A BFR What?

by Andy Conrad, MA, PLPC, NCC

This is another important acronym to know! A body-focused repetitive behavior (BFRB) falls under the obsessive-compulsive and related disorders category, characterized by body-focused, persistent urges and/or thoughts, followed by compulsive responses. These symptoms cause a significant amount of distress and/or impairment in a person’s functioning in important areas of life. In the general population, the prevalence is 2-5% for adults and adolescents, with over three-fourths being female. These statistics are subject to scrutiny due to social and cultural factors that may inhibit reporting. 

A BFRB is an often-overlooked diagnosis and one that so many people hide from the rest of the world. Those individuals suffering from compulsive hair-pulling (trichotillomania), skin-picking (excoriation), nail-biting, and other repetitive behaviors may feel a loss of control, isolated, embarrassed, guilty, shameful, depressed, anxious, and misunderstood. These overwhelming sensations come from the visual and social implications, the inability to refrain from the behaviors, lack of understanding from peers and loved ones, and the belief that those people with a BFRB simply aren’t trying hard enough to “get over it.”

Hair-pulling and skin-picking are not a “choice” for someone meeting this disorder head on. Many supportive friends and family make the mistake of pleading with a person with a BFRB to just “stop” because it is annoying, disruptive, or worrisome. There is no cure for a BFRB, and each person experiences various precipitating factors: life stress, anxiety, depression, nondescript urges, specific tinglings, body image issues, and boredom. 

Episodes of compulsive behavior can be brief or may last for hours. Some of the shared sensations include a tactile satisfaction in the picking or pulling, soothing and calming feelings, and a perceived imperfection on their bodies that is being corrected via the behavior. Unfortunately, this is generally followed by a sense of guilt and regret.

Where individuals find solace and understanding and connection is in a supportive and nurturing environment. And, in a group therapy setting, each person can share strategies, such as using fidgets to occupy hands, covering mirrors, tracking behaviors and triggers, building a sense of acceptance, and setting up a rewards system. The group setting is an important place to provide that feeling of connectedness. So many people with a BFRB live in silence and isolation, but they are not alone!

If you or a loved one is feeling challenged by a BFRB, please don’t hesitate to check out the group at https://mindfulstl.com/groups/body-focused-repetitive-behaviors-bfrb-groups/. To become a group member or for more information, please contact Dr. Laura Chackes at lchackes@mindfulstl.com.

now offering video therapy sessions

It's more important than ever to take care of your mental health, so all of our therapists are doing Telehealth and many have immediate openings for new clients.