Body-focused repetitive behaviors (BFRBs) are repetitive behaviors focused toward one’s own body that become problematic due to the distress they cause in one’s life and several unsuccessful attempts to stop. The most common BFRBs include hair pulling (trichotillomania), skin picking (excoriation disorder), and nail biting (onychophagia) but can also include other body-focused behaviors such as cheek biting, lip biting, scab picking, and tongue chewing. These behaviors are pretty common with The TLC Foundation for BFRBs reporting an estimation of 3% of the world’s population struggling with these behaviors. The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) states that two of the most common BFRBs, trichotillomania and excoriation disorder, most often begin in adolescence, and a recent study reported that 12.27% of its large college student sample had a pathological BFRB. Teens are thus an important age group to consider when it comes to BFRBs.
Being a teenager is already difficult with so many social and body changes, and adding a BFRB into the mix can be extra challenging. Teens often feel a lot of shame and embarrassment about their BFRBs due to perceiving their behaviors as different from their peers and due to the damage their behaviors may cause to their bodies. They may therefore be self-conscious when talking about their BFRBs, say they don’t want to talk about it, or hide their behavior and its effects to prevent people from noticing. Just like anyone with a BFRB, teens who struggle with these behaviors need understanding and support from their loved ones. Below are some important points to keep in mind when talking to teens about their BFRBs:
- Know that BFRBs are not the same as self-harm behaviors: It is a common misconception that BFRBs are done as a means of self-harm, but this is not the case the vast majority of the time! Self-harm is done to intentionally cause pain, whereas BFRBs are self-regulatory behaviors that may cause pain or body damage as an unintentional side effect. Also, having a BFRB usually does not mean that self-harm will develop in the future. Your teen is most likely engaging in their BFRB to regulate themselves, not to purposefully harm themselves!
- Do not prod them with questions or make them share more than they’re ready to about their BFRB: I know as the loved one of a teen, you just want to help them and may want to get a lot of information out of them in order to do this, but since having a BFRB can be so shame-inducing, it is really important to approach this matter with care. Asking a teen a lot of questions can feel interrogating to them, causing them to shut down; instead, create an open, loving, judgment-free environment for your teen and let them know you’re there for them if they ever want to talk more about their BFRB.
- Ask how you can best support them: This is crucial, because every teen with a BFRB may need something different. Some may want you to point out when you see them engage in the behavior (a common request if their behavior is mindless), some may want you to do something more subtle like say a code word or place a fidget in their vicinity when they’re doing the behavior, and some may want you to not comment on the behavior at all. Some teens may want you to connect them to professional help with a therapist, some may want your help identifying triggers and trying out different strategies to reduce their behaviors, and some may not be ready to receive help yet. It’s important to honor your teen’s request and check in every now and then to get feedback on your support and see if their needs have changed at all.
- Keep the focus on their progress with using strategies, not their appearance: Teens with BFRBs can be very self-conscious about the appearance of the area their BFRB involves. It is best not to comment on their appearance, even if you’re commenting that the area is looking better, because this implies that the area looked bad before and can induce shame. Instead, use positive reinforcement by praising or rewarding them when you notice they’re using strategies to help reduce the behaviors – make sure to talk with them beforehand about what would be rewarding to them for you to say or do.
- Do not share with others about your teen’s BFRB without their permission: BFRBs, just like any other mental health condition, can be an intimate subject, so asking your teen before you share this information with others shows that you value their right to privacy. Especially if a teen is feeling self-conscious about their BFRB, finding out that people were told about their condition without their knowledge can feel invasive and upsetting.
- Do not over-focus on the BFRB: When a teen is really struggling with a BFRB, it can be easy to go into overdrive trying to get them the right help, talking to them about it, and frequently checking in with them. While it is great to provide them with help and support, narrowing your focus too much on the BFRB can make them feel like that is all you care about. During this challenging time in your teen’s life, don’t forget about all the other wonderful aspects about them and make sure to keep some normalcy in their life as well. Foster their passions, ask them about their day, point out things you love about them, show interest in multiple areas of their life – your teen is such a unique, multifaceted person!
Community is also such an important resource for people with BFRBs, especially teens who can be prone to self-isolation. Group work can be an integral part of BFRB treatment, and we recently highlighted the benefits of groups in a previous article. Your teen knowing they are not alone in this struggle and that there are other teens like them who have BFRBs can be so helpful in their treatment and recovery. Connecting them with people with BFRBs through social media or support groups can be a huge support for your teen. We have an 11-week virtual therapy group for high school and college students meeting on Thursday evenings starting November 30th, 2023 which you can check out here. This could be a great option if your teen is ready to start working on their BFRB!
If you want to learn more about BFRBs and receive some support from others in the BFRB community, you can join our Facebook group Overcoming Skin Picking and Hair Pulling: Help for BFRBs. This group is open to any adult with a BFRB, parents of children with BFRBs, and therapists wanting to learn more about BFRBs.
Lauren Hendrix is a therapist here at The Center for Mindfulness & CBT and has experience treating teens with BFRBs. She currently has openings for individual therapy appointments and would love to support your teen if they are ready to receive help and start working on their BFRB. Click here to view her bio and request an appointment.