Body-Focused Repetitive Behaviors, often referred to as BFRBs, are repetitive, ritualized and compulsive behaviors that focus on one’s physical self (Solley & Turner, 2018). For many people, these behaviors—like hair pulling, skin picking, or nail biting—are not just habits, but deeply ingrained responses to stress, boredom, or even moments of stillness. If you’re someone who finds your hands moving before your mind catches up, or if you’ve ever felt ashamed, confused, or isolated by these behaviors, you’re not alone. This space is here to explore those experiences—without judgment, with compassion, and with curiosity.

Body-Focused Repetitive Behaviors Examples

What Are BFRBs?

Body-Focused Repetitive Behaviors (BFRBs) is an umbrella term for involuntary physical actions that often lead to physical injury or impairment (Okumus et al., 2023). These behaviors, while sometimes dismissed as “bad habits,” become pathological when they are repetitive, intentional, and result in visible physical harm and feelings of shame due to the individual’s inability to control them (Solley & Turner, 2018).

The most common types of BFRBs include:

  • Trichotillomania – hair pulling
  • Dermatillomania (Excoriation Disorder) – skin picking
  • Onychophagia – nail biting
  • Lip/Cheek Biting

Over the years, mental health professionals have observed significant changes in how these behaviors are classified and diagnosed. Trichotillomania was first recognized as a disorder in the ICD-9 in 1975, listed under “Other Disorders of Impulse Control” (Body-Focused Repetitive Behavioral Disorders in ICD-11). BFRBs were more formally identified as a specific category in the ICD-10 in 1990. In the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), BFRBs are classified under “Obsessive-Compulsive and Related Disorders” (Moritz et al., 2021).

Who Is Impacted by BFRBs?

BFRBs typically begin earlier than many other mental health disorders, often emerging in childhood or adolescence. These behaviors are more commonly reported among females and are frequently associated with co-occurring conditions such as anxiety, depression, and obsessive-compulsive disorder (Solley & Turner, 2018).

Prevalence rates for BFRBs as a broad category vary across studies, ranging from 0.5% to 4.4% of the population (Okumus et al., 2023). When broken down by specific behavior, prevalence estimates become significantly broader:

Skin Picking: 2% to 20% (Solley & Turner, 2018)
Nail Biting: 6% to 34% (Solley & Turner, 2018)
Lip/Cheek Biting: 6% to 42% (Solley & Turner, 2018)

Body-Focused Repetitive BehaviorsCauses and Triggers

There is no single known cause of Body-Focused Repetitive Behaviors (BFRBs), but over time, professionals have gained a better understanding of the factors that may contribute to their development. A clear genetic component exists, as these behaviors are more common among individuals who have parents, siblings, or other family members with similar experiences (Okumus et al., 2018). Psychological factors also play a significant role; research suggests that BFRBs may serve as self-regulation coping mechanisms in response to stress or chaos within the family system (Okumus et al., 2018). Additionally, these behaviors may be triggered by environmental or emotional factors, such as boredom, fatigue, or sensory discomfort. Once established, they can become habitual, creating a reinforcement pattern, which makes them difficult to stop.

Clinical Red Flags: When It’s Time to Seek Help

It can sometimes be difficult to determine when a behavior has crossed the line from a harmless nervous habit to a Body-Focused Repetitive Behavior. Often, individuals have engaged in these habits for years, and they may become so normalized that the severity goes unnoticed. However, if you recognize any of the following signs, it may be time to seek support:

Inability to Stop

Many individuals with BFRBs have made repeated efforts to stop the behavior, often without success. The inability to control or reduce the behavior is a key indicator that it may be more than just a habit.

Physical Complications

Common physical consequences of BFRBs include scars, sores, bald patches, or damaged nails and skin (Talcherkar, 2025). These behaviors can lead to irritation, infection, and long-term damage (Talcherkar, 2025).

Social and Emotional Distress

Feelings of shame, embarrassment, and self-consciousness are frequently reported by those who experience BFRBs (Talcherkar, 2025). The visible physical effects can contribute to emotional distress and fear of judgment from others.

Interference with Daily Life

BFRBs can significantly disrupt daily routines and responsibilities. Individuals may avoid social situations, withdraw from relationships, or feel compelled to hide the evidence of their behavior (Talcherkar, 2025). This cycle can lead to decreased self-esteem and may contribute to the development of other mental health conditions, such as anxiety and depression.

Body-Focused Repetitive Behaviors Treatment

Treatment Options

There are multiple treatment approaches available for individuals struggling with Body-Focused Repetitive Behaviors (BFRBs). Therapy and medication can be highly beneficial for many, and alternative or complementary strategies are also gaining attention for their effectiveness.

Therapeutic Approaches

Cognitive Behavioral Therapy (CBT)—specifically Habit Reversal Training (HRT)—is widely regarded as the most effective therapeutic approach for BFRBs (Mortiz et al, 2021). HRT involves identifying situations or emotional states that trigger the behavior and then replacing the behavior with a healthier, competing response. This process includes awareness training, developing alternative behaviors, and practicing self-monitoring (Mortiz et al, 2021).

Other effective therapeutic approaches include:

Comprehensive Behavioral Treatment (ComB)

This approach addresses five domains that contribute to BFRBs: Sensory (physical sensations that trigger the behavior), Cognitive (thoughts and beliefs surrounding the behavior), Affective (emotions associated with or triggering the behavior), Motor (the physical movements or routines involved), and Place (the environment or location where the behavior typically occurs) (Ruths, 2025). ComB is highly individualized and tailored to each person’s unique experience (Ruths, 2025).

Acceptance and Commitment Therapy (ACT)

ACT helps individuals learn to accept difficult emotions rather than avoiding or suppressing them. This approach focuses on mindfulness, emotional acceptance, and values-based decision-making to reduce the emotional pull of BFRBs and promote meaningful behavior change (Twohig & Woods, 2004).

Medication

It is important to note that, while some medications can be helpful, no psychiatric medications have been officially approved by the FDA for the treatment of Body-Focused Repetitive Behaviors (BFRBs) (Moritz et al., 2021). However, studies have shown that certain medications may reduce symptoms in some individuals. For example, selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), have demonstrated some efficacy. Additionally, N-acetylcysteine (NAC), a supplement that influences glutamate regulation, has shown promising results in targeting symptoms of BFRBs by reducing urges and compulsive behaviors (Moritz et al., 2021) (Ruths, 2025).

Adjunct Approaches

In addition to formal therapy, several supportive strategies can complement treatment:

  • Support groups provide individuals with opportunities to connect with others who share similar experiences, which can significantly reduce feelings of isolation (Ruths, 2025).
  • Psychoeducation for families equips loved ones with a better understanding of BFRBs, enabling them to provide more effective support and reduce unintentional reinforcement of the behaviors.

Body-Focused Repetitive Behaviors Support

How to Support Someone with a BFRB

  • Avoid shaming or blaming
  • Create a supportive, non-judgmental environment
  • Encourage treatment
  • Educate yourself and others

Resources for Body-Focused Repetitive Behaviors (BFRBs) and OCD

The TLC Foundation for Body-Focused Repetitive Behaviors

Website: www.bfrb.org

International OCD Foundation

Website: www.iocdf.org

Free Monthly Online Support Group

Hosted by Anxiety Specialists of Atlanta
Event Info: BFRB Support Group Events
Join via Zoom: Meeting Link

Local Support Groups

Concerned about your mental health? Contact us today to schedule with a licensed psychiatric nurse practitioner in Columbus, Ohio. Schedule now.

References

Body-focused repetitive behavioral disorders in ICD-11. (2014). Brazilian Journal of Psychiatry, 36 (suppl 1). https://doi.org/10.1590/1516-4446-2013-1228

Moritz, S., Penney, D., Ahmed, K., & Schmotz, S. (2021). A Head-to-Head Comparison of Three Self-Help Techniques to Reduce Body-Focused Repetitive Behaviors. Behavior Modification, 46(4), 894-912. https://doi.org/10.1177/01454455211010707

Okumuş HG, Akdemir D. Body Focused Repetitive Behavior Disorders: Behavioral Models and Neurobiological Mechanisms. Turk Psikiyatri Derg. 2023 Spring;34(1):50-59. doi: 10.5080/u26213. PMID: 36970962; PMCID: PMC10552165.

Ruths, A. (2025). Breaking the Cycle: Managing Body-Focused Repetitive Behaviors (BRBs). Houston Anxiety and Wellness Center.

Solley, K. & Turner, C. (2018). Prevalence and correlates of clinically significant body-focused repetitive behaviors in a non-clinical sample. Comprehensive Psychiatry, 86, 9-18. https://doi.org/10.1016/j.comppsych.2018.06.014

Talcherkar, A. (2025, May 5). Understanding body-focused repetitive behaviors (bfrbs): Symptoms, causes, and treatment options . Footprints to Recovery, Mental Health Treatment Program in NJ. https://footprintstorecoverymh.com/understanding-body-focused-repetitive-behaviors-bfrbs-symptoms-causes-and-treatment-options/