Understanding Body-Focused Repetitive Behaviors (BFRBs)

Body-Focused Repetitive Behaviors (BFRBs) are a group of disorders that involve compulsive self-grooming habits—like hair pulling, skin picking, or nail biting—that can lead to emotional distress, isolation, and even medical complications. These behaviors can feel impossible to control, but effective treatment options are available.

Common Types of BFRBs

Trichotillomania (Hair Pulling)

Trichotillomania is a condition that causes people to repeatedly pull out their hair, often from the scalp, eyebrows, or eyelashes. While some may do this unconsciously, others feel an intense urge to pull, especially during times of boredom or distress. This can lead to feelings of shame, isolation, and even medical issues like skin infections or digestive problems from swallowing hair.

Body Excoriation Disorder (Skin Picking)

Also known as excoriation disorder, skin picking involves compulsively scratching, picking, or squeezing the skin—often in an attempt to remove perceived imperfections. The most commonly affected areas include the face, arms, and hands. Over time, this behavior can lead to sores, scarring, and significant tissue damage. Like hair pulling, skin picking can feel uncontrollable, despite repeated efforts to stop.

Effective Treatment Options

ComB Model

 

The comprehensive behavioral treatment or the ComB model is a treatment protocol that tackles the complexity of treating BFRBs. It begins with using a CBT assessment tool, a functional analysis. This looks at ways that internal and external environments are impacting the BFRB and find areas that you may want to change. I will work with you to develop a very unique and specific individualized treatment. I will help you to set up your environment so that you are more likely to manage the urge to pick or pull.

Below is an example:

The SCAMP model is a framework that guides the clinician through different areas or domains to assess. Each domain tackles treatment from a variety of creative angles and leaves the client with a variety of skills and techniques for specific triggers.

Sensory – We all have a nervous system that has different needs. Using this domain, we look at particular sensory needs the client has and choose techniques based on that. For example: If a client’s nervous system is craving a smooth feeling, the clinician can provide examples of smooth items the client can use such as using a face mask or pimple patches that create a smoothness over a pimple or bump. Or using a worry stone or calm patch to touch.

 

Cognitive – There are specific cognitive belief systems and thoughts that frequently come up in therapy. The self-help book lists out some of them. This is a way to see how the client’s internal self-talk and thoughts can unknowingly increase picking/pulling or managing it. For example: “I’ll just pick/pull for a minute/just one” Rebuttal: How often do I stop after a minute or after just one? Answer: Never!. Using post-it notes in the bathroom with some of these rebuttals can be helpful.

 

Affective – Our moods and emotions impact how we view things and how we interact with them. This part of the model goes through emotion regulation skills. For example: If a client’s picking/pulling happens every time they get stressed, the clinician would provide stress relieving techniques and options for the client to do instead of picking/pulling.

 

Motor – Specific motions that a client does or a position they place their hand might trigger an urge to pick or pull. Thinking of things to make it less appealing or harder to pull/pick. For example: getting gel nails or a manicure can change the feeling of the client’s nails and they are less likely to get the same relief/feeling from picking and pulling.

 

Place – Specific places might trigger a client to pick or pull more, such as the bathroom or while driving. For example: dimming the lights in the bathroom so that you can’t see in the mirror as clearly/closely and less likely to get triggered by a hair or skin bump.

Habit Reversal Training (HRT)

One of the most effective therapies for BFRBs is Habit Reversal Training (HRT). This structured approach helps individuals recognize their triggers and develop healthier, alternative responses. We’ll work together to identify daily habits that may be fueling these behaviors and implement strategies to reduce them.

Additional Therapeutic Approaches

  • Acceptance and Commitment Therapy (ACT) & Mindfulness: These approaches help individuals accept their urges without acting on them, allowing the impulses to pass naturally.
  • Compassion-Focused Therapy: This is especially helpful for individuals struggling with guilt, self-criticism, and low self-compassion.
  • Family Therapy: Support from loved ones plays a crucial role in recovery. We’ll work with your family to create a plan that encourages progress while addressing any relationship challenges.

Helpful Resources

For more information and support, consider these trusted organizations:

  • Trichotillomania Learning Center
  • International OCD Foundation