Body-focused repetitive behaviors (BFRBs) can often make us feel like we have no control over our behaviors and are at the mercy of an endless cycle. We scratch our skin, pull out our hair, pull out our nails, etc. We tell ourselves we won’t pick or pull again and then we end up falling back into the same old habits and routines. Cue the spiral of shame, frustration, guilt and helplessness.
Understanding BFRBs
Body-focused repetitive behaviors include things like skin picking (excoriation disorder), hair pulling (trichotillomania), nail biting/picking, cheek biting, and more. Unfortunately, due to the shame and embarrassment caused by these behaviors and the possible notable consequences (i.e. bleeding nails, bald spots, split scabs, etc.), they often go unreported or undiscussed. Therefore, they are not as well researched as many other mental health disorders.
However, there is enough research to suggest that these can be understood and treated successfully in most cases. The process of a BFRB often begins with a need to engage in the behavior. This urge can be the result of internal or external triggers, such as a sensory cue (itchy sensation), an emotional cue (boredom or anxiety), a cognitive cue (hair is gray/out of place, nails are too long, etc.) or others. This is not always conscious of the person, which makes it difficult to resist the urge.
Treatment of BFRBs
When working with a mental health professional specialized in treating BFRB, the evidence-based treatment is the Comprehensive Model of Behavior (ComB). The therapist works to increase awareness of the individual’s internal and external triggers. They come up with competitive strategies to implement once they realize their impulses. After practicing these competitive strategies, they learn that impulses and sensations pass and that they can successfully overcome that experience without having to continue pinching, pulling, or biting. These strategies might include learning new ways to respond to your emotions, finding other ways to “satiate” the physical sensation, or removing external triggers (i.e., tweezers) from your sight. The more often they overcome this, the more they experience less intense urges and sensations and the more confident they can successfully manage their BFRBs.
Anyone who has tried to monitor their BFRB in the past will probably say that it is quite a task. However, this can be much more challenging when we are in environments where the skills are not available. The good news is that we can still set ourselves up for success even in places that are not ideal.
Choose strategies you can implement
Here are 6 ways you can prepare to combat your BRFB outside your home:
- Place a visual cue to remind you to implement your strategies. It could be a sticky note, a picture, a single word, or anything else that simply reminds you to use your skills.
- Have a bag of items on hand that can serve as competitive strategies. Maybe use a furry ball to squeeze, hair ties to tie it back, long sleeves to cover your arms, or a pair of gloves to make it harder to pick up or pull.
- Focus on mindfulness strategies, specifically attending to your five senses. By doing this, you will be able to stay off “autopilot” and remain aware of your actions. Many times our BFRBs present with boredom, anxiety, distress or other emotions that we experience when we are not present.
- Take a few moments to review your goals regarding picking up or throwing. For example, maybe you want your bald spot to grow back, or you want your cuticles or other scabs to stop bleeding, etc. Maybe you just want to feel like you have more control over your body.
- Reach out to and utilize your support system. This might involve talking to someone who knows your struggles while you’re driving home, or playing a podcast to help you stay focused on your goals.
- Place something that serves as a tactile stimulus in these places. A piece of Velcro could be used on the back of the steering wheel or under the desk at work or school. With this strategy, less destructive stimulation is provided to your fingers.
Planning is key
The cycle of any BFRB can be difficult to break, but with a solid plan in place and consistency in practicing your skills and strategies, it absolutely can be done.
To create an effective plan, ask yourself these questions:
- Am I willing to be uncomfortable and overcome impulses in this environment?
- What will I have access to wear/bring?
- Does anyone there already know my BFRB and support my treatment and strategies? If so, how can I use them or ask for help?
Like anything else worth achieving, it will be a process that will include both successes and failures. If you’re already seeking professional help, try adding these tips to your list of strategies. If not, and you are having difficulty coping with these unwanted pinching/pulling behaviors, find a professional who specializes in cognitive behavioral therapy for BFRB.
This publication is brought to you in collaboration with the ADAA OCD and Related Disorders SIG. Learn more about GIS.
