What is Body Focused Repetitive Behavior?
Body focused repetitive behavior (BFRB) or body focused repetitive disorder refers to a grouping of compulsive behaviors that damage an individual’s physical appearance through repeated negative tactile attention.
These disorders are considered to be on the obsessive-compulsive disorder spectrum. BRFBs can take a number of forms, focused on different parts of the body.
Common BFRPs include:
- Trichotillomania: hair-pulling that may cause seriously thinned or bald spots, and can include pulling of the eyebrows, eyelashes, and other parts of the body.
- Excoriation Disorder: skin-picking, in which an individual repeatedly touches, rubs at, picks, squeezes, pops, or digs into their skin, often focusing on real or perceived blemishes, scabs, and other imperfections, and leading to open wounds and scarring.
- Onychophagia: nail-biting disorder in which an individual bites or chews their nails to an extreme, often biting nails or cuticles until they bleed, leaving them prone to infection.
What These Disorders Mean for Your Client
These disorders, often linked in their psychological roots, can be co-morbid, and are often performed in states of stress, excitement, boredom, or anxiety. Individuals suffering from these disorders may spend hours per day engaging in the body focused repetitive behavior and the resulting guilt, shame, and change in appearance may seriously impair the individual’s ability to function in daily routines.
These impulsive actions are often dismissed as bad habits but the recent inclusion of these complex disorders in the DSM-V has brought greater awareness and clinical attention to the underlying causes and possibilities for treatment of these disorders.
These behaviors are distinct from bad habits in that they cause distress and impairment, cause significant damage, and individuals engaging in such behaviors have tried repeatedly without success to decrease or stop the behavior.
Unlike a bad habit, these are chronic conditions that cannot easily be fixed. A defining feature of body focused repetitive behavior is the way individuals experience the urge to pick/pull/bite a compulsion, and managing those urges is a constant cognitive process.
The causes of body focused repetitive behavior, like many behavioral issues, cannot be clearly defined as there is great variation between individuals who engage in BFRB.
However, research has shown a variety of factors that can contribute to the development of BFRB, including:
- Genetics: an inherited predisposition to BFRB, meaning multiple family members often exhibit the same or similar symptoms
- Stress and anxiety: many individuals engage in BFRBs in moments of stress and anxiety, feeling the urge to engage in the behavior build with the stress or anxiety, and finding some relief after engaging in the behavior
- Environmental factors: there is a range of other factors such as the age of onset, family stress, and living situation that impact an individual’s environment and can influence the onset of body-focused repetitive behaviors.
Treatment Options for BFRB
There are a variety of treatment approaches, many of which are still being further investigated as these are still not very commonly known disorders.
Treatment options that have proven useful in some cases are:
- Several approaches to talk therapy, such as psychotherapy, cognitive behavioral therapy, and acceptance and commitment therapy
- Physical barriers, such as gloves, bandages, and even lotions or creams that create a barrier between hands and skin
- Medication, such as antidepressants, anxiety medication, and nutritional supplements to cope with stress and reduce urges
- Support groups, allowing individuals to understand they are not alone and discover what strategies have worked for others
Treatment is an Individualized and Long-Term Process
Treatment for body focused repetitive behavior is a highly individualized and long-term process, with differing results for everyone.
There are many barriers to effective treatment, such as shame and embarrassment, a lack of therapists with experience in treating BFRB, denial of the disorder, and misdiagnosis.
It is important for social workers to be well-informed about the various disorders associated with body-focused repetitive behaviors, and to remind clients that recovery is possible.
1 Fawcett, K. Understanding Body-Focused Repetitive Behaviors [Internet]. U.S. News and World Report, 2015, Aug. 10. Available from: http://health.usnews.com/health-news/health-wellness/articles/2015/08/10/understanding-body-focused-repetitive-behaviors