Body-Focused Repetitive Behaviors

Millions of people around the world suffer from Body-Focused Repetitive Behaviors (BFRBs). These are common and often misunderstood disorders.

Body-Focused Repetitive Behaviors


Millions of people around the world suffer from Body-Focused Repetitive Behaviors (BFRBs). Two of the most common are Trichotillomania (TTM; pulling hair from the head, face, or other parts of the body) and Excoriation Disorder (ED; an intense urge to pick, squeeze, or scratch the skin). About 2-5% of people around the world suffer from TTM, and about 5% suffer from ED.

Some Background

  • TTM
    • Pulling out hair from the scalp, eyebrows, eyelashes, or elsewhere on the body
    • Visible hair loss
    • In extreme cases, TTM sufferers swallow the hairs, which can lead to intestinal blockages
  • ED
    • The targets often are skin imperfections on the face, nails, cuticles, scalp, chest, legs, back, and lips
    • Can result in sores, abscesses, or harsh skin damage, sometimes requiring a skin graft

Sometimes viewed as “nervous habits”, BFRBs can be diagnosed as a type of OCD. Some theories suggest that BFRBs reduce stress or anxiety. Also, an imbalance of the neurotransmitters dopamine and serotonin can affect BFRBs. 

BFRBs can start at any age: the onset of hair pulling can occur as early as age five, and the onset of skin picking normally occurs during adolescence. Most BFRBs present before age 12, yet they can continue for a lifetime. Moreover, BFRBs can impact anyone, regardless of ethnicity or socio-economic status.

How can you manage these disruptive behaviors? Specific therapy can help.

Cognitive Behavioral Therapy (CBT) is the treatment of choice for BFRBs. CBT identifies the sensory, cognitive, emotional, situational, and other behaviors associated with BFRB behavior. Although some medications help as well, studies show that CBT is superior to medication alone. Beyond CBT, other therapies include Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT). 

To provide optimal therapy for BFRBs, I start with a full assessment, including a behavioral analysis. In session, I help you create responses to the BFRBs to either compete with or satisfy urges, to help you handle the impulses better.

The process takes time, and learning from setbacks from slip-ups and getting back on track is key. Ultimately, with the right help and guidance, you can live a better, happier life without BFRBs.