Individuals diagnosed with BFRBs would not describe these behaviors as a choice. In many instances, people do not realize they are engaging in repetitive behavior since it feels so familiar or second nature. A BFRB may start to feel normal for people after performing behaviors for weeks, months or even years. By definition, individuals with BFRBs have a lack of impulse control when it comes to overgrooming. Much like a gambling addiction, BFRBs cannot easily be controlled or mitigated without therapeutic intervention.
Myth #6: BFRBs Are a Type of OCD
Fact: BFRBs are related to, but separate from, OCD.
Obsessive-compulsive disorder (OCD) is a condition where individuals cannot control their obsessive thoughts or compulsions. This occurrence usually ends in physically acting on their obsessions and compulsions. BFRBs solely involve physical body-grooming behaviors. The DSM-5 classifies both disorders as related but separate conditions. Trichotillomania (hair pulling) and excoriation disorder (skin picking) are considered under obsessive-compulsive and related disorders by the DSM-5. Other BFRBs fall under the broader diagnosis of a BFRB disorder, which is considered under other unspecified obsessive-compulsive and related disorders, by the DSM-5.
Myth #7: Body-focused Repetitive Behaviors Can’t be Stopped
Fact: Treatment can help Individuals stop BFRBs.
Although the underlying causes of BFRBs are mostly unknown, individuals can receive effective treatments to manage and stop these behaviors over time. The most common treatments for BFRBs include cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), prescription medication, acceptance and commitment therapy and habit reversal training.
Some treatment methods will be more effective for certain people than for others. The overall goals of treatment for individuals struggling with BFRBs are to recognize why and how these behaviors impact their physical and mental well-being. Finally, treatment seeks to teach people how to replace their destructive and pathological behaviors with more productive and constructive ones.
If you or a loved one live with a substance use disorder and co-occurring mental health disorders, like body-focused repetitive behaviors, contact The Recovery Village today. Call to speak with a representative about treatment options. You or your loved one deserve a healthier future, call today.
Chamberlain, Samuel; Odlaug, Brian. “Body Focused Repetitive Behaviors (BFRBs) and Personality Features.” Current Behavioral Neuroscience Reports, March 2014. Accessed June 8, 2019.
Houghton, DC; Alexander, JR; et al. “Body-focused repetitive behaviors: More prevalent than once thought?” Psychiatry Res, December 2018. Accessed June 8, 2019.
Lochner, Christine; Roos, Annerine; Stein, Dan. “Excoriation (skin-picking) disorder: a systematic review of treatment options.” Neuropsychiatric Disease and Treatment, July 2017. Accessed June 7, 2019.
Solley, K; Turner, C. “Prevalence and correlates of clinically significant body-focused repetitive behaviors in a non-clinical sample.” Compr Psychiatry, October 2018. Accessed June 7, 2019.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a 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 provider.