There are many opinions or even just curiosity throughout the body-focused repetitive behaviour (BFRB) community about whether recovery is possible. With how much is still unknown about BFRBs, it can probably seem premature to even make that call. But we don’t believe it is too early, and with the responses we got from the professionals we spoke with, they don’t seem to feel it is either.
When we asked if they believe BFRB recovery is possible, Karen Pickett, LMFT, Stacy Nakell, LCSW, and Kimberley Quinlan, LMFT gave a resounding yes. Pickett and Nakell even shared that they have recovered or are in recovery from excoriation (skin-picking) disorder themselves.
How these pros define recovery, though, may surprise you. Pickett defines recovery as a significant reduction of urges and engagement with the behaviours, something that’s achieved over time with proper treatment and/or support. Nakell agrees, noting that she sees relying on the BFRB less alongside development of healthier emotional regulation skills as being recovery. For Quinlan, she described it as “not feeling held hostage to one’s urges.”
“I believe it’s important that those dealing with BFRBs understand that recovery doesn’t mean you will never engage in the behaviour again,” Pickett says. “Why? It’s unrealistic because these behaviours exist in the entire human population as grooming behaviours.”
When thinking of BFRBs, obsessive compulsive disorder (OCD) probably jumps to mind first, or maybe even its old designation as impulse control disorders. It’s true, BFRBs are currently categorized as obsessive-compulsive related disorders in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, but apart from that designation, these behaviours do have their roots in grooming behaviours. It’s not uncommon for people to pull a hair, pick at a scab, or bite their nails. BFRBs just take it to the next level—a grooming behaviour in overdrive.
With her 20 years of experience treating BFRBs, Pickett says she’s helped others with their recovery from BFRBs. One of the most notable cases for the BFRB community is her helping Angela Hartlin with her recovery after they appeared on the show The Doctors in 2015.
Nakell also has seen BFRB recovery with her clients.
“Most of my clients get better, both in relying less on their behaviour and in becoming more assertive and having healthier relationships,” she says.
That’s not to say that recovering from your BFRB is without its challenges, even if you connect with a professional. To start, they each agree that recovery is not one size fits all.
“While the treatment is the same, the supplemental work is different,” Quinlan explains.
Many BFRB treatment providers turn to cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT), or even habit reversal training (HRT). As a subsect of CBT, ComB—Comprehensive Model for Behavioural Treatment—is another that’s being explored by those who treat or work with people with BFRBs.
Pickett says that many with BFRBs share common traits and experiences, but ultimately, each person is unique and the treatment is tailored to address the individual even if the overall methodology is something used with other clients. She also says that it’s important to allow each person to decide what recovery means to them.
Other challenges that these professionals see when it comes to BFRB recovery are things like expecting quick results, giving up, negative self-talk, wrestling with stigma, and letting go of the hate for BFRBs.
“Paradoxically, we are more likely to loosen the grip of the behaviour if we let go of hating it,” Nakell says.
So where do you start with overcoming these challenges and finding BFRB recovery? Finding the right support is a big one. This could be starting small with telling someone you trust about your BFRB or seeking out a professional treatment provider who can work with you. Quinlan encourages people to not be afraid to ask for help.
Being kinder to yourself when it comes to your BFRB is also a good first step.
“Your picking, pulling, or biting have helped you calm your restless hands for a long time!” Nakel notes. “You can learn other ways to release that tension. It just takes a lot of support and time.”
Learning is another standout component. Pickett says learning everything you can about BFRBs through reputable sites like canadianbfrb.org and bfrb.org is a good starting point, and then you can take that knowledge to share with your loved ones. She does have a word of warning for your searches, though.
“Don’t believe in promises of quick fixes because you’re likely to end up very disappointed. Find a knowledgeable and supportive community to help you on your recovery journey.”
It’s not all grim though as she adds, “Don’t give up. Don’t put your life on hold until you recover. Do your best and acknowledge your growth consistently!”
So does BFRB recovery have its challenges? Yes. Are there multiple steps to take to address those challenges? Also yes. But is BFRB recovery possible? We’re happy to share that these professionals feel the answer to that, too, is yes.
Find a BFRB treatment provider in your area
- Canadian BFRB Treatment Providers
- Find a Therapist (TLC Foundations for BFRBs International directory)
For additional professional insight on treating BFRBs, check out this podcast from our friends at Fidget: Episode 10: Lop the whole thing off