Body-Focused Repetitive Behaviors

Specialized treatment for hair pulling, skin picking, nail biting, and related behaviors

Body-focused repetitive behaviors, or BFRBs, are repetitive behaviors involving the hair, skin, nails, mouth, or other areas of the body. Common BFRBs include:

  • Hair pulling, also called trichotillomania

  • Skin picking, also called excoriation disorder or dermatillomania

  • Nail biting or picking

  • Cheek, lip, or tongue biting

These behaviors can be difficult to explain to other people. You may have been told to “just stop,” become more aware of what you are doing, or find another way to manage anxiety. You may already know that the behavior is causing damage and genuinely want to change it but still find yourself returning to it.

BFRBs are not simply bad habits, and they are not always caused by anxiety. They are complex, learned patterns that may be influenced by sensations, thoughts, emotions, movements, environments, and the consequences of the behavior.

What BFRBs Can Feel Like

Some BFRBs happen with very little conscious awareness. You may notice only after you have been pulling, picking, biting, rubbing, or searching for some time.

Other episodes are highly focused. You may become absorbed in finding a particular hair, texture, bump, scab, split end, or perceived imperfection. The behavior may temporarily feel soothing, satisfying, regulating, or necessary, even when the longer-term consequences are painful.

Many people also experience shame, embarrassment, frustration, or fear of being judged. They may spend significant time covering affected areas, changing clothing or hairstyles, avoiding activities, or trying to repair damage.

BFRBs Are Not All the Same

Two people with the same diagnosis may have very different patterns.

One person may pull hair while reading, driving, working, or trying to fall asleep. Another may intentionally search for hairs that feel coarse, uneven, or “wrong.” Skin picking may begin with acne, dry skin, ingrown hairs, scabs, or a desire to smooth the skin. Nail or mouth biting may be connected to concentration, stimulation, tension, or sensory discomfort.

Effective treatment begins with understanding your individual pattern, not simply telling you to stop.

How We Treat BFRBs

At Burnett CBT, we use the Comprehensive Behavioral Model, or ComB, to understand the factors that contribute to each person’s behavior. ComB breaks a complex behavior into smaller, more understandable parts so that treatment can be individualized. Your current services page already introduces ComB in this way, so this page would expand that explanation rather than repeat it.

Treatment may include:

  • Learning to recognize patterns, triggers, and early warning signs

  • Understanding the sensory experiences connected to the behavior

  • Identifying thoughts and emotions that influence pulling or picking

  • Changing environments and routines that make the behavior easier to perform

  • Developing realistic competing responses and barriers

  • Finding safer ways to meet sensory, emotional, or physical needs

  • Addressing shame, avoidance, and the impact of BFRBs on daily life

  • Practicing skills between appointments and adjusting them based on what actually happens

The goal is not to hand you one or two suggestions or tell you to use more willpower. We work together to understand what the behavior is doing for you and build strategies that fit your life.

Is a BFRB the Same as OCD?

BFRBs are grouped with obsessive-compulsive and related disorders, but they are not simply another form of OCD.

OCD compulsions are generally performed in response to intrusive thoughts, feared outcomes, doubt, guilt, or a need to prevent something bad from happening. BFRBs are often more closely connected to sensory experiences, automatic routines, focused searching, physical gratification, emotional regulation, or a feeling that something on the body needs to be changed.

Some people experience both OCD and a BFRB. Careful assessment helps determine what is maintaining each behavior and which treatment strategies fit.

You Do Not Have to Hide It Here

Many people have done everything possible to keep others from noticing their pulling, picking, biting, hair loss, skin damage, or attempts to cover affected areas. Some have never spoken openly about the behavior, even with previous therapists.

You do not need to arrive with the right terminology or a clear explanation. We can begin by understanding what has been happening, how it affects your life, and what you would like to change.