Many people may have a nervous habit; a tic or behavior that they do mindlessly when they’re anxious or uncomfortable. Body-focused repetitive behaviors (BFRBs) go beyond nervous habits. These repetitive behaviors — like nail biting, hair pulling or skin picking — can cause significant distress. BFRBs can stem from negative emotions, from boredom to frustration, and serve as a coping strategy to help relieve some of these negative feelings.

How Common are BFRBS?

The prevalence of BFRBs varies by behavior. Surveys have estimated rates of BFRBs to be approximately 22%23%, though these may differ by behavior type and age. In general, BFRBs appear to be more prevalent in women, and are often common in childhood and adolescence, but may decrease with age. Notably, it’s common for multiple BFRBs to occur simultaneously.

  • Trichotillomania (Hair Pulling): Trichotillomania involves the pulling of hair, generally from one’s head, eyelashes, eyebrows or elsewhere on the body. The prevalence of trichotillomania is estimated to be 0.6% but may be higher in groups with other mental health conditions, like anxiety disorders.
  • Excoriation (Skin Picking): Excoriation, or skin picking, is characterized by recurrent picking of the skin, resulting in cuts or lesions. The prevalence of skin picking is approximately 1.4% in the general population. The face is the most commonly affected area, which can lead to scarring. Skin picking is generally more common in females and psychiatric patients.
  • Onychophagia (Nail Biting): Prevalence of nail biting can range from 20–45% among children and adolescents but tends to decrease with age. Although it is relatively common, excessive nail biting can cause shame or embarrassment, as well as damage to the nails and surrounding skin, which can increase the risk of infection.

Who Is Affected by BFRBs?

BFRBs tend to emerge for the first time early in life and are fairly common in childhood or adolescence. People who exhibit BFRBs may have certain characteristics, like difficulty regulating emotions, ineffective planning styles and high anxiety levels. Many people who demonstrate BFRBs have close family members who do as well. BFRBs are often observed among people who have high standards, experience high levels of stress or have difficulty or unwillingness to relax.

Some of these behaviors seem to be particularly common in college students. For example, skin picking prevalence increases from 1.4% in the general population to 2.2% in college students. BFRBs are frequently linked to higher levels of stress or feelings of boredom, which are both commonly experienced by students. BFRBs may indicate that students are struggling to manage feelings of stress or anxiety related to the demands of their program.

Risk Factors and Causes

Risk factors and causes of BRFBs can be linked to how people cope with stress or negative emotions. In many cases, people with BFRBs have family members who also exhibit these behaviors. Comorbidity of BFRBs is high; people who exhibit these behaviors are also likely to have other conditions with shared symptoms, like anxiety.

BRFBs and Related Conditions

Avoidance of negative feelings, impulsive behaviors and feelings of anxiety are common to a range of psychiatric conditions. People with BFRBs typically experience more than one of them; these behaviors often come from a similar place of stress or difficulty managing negative feelings and can present in multiple behaviors at once.

BFRBs also co-occur with psychiatric conditions, such as mood disorders and obsessive-compulsive disorders. These behaviors also share features with substance use disorders, including difficulty stopping even knowing the negative consequences. BFRBs can also be considered impulse control disorders or addictions.

Statistics on Body-Focused Repetitive Behaviors Treatment

Treatment for BFRBs requires addressing the repetitive behaviors, most commonly through habit reversal training. This treatment involves bringing awareness to the behaviors, developing a new response to replace the behavior and having social support. BFRB treatment may also vary depending on the behavior. Additional treatments may include:

Modifying habits related to feelings of stress, anxiety or impulse can take time and can benefit from professional support. If you or someone you love may be dealing with body-focused repetitive behaviors that could be related to substance use, contact The Recovery Village to discuss treatment options.