BFRB stands for body-focused repetitive behaviour. This is an umbrella term for a group of repetitive self-grooming behaviours in which an individual damages* their appearance or causes physical injury through pulling, picking, biting or scraping of the hair, skin or nails.

BFRBs are currently mentioned in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. They’re classed as obsessive-compulsive related disorders. Over time these conditions can cause very significant distress, which can affect work, social and daily activities. Learn more here: What the DSM-5 Says About BFRBs

An estimated 1 in 20 people have a BFRB.

BFRBs are not considered self-harm because the intent of the behaviour is not to harm oneself, but rather to fix, correct or otherwise make better some aspect of physical appearance (for example, get rid of a blemish, or a hair that doesn’t seem to belong). BFRBs are also a coping mechanism for overwhelming emotions, but once again the intent is not to cause damage. When it comes to BFRBs, the physical damage done is just a by-product of the behaviour. Learn more: Why BFRBs Are Not Self-Harm Behaviour

• Trichotillomania / Hair Pulling Disorder (Trich/ TTM) – The compulsive urge to pull out hair from various parts of the body resulting in noticeable hair loss. Areas where pulling usually occur include scalp, eyelashes, eyebrows, arms, legs, and pubic area. This is a diagnosable condition since 1987.
• Excoriation (Skin-Picking) Disorder / Dermatillomania (Derma / Derm) – The compulsive urge to pick at one’s skin resulting in noticeable damage (sores, scabs, infections) and scarring. Common areas include face, head, cuticles, back, arms and legs, hands and feet. This is a diagnosable condition since 2013.
• Trichophagia / Hair Eating Disorder – Coinciding with trichotillomania, trichophagia is the compulsive urge to eat or ingest the hair that has been pulled. In extreme cases, this can lead to a hairball called a trichobezoar, which can cause significant health problems. Removal of the hair ball is usually done through surgery.
• Dermatophagia / Skin Biting Disorder – This can manifest in a number of ways, including biting lips, cheeks, and around the nails.
• Onychophagia / Nail Biting Disorder – The severity and extent of damage to the skin and nailbeds is variable, but can lead to damaged nailbeds, infections, pain in the fingers, and torn skin around the fingernails. Some signs include short nails, skin damage around nails, bleeding skin around nails, and callouses.
• Rhinotillexomania / Nose Picking Disorder – Not to be confused with people picking thier nose from time to time for strictly hygienic purposes. Compulsive nose picking causes a greater risk of infection/damage to the lining of the nose.
• Trichotemnomania / Compulsive Hair Cutting – Those with this BFRB compulsively cut or shave their hair.
• Scab Eating Disorder – This often accompanies excoriation (skin-picking) disorder and involves the individual ingesting the picked scab.

Anyone, regardless of gender and age, can have a BFRB. Studies show more women than men reporting having a BFRB, but these numbers can be impacted by lack of reporting due to shame and older studies that didn’t take into account gender identity.

The most common age of onset is reported to be adolescence, but many with BFRBs say they developed their BFRB earlier (as toddlers) or later (as adults).

Research indicates these behaviours are possibly related to genetics and/or environmental causes, but there is no concrete answer yet as to why people begin these behaviours. At their core, picking, pulling, and biting are grooming behaviours common to humans, and BFRBs appear to be overactive grooming drives. These behaviours are often used as coping mechanisms to regulate emotions and over- or under-stimulation. The symptoms are not negative personality traits or something that a person can just “snap out of” or stop.

These are highly misunderstood and ridiculed conditions, which leaves people feeling heavily ashamed and scared to tell even their loved ones about their struggles. This often leads people to believe they are the only ones with these behaviours and they suffer silently.

We love that you want to be there for your friend, family member, or loved one. That’s a great first step in helping them. Letting them know that you’re there for them without judgement whenever they’re ready to talk is key. You can education yourself and then, when they’re ready, share resources from websites like ours, the TLC Foundation for BFRBs, PickingMe Foundation, and other mental health organizations that have information about BFRBs. Most importantly, ask your friend, family member, or loved one how they want to be supported and in what ways you can help them.

First and foremost, be there to support your child. Punishing your child for their behaviour is not recommended. Although it may seem like a good deterrent, BFRBs are a group of disorders, not just bad behaviour that can be solved by punishment. Keep in mind that your child very likely doesn’t want to pick, pull, or bite and is probably ashamed of the behaviour. They probably want to stop just as badly as you want them to.

Knowledge is power! Educate yourself about BFRBs and if you take your child to the doctor for the behaviour(s), bring some printed materials and information along with you. It will take some effort, but find what’s best for your child as they deal with their BFRB(s).

While there is no one-size-fits-all treatment for BFRBs, there are a number of options you can explore. Read more about these below.

• Treatment options including CBT, ACT, HRT, and ComB
• An Inside Look at BFRB Treatment Providers
• An Inside Look at BFRB Coaches
• Peer Support Groups

Many doctors still aren’t familiar with BFRBs and their specific needs when it comes to treatment. While there are specialists familiar with BFRBs, if there isn’t one in your area or that you can reach out to, be sure to go prepared with BFRB information the next time you see your doctor.

At this time, there are no cures. Researchers specializing in BFRBs are still working to unravel many of the mysteries of these disorders and to find the most effective treatments and, hopefully, a cure. With treatment, BFRBs can be reduced to a minimum (although even that isn’t guaranteed), but there is no cure-all to stop completely. With that being said, there are people who have gone without engaging in the behaviour for years and others still who live full, happy lives even with their BFRBs. Be wary of those offering quick fix solutions.