Body-focused Repetitive Behaviors
Body-focused repetitive behaviors (BFRB’s) are repetitive, excessive, grooming behaviors that result in damage to the body. Common BFRBs include hair-pulling, skin-picking, nail-biting and cheek-biting, although there are other behaviors that fall into the BFRB category because they share common characteristics, including damage to the body and significant distress or impairment in functioning. Here are the names and brief descriptions of some BFRB’s:
- Hair-pulling (Trichotillomania) entails pulling hair from the scalp, eyebrows, eyelashes or other areas of the body, often resulting in noticeable hair loss.
- Skin-picking (Excoriation Disorder) involves repeatedly picking at the skin, leading to skin lesions.
- Onychophagia refers to chronic nail biting, which can damage the nails and surrounding skin and may lead to infections.
- Dermatophagia involves biting of the skin, such as the cuticles and digesting scabs or skin, associated with skin-picking disorder or nail-biting. Lip, cheek, and tongue biting may be considered dermatophagia as well.
- Trichophagia is eating of hair, which can lead to gastrointestinal problems such as trichobezoars (hairballs) in severe cases.
BFRB’s are not the same as obsessive-compulsive disorder; nor are these behaviors generally symptomatic of deep emotional issues or trauma or associated with self-mutilation or eating disorders. However, some individuals may have a major depressive disorder in addition to BFRB’s.
Research into the causes of BFRB’s is relatively new and has focused more on hair-pulling although there are studies that have looked at skin-picking. Several studies show a higher number of BFRB’s in immediate family members of persons with skin-picking or hair-pulling disorders than would be expected in the general population. Examination of hair-pulling in identical and fraternal twins produced results consistent with a significant inherited component in hair-pulling disorder. (See https://www.bfrb.org/faqs/what-causes-bfrbs.) An inherited predisposition to develop a BFRB most likely interacts with other variables, such as environment and stress, that affect the likelihood that a person will develop a BFRB.
The research into treatment of BFRB’s is growing. Cognitive- behavioral therapy is the treatment of choice for BFRB’s, specifically habit-reversal training. Comprehensive behavioral treatment (ComB) is widely used, and other CBT approaches are employed to enhance treatment, including acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT). There is no FDA-approved medication for treatment of BFRB’s; however, there is research suggesting that some people may benefit from N-acetyl cysteine, a nutritional supplement; olanzapine, or clomipramine.
