Body-Focused Repetitive Behavior (BFRB) is a term used to describe excessive and repetitive self-grooming that leads to emotional distress and physical harm. BFRBs include biting, pulling, picking, scratching, or scraping one’s own hair, skin, lips, cheeks, tongue, or nails. Many people with BFRB spend hours each day focused on grooming tasks which lead to physical harm such as bald spots, open wounds, scars, or infection. It is common for these behaviors and their outcomes to be kept hidden due to great shame and isolation.
BFRB is currently classified as an Other Specified Obsessive-Compulsive and Related Disorder. This is a DSM-5 diagnosis that applies to those who have characteristics of obsessive-compulsive disorders but do not meet the full criteria. No medication has proven to be effective for BFRB and research and supports are highly limited.
Online OTs is helping to bring awareness to misunderstood conditions such as Hair Pulling Disorder (Trich) and Skin Picking Disorder by providing outreach to patients and their families, as well as healthcare providers. Our telehealth habit reversal program is rooted in occupational therapy activity analysis, sensory awareness, and purposeful activities to address unwanted and harmful repetitive behaviors. We also utilize CBIT competing responses and the SCAMP protocol. To request intake forms for a BFRB evaluation and treatment with Online OTs, please contact us. Services are available via telehealth in MA, NH, NY, VT, and ME.
Hair Pulling Disorder (also known as Trichotillomania orTrich) is a BFRB that involves excessive hair pulling. Hair is often pulled from the scalp, eyelashes, eyebrows, arms, legs, and/or pubic areas. People with Hair Pulling Disorder are often aware of different textures of their hair and target those that seem coarse or not properly aligned. Hair pulling may lead to bald spots on the scalp or elimination of eyelashes or eyebrows. Hair pulling is commonly done with finger pads and fingernails and/or a set of tweezers, with each tweezer targeting a different type of hair.
Skin Picking Disorder (also known as Excoriation) is a BFRB that involves excessive skin picking, resulting in scabs, scars, open wounds and/or infection. People with Skin Picking Disorder often target areas on their skin that are dry, bumpy, or have an imperfection such as a pimple or scab. Skin recovering from surgery is also often picked at, prolonging recovery and creating an uneven surface that will continue to be targeted. Skin picking is commonly done with finger pads and fingernails.
Nail Biting Disorder (Onychophagia) is a BFRB that involves the habitual and destructive biting of nails. This disorder may lead to skin infections as well as dental problems.
Onychotillomania is a BFRB that involves excessive picking, pulling, and manicuring of nails. This repetitive behavior is often highly noticeable and painful, making it difficult to do some everyday tasks.
Lip Biting Disorder and Lip Picking Disorder are BFRBs that cause damage to the lips. Dry and scabbed skin are often targeted. Damage to the lips can make drinking, eating, talking, playing some instruments, and kissing painful.
Cheek Biting Disorder (Cheek Keratosis) is a BFRB that involves biting the inner cheek, causing ulcerations, sores, inflammation, and/or a callous like formation. Cheek Biting can make eating, drinking, talking, singing, and brushing teeth painful.
Tongue Chewing is a BFRB that involves chronic chewing of the tongue, resulting in sores and callouses. Tongue chewing can impair the ability to eat and drink and communicate verbally.
Nose Picking Disorder (Rhinotillexomania) is a BFRB that involves chronic nose picking that destroys structures in the nose and frequently leads to infection.
Sucking on a pacifier or thumb is a common way for infants and toddlers to self-soothe. Thumb sucking in older children or adults is often also self-soothing and due to a Body-Focused Repetitive Behavior. Excessive thumb sucking can shift the position of front teeth and lead to oral surgery.