What are BFRBs?
BFRB is short for body-focused repetitive behaviors. This is an umbrella term for a wider group of a connected disorders. These include conditions like excoriation disorder (dermatillomania), trichotillomania, rhinotillexomania (nose picking), nail biting, cheek biting, etc.
BFRBs are more common than most people think and tend to include the weight of a lot of shame and stigma attached. They can result in skin or tissue damage, infections and even scarring, and hair pulling can lead to hair loss. We treat them as psychological disorders because their causes appear to be psychological, as well as their consequences: low self-worth, body image issues, guilt, shame, anxiety, etc.
Our approach is
highly individual
Every person is different and it’s not wise to generalize about causes and consequences. For some people, BFRBs may be stand alone issues, whereas for others they may be coupled with OCD, anxiety or mood disorders, or they can come about as a result of trauma. This is precisely why we are concerned in understanding peoples’ experiences and not putting them in prefabricated boxes.
A common mistake that people make is to treat BFRBs as mere habits. They, indeed, include a habitual aspect, but they are much more than that. Often, once people begin treatment, they uncover numerous complex and even contradictory functions that BFRBs perform: on one level, they may cause significant problems and social withdrawal, but on another level, they may be experienced as a necessary tool for self-regulation.
In DSM 5, BFRBs are classified as obsessive-compulsive and related disorders. This means they share some characteristics of OCD but they are distinct entities.
-
At this time, there is no comprehensive theory that explains the causes of BFRBs. As it is often the case when it comes to our behaviors, emotions and thoughts, causes are multiple, complex and highly individual. Remember: everyone has their own life story and symptoms arise from that highly specific context. It’s difficult and not always helpful to generalize.
When it comes to mental health, we like to look at causes and consequences from three distinct perspectives: from a biological, psychological and social perspective. Each person will have a different combination of the three. We can see them as partly biological, because grooming behavior is genetic and present in different species, not just in humans. We can see BFRBs as psychological because, like everything else related to our behaviors, they have deep psychological meaning and perform a function in our psychological life. We can see them as social too, because they can bring about rather undesirable social consequences and they play a role in how we’re perceived (and, in turn, how we perceive ourselves). They can be seen as social in part because some research indicates gender disparity (more women than men report struggling with BFRBs) and gender roles tend to be heavily socially regulated. When a man pulls his hair, that has entirely different social meaning than when a woman pulls her hair.
-
Roughly speaking – and this may not apply to everyone! – we can think of BFRBs as dysfunctional mechanisms of emotional regulation. A commonly reported effect of hair pulling or skin picking is soothing, often followed by shame, guilt or remorse. The self-soothing, however, plays an important role in maintaining BFRBs, as this allows a person to get temporary relief from intense private experiences such as feelings, thoughts or memories.
Shortly put: BFRBs allow you to cope with your emotions without having to feel them fully and process them psychologically.
-
At the time of writing this article, FDA hasn’t approved a single drug to treat BFRBs, although some are prescribed off-label with varying degrees of success. Even though the number of studies testing different pharmacological treatments for BFRBs are growing, they are still insufficient and usually feature small sample sizes or other methodological limitations that make it difficult to reach definitive conclusions.
Several types of psychotherapy were tested in numerous studies and shown to be effective, most of them belonging to cognitive-behavioral therapies. Habit reversal training, stimulus control, acceptance and commitment therapy all seem to be effective ways of treating BFRBS.
From the available research, it’s possible to say that psychotherapy appears to be a more effective form of treatment.
Keep in mind, however, that psychotherapy is not quick and certainly not easy!
Join today
Get access to monthly webinars and read about latest research and clinical insights, weekly reflection/journaling prompts, exchange experience with other members and learn new coping techniques. Connect with other people on the same journey.