Body Focused Repetitive Behavior Bfrb

Overview

Body-focused repetitive behaviors (BFRBs) are actions where a person repeatedly touches, pulls, picks, or damages their own hair, skin, nails, or other parts of the body. Common examples include hair pulling, skin picking, nail biting, and cheek chewing. These behaviors are not deliberate self-harm – they often happen as a way to cope with stress, anxiety, or other strong feelings. People may feel unable to stop even if they want to.

Yes. It is estimated that up to 5% of people have a BFRB at some point in their lives, though many do not talk about it or seek help.

People of all ages, genders, and cultural backgrounds. BFRBs often begin in late childhood or the teenage years, but they can start at any age. Many people feel embarrassed about it, so it may be under-reported.

Symptoms

Common symptoms

• Repeatedly pulling out hair from your scalp, eyebrows, eyelashes, or elsewhere
• Picking at healthy skin, minor blemishes, or scabs
• Biting your nails or cuticles until they bleed
• Chewing the inside of your cheeks or lips
• Feeling an urge before the behavior and tension after
• Trying to stop the behavior but having difficulty
• Spending significant time on these behaviors, sometimes for hours

Symptoms in children

• May be linked to stress at school or home
• Children may hide the behavior, so parents might see bald patches, damaged clothes, or missing eyelashes
• A child may not be able to explain why they do it
• They may feel shame or worry about being judged

Symptoms in older adults

• May be mistaken for normal aging or a skin condition
• Can be triggered by loss, change, or chronic stress
• Might coexist with other conditions such as dementia, but not always
• Health care workers may need to ask directly about the behavior

Causes

Main causes

• The exact cause is unknown. Research suggests BFRBs are linked to differences in how the brain regulates habits, impulses, and emotion.
• They are not a sign of laziness or a personality flaw.
• Many people feel a build-up of tension before the behavior and relief afterward, which can make the habit stronger.

Risk factors

• A family history of BFRBs or other compulsive behaviour
• High levels of stress or anxiety
• Perfectionism or being hard on yourself
• Age – it often starts in adolescence
• Certain life changes such as loss or separation, though anyone can develop it

When to see a doctor

See a doctor urgently if:

• If the behavior is causing severe damage, infection, or bleeding that you can't control
• If you feel like you might hurt yourself

Book a routine appointment if:

• You don't have to wait for a crisis. Talk to your GP if BFRB is affecting your daily life, your mood, your appearance, or your relationships.
• A doctor can offer understanding and refer you for effective treatment.

Diagnosis

A healthcare professional will ask about your symptoms, how often you do the behavior, and how it affects you. They will ask whether you feel a sense of relief after doing it. There is no blood test or scan for BFRB – the diagnosis is based on a detailed discussion.

Tests that may be done

• Often no tests are needed.
• If there are skin or hair changes, the doctor may examine the area.
• They might order blood tests to rule out other conditions like iron deficiency anaemia, which can affect hair or skin.
• You may also be asked about mood and anxiety.

What to expect at your appointment

Your doctor will listen without judging. They may ask about stress, sleep, and how long you've had the behavior. You can bring a diary or photos if helpful. They will explain treatment options and, if needed, refer you to a mental health specialist or psychologist.

Treatment

The most effective treatment for BFRB is cognitive behavioural therapy (CBT), particularly a technique called habit reversal training. This helps you notice the situations that trigger the behaviour and replace it with a harmless alternative. Some people may also benefit from medication, but this is not a first step for everyone. Always discuss options with a qualified professional.

Self-care at home

• Keep a diary of when the urge appears – noticing patterns is the first step to change.
• Try a harmless alternative, like squeezing a stress ball or playing with a smooth stone, to give your hands something else to do.
• Set small goals – for example, avoiding nail biting for one hour at a time – and reward yourself.
• Create physical barriers: wear gloves, keep nails very short, or use bandages on frequently picked areas.
• Reduce stress with deep breathing, mindfulness, or talking to someone you trust.

Medical treatments

Talking therapies are the main medical approach. In some cases, a doctor may prescribe a type of medication to help with urges or related anxiety or depression. This decision is always made together with your doctor and is tailored to you.

Living with this condition

Living with BFRB can feel frustrating, especially because the behavior can be hidden or dismissed as a 'habit'. Try to be kind to yourself. Build awareness by using notes or sticky reminders, and give yourself a 'safe' place to manage urges, like washing your hands or using a fidget toy. Keep your hands busy during low-level activities like watching TV. Seek support from someone you trust – you don’t have to manage alone.

Lifestyle tips

• Get enough sleep – tiredness makes urges stronger.
• Exercise regularly – it is a healthy way to release built-up tension.
• Practise relaxation techniques such as deep breathing or progressive muscle relaxation.
• Avoid caffeine or stimulants late in the day if they make you feel more tense.

Diet and exercise

There is no special diet for BFRBs. Eating a balanced, regular diet and staying physically active support your overall wellbeing and can help improve mood and resilience. If the behaviour affects your eating or you have dental damage from cheek biting, speak to your doctor or dentist.

Mental health and emotional wellbeing

BFRBs can cause significant embarrassment, shame, and anxiety. People often isolate themselves or avoid social activities. It is important to remember that you are not alone and that these feelings are part of the condition. 'Just stop' does not work. The right therapy can help you feel more in control and less burdened.

Prevention

There is no sure way to prevent BFRBs. But recognising early signs and getting help early may make it easier to manage. For parents, if you notice your child has patterns of pulling or picking, talk to a health professional rather than telling them off – a positive approach works better.

Screening programmes

There are no routine screening tests for BFRBs. However, doctors can ask about repetitive body-focused habits during general health visits, especially if there are signs of hair or skin damage. If this happens, it is an opportunity to talk openly and get help.

Complications

If left untreated

• Hair loss or bald patches that may be permanent if damage is repeated
• Skin wounds that become infected or leave scars
• Damage to teeth or gums from cheek biting
• Social and work problems due to shame
• Anxiety or depression

Long-term outlook

With the right support, most people improve. Treatment is not quick – it takes practice – but many people find they can dramatically reduce the behavior and feel more confident. Even if full control is not possible for everyone, learning to cope differently can make a big difference to your quality of life.

Find support

International organisations

• The TLC Foundation for Body-Focused Repetitive Behaviors ↗

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