Why Body-Focused Repetitive Behaviors Are More Than Just a Bad Habit

Apr 14

Author: Mokshvi Shah, BS Northeastern University Student

Published: April 2024

If you’ve ever found yourself biting your nails until they bleed, pulling out strands of hair without even realizing it, or picking at your skin for hours, you may have heard phrases like:
"Just stop doing it,"
"It’s just a bad habit," or
"You’ll grow out of it."

But here’s the truth: Body-Focused Repetitive Behaviors (BFRBs) are not just bad habits. They are complex mental health conditions that deserve understanding, support, and effective treatment.

What Are BFRBs?

Body-Focused Repetitive Behaviors (BFRBs) are a group of conditions that involve repetitive self-grooming behaviors that can cause physical damage to the body. These behaviors often serve as a way to manage stress, anxiety, boredom, or tension.

Some common BFRBs include:

Trichotillomania – hair pulling
Dermatillomania – skin picking
Onychophagia – chronic nail biting
Cheek biting or lip biting

While everyone engages in these behaviors from time to time, BFRBs become problematic when they’re frequent, feel uncontrollable, or lead to distress and impairment in daily life.

Why It’s More Than a Habit

Let’s break down a few myths and truths:

Myth: “You’re just doing it for attention.”

Truth: Most people with BFRBs go out of their way to hide their behavior. There’s often deep shame and secrecy involved.

Myth: “You could stop if you really wanted to.”

Truth: BFRBs are not a matter of willpower. They’re often automatic, meaning people engage in them without even realizing it, especially during moments of stress, fatigue, or even intense focus.

Myth: “It’s harmless.”

Truth: BFRBs can lead to physical scarring, infection, hair loss, emotional distress, and social withdrawal.

These behaviors fall under a category called Obsessive-Compulsive and Related Disorders in the DSM-5, which speaks to their clinical significance. They are neurological, psychological, and emotional in nature, not laziness or self-sabotage.

What Triggers BFRBs?

Triggers can vary, but some common ones include:

Stress or anxiety
Boredom or restlessness
Perfectionism or feeling “something isn’t right”
Sensory triggers (e.g., rough skin, a split end, etc.)
Emotional overload or numbness

Many people report a kind of temporary relief, release, or satisfaction during the behavior, followed by guilt, embarrassment, or distress afterward. It’s a cycle that can feel confusing and frustrating.

How Are BFRBs Treated?

There is help and hope for people struggling with BFRBs. Treatment approaches often include:

Cognitive Behavioral Therapy (CBT)

CBT helps individuals recognize thought patterns and triggers that fuel the behavior and replace them with more adaptive coping strategies.

Habit Reversal Training (HRT)

This is one of the most evidence-based interventions for BFRBs. It involves awareness training, identifying urges, and substituting the behavior with a “competing response,” a behavior that is incompatible with the BFRB.

Mindfulness & Emotion Regulation

Practices that improve emotional regulation and body awareness can reduce the urge to engage in repetitive behaviors, especially for those who use BFRBs to manage distress or sensory discomfort.

Support Groups and Therapy

Knowing you’re not alone is incredibly healing. Many people find comfort and motivation through group therapy, peer communities, or individual counseling with a therapist who understands BFRBs.