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The week of October 1-7 of every year marks a week of raising awareness and building understanding globally for those individuals experiencing the negative impacts of Body Focused Repetitive Behavior (or BFRB). Our resident BFRB specialist, Gayatri Kainth, provides the following article to assist those who may be experiencing BFRB or who cares for someone who is.
Samantha, a 34-year-old female, initiated therapy to find support with skin picking, not only on her face but also scalp, chest, arms, and legs. The client had also suffered severe skin infections and scars. The client reported spending 4-5 hours per day on this habit in the bathroom, when driving, while working on computer, and when talking on phone, mostly when she was alone. Her professional and personal life were impacted, and she reported a lot of shame and guilt associated with this behaviour. The client reported social isolation and feelings of being stuck or trapped because she did not want to meet with friends and was fearful of forming close personal/intimate relationship (i.e., going out on dates).
George, an 18-year-old adolescent sought support for nail biting and skin picking. Initially, this habit was associated with high stressors, but eventually became generalised and automatic. It caused him severe emotional distress.
Parents of 12-year-old Annie approached the therapist seeking support for her hair pulling. Annie’s parents noticed a bald spot at the back of Annie’s head and were distressed by the discovery. It started with Annie simply playing with her hair, but gradually the time spent playing with her hair increased exponentially. As a solution parents convinced Annie to get a hair cut with short hair. For some time, there was relief, but Annie eventually reverted back to the behaviour while watching T.V., on long car journeys, while waiting for meals, or while scrolling on her phone.
Body-Focused Repetitive Behaviours (BFRBs) is an umbrella term that describes a complex set of behaviours driven by a strong urge to perform repetitive actions with one’s own body. These behaviours are usually dismissed as just “bad habits”.
There are two official BFRB diagnoses, including hair-pulling (trichotillomania), and skin-picking, on pimples, scabs, and bumps (excoriation disorder). Other BFRB’s like nail-biting (onychophagia), cheek-biting, or nose picking (Rhinotillexomania) can be given the diagnoses of Unspecified Obsessive-Compulsive and Related Disorder, with a designation of Other Body-Focused Repetitive Behavior Disorder. BFRBs affect boys and girls equally in childhood, with somewhat higher numbers of affected females in adulthood.
As evident from the examples above, BFRBs can have significant impacts on health and wellbeing. These behaviours can range from mild (takes up little time with minimal physical damage) to severe (incredibly time consuming, causing significant physical damage or changes in appearance and in some cases may be fatal).
The Physical consequences of BFRBs can include permanent hair loss, follicle damage, scalp irritation, repetitive strain injuries, scarring, sores, and infections.
The Emotional consequences may include feeling unattractive, shame, guilt, embarrassment, social difficulties, poor school attendance, and poor academic performance. People with BFRBs might avoid social gatherings, brightly lit areas, swimming, sports, and even being outdoors.
BFRBs tend to be chronic (long-lasting) disorders that may fluctuate over time. The symptoms of BFRBs can start at any time during childhood or adolescence.
Skin-picking first occurs in adolescence as a grooming behaviour with the onset of pimples or acne. Many people may pick at bug bites, dry skin, minor skin imperfections and even healthy skin. Most people tend to pick from the face; however, picking can occur anywhere on the body.
Trichotillomania (hair pulling) can occur at any age, but the most common age of onset is adolescence. Most individuals pull hair from the scalp. However, hair pulling may occur from eyebrows, eyelashes, underarms, pubic hair, arms, or legs. Hair-pulling in men may not draw attention since baldness in men is often more socially acceptable.
There are two common primary interventions implemented to support individuals with BFRBs.
The first one is Habit-Reversal Training (HRT), in which the individual learns to focus on engaging in behaviours that prevent them from doing the BFRB. This is done through psychoeducation, functional analysis, awareness training, stimulus control, and competing response training.
The second treatment modality is the Comprehensive Behavioural Treatment Model (ComB). With ComB, people learn to identify five components to their BFRBs – Sensory, Cognitive, Affective, Motoric, and Place (i.e. SCAMP). The therapist supports the client with identifying and implementing strategies and tools to work on reducing the BFRB by creating a change in the SCAMP components.
Additionally, Acceptance and Commitment Therapy (ACT) and Dialectical Behavioral Therapy (DBT) are also utilised to support clients.
If you’ve made repeated, unsuccessful attempts to stop the BFRB’s, then you know that it’s a problem. If any of the above-mentioned scenarios or examples fit with your experience, know that it’s possible to initiate change with these seemingly small but potentially distressing behaviours. With intention, attention, knowledge, insight, intervention and support, one can learn to take charge of their life and gain voluntary control over BFRB’s.
Perhaps you have a concern that I haven’t mentioned in the article. Please feel free to reach out to me (Gayatri Kainth) if you have a concern, question, query or you feel that you can be helped with BFRB’s. You reach can me by filling out our contact information form here.
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