BFRBs and Why You’ve Never Heard of Them

group counseling sessionBody Focused Repetitive Behavior (BFRB) is a term used to describe disorders that cause people to pull out their hair, pick their skin, bite their nails, or repeatedly damage their body in some other way. These aren’t just habits, but rather very complex psychological disorders that result in substantial physical damage to the hair or skin. While the BFRB is self-inflicted, it is not the same as self-harm. People with BFRBs are not trying to inflict pain or harm to themselves, and in fact often find that the behavior is self-soothing, similar to thumb-sucking. Individuals with a BFRB usually want desperately to be able to stop the behavior; yet, at the same time find the behavior to be very positively reinforced.

Current research suggests that three percent or more of the population has a BFRB, which is over ten million people in North America alone. Despite these disorders being more common than anorexia, most people have never heard of them. This is due to the stigma surrounding these disorders, which is much greater than that of other psychological disorders. Most people with a BFRB are embarrassed and/or ashamed about doing the behavior, and since they do not even know that the behavior is related to a disorder, they do not seek help. This causes many with the disorders to hide their behavior for decades, often causing them to isolate from family and friends. The most devastating aspects of the disorders tend to be the shame and isolation that results from the stigma associated with these disorders, which can be altered over time through awareness. By spreading awareness of these disorders, more people will realize that help is available and will no longer have to suffer in silence, and eventually these disorders may not be viewed as negatively as they currently are.

The two most common types of BFRBs are Trichotillomania and Excoriation Disorder. Trichotillomania, also known as Hair Pulling Disorder, causes people to pull hair from their scalp, eyelashes, eyebrows, or other parts of their bodies, often resulting in noticeable bald patches. Similar to nail biting, this behavior often develops into a habit that becomes very hard to resist, even though those who do it want nothing more than to stop pulling. Trichotillomania typically occurs in high-functioning, intelligent people, and is not a sign of a more serious mental illness. 

Excoriation Disorder, also known as Dermatillomania or Skin Picking Disorder, involves excessively picking or scratching at skin anywhere on the body, often to remove or “fix” a perceived imperfection. Similar to hair pulling in Trichotillomania, the behavior of skin picking is very difficult to stop, and in extreme cases can cause life threatening skin infections. While many people pick at their skin or pop pimples, Excoriation Disorder is only diagnosed when the behavior causes significant emotional distress or physical harm to the skin. Skin picking can become very dangerous and even life-threatening, as some people with the disorder will develop serious infections from picking.

The good news is that treatment is available for these disorders. While the research in this field is minimal due to the fact that these disorders are not well-known, research has found that Cognitive Behavioral Therapy (CBT) and Mindfulness are effective in reducing symptoms. In addition to a reduction of the behaviors themselves, therapy helps reduce the shame and isolation that those who suffer with them often feel. Medication can also be helpful in reducing co-existing conditions such as anxiety and depression. 

At The Center for Mindfulness & CBT, we offer individual, family, and group therapy for those suffering from BFRBs, as well as medication management. Group therapy is led by Dr. Laura Chackes, a psychologist who has specialized in treating BFRBs for over a decade, and combines support with the latest evidence-based treatment approaches. While most are anxious about attending group for the first time, they find tremendous relief in knowing they are not alone, and with support from other group members begin on the path to reducing their BFRB and gaining self-acceptance.