Body-focused repetitive behaviours (BFRBs)

What are body-focused repetitive behaviours?

Often mistaken as ‘just a bad habit’, body-focused repetitive behaviours are intense urges often referred to as a form of ‘over-grooming’. These can include a wide range of repetitive behaviours such as nail biting, skin picking, hair pulling, and teeth grinding.

Over time, some BFRBs can cause physical injuries, scarring, infections, or bald spots. Many body-focused repetitive behaviours cause emotional distress, embarrassment, shame or feelings of guilt, which can negatively impact your ability to spend time with others socialising or working. 

You may feel like you have to hide what you are doing, like it’s not ‘serious’, or that it's ‘just a bad habit’. It’s important to remember that something that causes you distress or interrupts your day-to-day life can, given time, develop into something more serious. It’s never too early to seek help and support if you are worried.

What causes body-focused repetitive behaviours?

Anyone can develop a BFRB, but experts have discovered that genetics play a part. If you have a family member who has experienced body-focused repetitive behaviours, you're more likely to develop one. Overall, women are more likely to experience BFRBs.

Other factors that can play a role include:

• your personality and temperament
• stress levels
• childhood influences

Older children and teens are most likely to develop body-focused repetitive behaviours. It is much rarer for BFRBs to first develop as an adult or a younger child. Around 90% of those who seek help for BFRBs are female.

Engaging in BFRBs may be a conscious or unconscious way of trying to relieve stress, experience gratification or other specific sensations. They are not typically a way for someone to punish, harm, or distract from upsetting thoughts or feelings.

Researchers still don’t fully understand what causes BFRBs. Not all types of body-focused repetitive behaviours are a sign of deeper issues or unresolved trauma. According to experts, trichotillomania, dermatillomania (also known as excoriation), and nail biting do not typically indicate deeper issues.

Are body-focused repetitive behaviours mental illnesses?

Some body-focused repetitive disorders (skin picking and hair pulling) are currently categorised as obsessive-compulsive and related disorders in the DSM-5. While experts think BFRBs could be related to anxiety disorders, impulse control disorders, or obsessive-compulsive disorders, they do differ significantly and are not exactly the same thing.

If you're worried that you're unconsciously or consciously doing something that is causing you physical or emotional harm, stress, or upset, it's important to speak with someone and seek help.

Are body-focused repetitive behaviours self-harm?

BFRBs are different from self-harming rituals. Self-harm is typically a purposeful act, where someone hurts themselves, often as a way to express things they struggle to put into words. Body-focused repetitive behaviours are typically done with little or no conscious awareness. Some experts compare BFRBs to self-soothing behaviours people may unconsciously do to try and calm themselves or provide comfort.

Types of body-focused repetitive behaviour 

Nail biting

Nail biting (onychophagia) is something that around 30% of adults and up to 45% of teenagers do, often without realising it. Often assumed to be a sign of anxiety or nervousness, it can also be a BFRB. While seeming harmless, biting your nails can lead to damage to your skin, nails, and teeth, and can even cause infections.

Some people also experience the urge to bite, pick, or pull at the skin around their fingernails or toenails, or may even try to pull their nails off completely. Keeping your nails trimmed and using special nail products that you can apply like nail varnish to produce a bitter taste can help. 

Cheek biting

Cheek biting refers to when you can’t stop biting the insides of your mouth. This can lead to sore skin, sores, and swelling, and can make your mouth feel more ‘bumpy’. This, in turn, can make you more likely to chew on the unusually textured skin. 

Some people find that chewing gum or sucking on mints can help them to re-focus what they are doing with their mouths, providing the same or similar sensation, without the risk of accidental self-harm. 

Teeth grinding (bruxism)

Also known as bruxism, grinding your teeth and clenching your jaw can lead to headaches, earache, and even dental damage. Affecting around one in 10, teeth grinding can happen when you are asleep or awake, and is often associated with depression, anxiety, stress, and sleep disorders.

Hair pulling (trichotillomania)

Trichotillomania (also called trich, or hair pulling disorder) refers to the urge to pull out your hair. This can be any hair, including eyebrows, eyelashes, arms, legs, or on top of your head. Most common in young adults and teenagers, you may experience the urge to pluck your hair using tweezers or your fingers. Those experiencing trichotillomania may pluck hair from a single spot until bald patches appear or may pull hair from a number of different places. 

Many report a sense of relief when pulling their hair. Some may chew, bite (trichodaganomania), eat hair (trichophagia), or may play with the removed hair (e.g. rubbing it across your lips or face). If you experience an urge to pull your hair, it is also common to experience urges to pick your skin, bite your nails, or chew your lips. You may do this on purpose, as a way to relieve feelings of tension or stress. Or you may find yourself doing it automatically without thinking, as you do other things like work, read, or watch TV.

Hair removal (trichotemnomania) is another body-focused repetitive behaviour, where you have the urge to remove hair from your body. 

Skin picking and skin biting (dermatillomania and dematophagia)

Also referred to as excoriation disorder, those who experience dermatillomania have the urge to pick at healthy and unhealthy skin. You may find yourself picking or scratching at spots, scabs, bumps, pimples, or regular patches of skin. Those who have obsessive-compulsive disorder (OCD) are more likely to be diagnosed with dermatillomania. 

Those experiencing dermatophagia have the urge to chew their skin, and may chew and eat the skin or scabs that occur from this. Some experts believe that dermatophagia may be triggered by tension or worry.

Some people find that distracting themselves and keeping their hands busy with fidget toys (stimming) can help to reduce their picking. Others recommend wearing plasters or bandages on their fingers to remind themselves not to pick.

Nose picking (rhinotillexomania) 

While many people will pick their nose occasionally, some people experience the urge to repeatedly pick their nose to the point of it becoming sore, breaking the skin, or bleeding. Over time, it can increase your risk of developing respiratory infections, damaging or perforating your nasal septum, spreading illness, or developing sinus infections. As nose picking is generally seen as socially unacceptable, this can lead to additional feelings of guilt and embarrassment.

While researchers do not fully understand the reasons behind compulsive nose picking, genetics, anxiety, medication, and hormonal changes are all thought to contribute. 

How common are body-focused repetitive behaviours?

Some body-focused repetitive behaviours are more common than others. It is thought that around one in 20 people experiences BFRBs, but often dismiss them as ‘bad habits’. Other BFRBs, such as bruxism, can affect up to one in 10 people, while trichotillomania is thought to affect somewhere between 0.5-2% of people. 

What triggers or causes BFRBs?

The exact causes of body-focused repetitive behaviours are still widely unknown. Experts think BFRBs could be related to anxiety disorders, obsessive-compulsive disorder, or impulse control disorders, but generally agree that they are still distinctly different from each of these conditions. 

While it can vary between individuals and different types of body-focused repetitive behaviours, many people report feelings of anxiety, boredom, or distraction. 

How do you treat or get rid of body-focused repetitive behaviour? 

There are a number of different ways you can manage or treat BFRBs. These can include:

Identify your triggers

Not all BFRBs have clear triggers, but some do. These could be physical triggers (e.g. when you see you have a broken or uneven nail you may feel the urge to bite it, or when you see a spot you may automatically pick at it or the skin around it) or emotional (stress, boredom, anxiety). Acknowledging your triggers can help you to recognise them, and may help stop the automatic behaviour, helping you to interrupt or even break the cycle. 

Replace old habits with new ones

Stress balls and fidget toys can provide alternative ways to occupy your hands and keep them away from your skin, mouth, or hair. This can help you to break the initial, automatic ‘bad habit’ that may be causing you physical harm or discomfort.

Behavioural therapy

Working with a therapist specialising in changing unhelpful behaviours, such as a cognitive behavioural therapy (CBT) practitioner, can help you to replace negative or unwanted behaviour. Working with a cognitive behavioural therapist can be particularly helpful for identifying any underlying triggers that may be causing BFRB. 

Stress management

While stress isn’t always a cause for body-focused repetitive behaviours, it can often be a trigger. Creating a sustainable self-care routine can help you to achieve a healthier work/life balance, find positive ways of releasing tension, and regularly make your well-being a priority. 

Speak with your loved ones

Many who experience BFRBs express feelings of shame about their experiences. Talking with your friends or family can be an empowering experience and, as genetics often can contribute to BFRBs, you may find other family members have had similar experiences. 

How can hypnotherapy help?

Hypnotherapy can help with a wide range of body-focused repetitive behaviours. Working with a qualified, specialist hypnotherapist, you can discover how to interrupt familiar, unhelpful or harmful urges. Using hypnosis and the power of suggestion, a hypnotherapist can put you in a deep state of relaxation (a hypnotic state), and introduce healthier alternatives. 

As one hypnotherapist explains, hypnotherapy can be used to establish a sense of safety and security in both everyday life and during high-pressure situations. A hypnotherapist can help introduce new techniques to help promote relaxation, reduce anxiety, and manage stress. This, in turn, can decrease your likelihood of triggering a BFRB response. 

Cognitive behavioural hypnotherapy (also referred to as cognitive hypnotherapy) can be a particularly effective form of hypnotherapy to help reduce or stop body-focused repetitive behaviours.

Cognitive-behavioural hypnotherapy lets you explore your current habit in detail to help you make the environmental, emotional, cognitive and physical changes you need to effectively stop or manage your compulsion. It gives you the opportunity to imagine and experiement doing, feeling and thinking differently within the relaxing comfort of hypnosis.

- Morag Stevenson, Cognitive Behavioural Hypnotherapist explains more in How to effectively manage a BFRB habit with an elephant! 

Hypnotherapist Kim Searle explains more about cognitive hypnotherapy and how it can help you:

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