Why We Pick, Pull, and Bite: A BFRB Breakdown

No matter how hard you try to stop, do you find yourself constantly picking, pulling or biting? You may be struggling with a Body Focused Repetitive Behavior, or BFRB. They are especially common among individuals living with OCD. According to the International OCD Foundation (IOCDF), “roughly seven to as many as 26 million people experience a diagnosable BFRB condition in the U.S. alone.”

BFRBs can have various manifestations but primarily involve either hair-pulling or skin-picking such as pulling out hair from the head, eyebrows or eyelashes, picking cuticles, nails, lips, scalp, scabs or pimples. They may also include biting the inside of the cheek, biting nails, lips, or compulsive nose picking.

BFRBs are not considered self-harm (although they can be misinterpreted as so), however, physical injuries or consequences can occur. These include hair thinning or loss, skin infections or scarring, injury to the back or shoulders from the position in which the behavior is performed, and trichobezoars: masses of swallowed hair that accumulate in the stomach or intestines when hair is consumed by the individual.

Typically, BFRBs can be classified as either impulsive or compulsive. Here is a breakdown of the two different types according to the Mayo Clinic:

Impulsive

• Picking, biting or pulling happens automatically
• Low awareness
• Tends to be frequent but brief
• Experienced during times of boredom and stress (while watching TV, working, etc.)

Compulsive

• Usually intentional and with a purpose (someone might look for hairs that need to be plucked or for blemishes to be picked)
• Typically happens in private settings and during periods of high stress
• Less frequent but longer lasting (increases the likelihood of causing serious damage to skin, nails and hair)
• May occur in front of a mirror and/or involve use of tools like tweezers, clippers, pins or needles.

Many People Have Both Impulsive and Compulsive Features of Their BFRB.

Among the most effective treatments for BFRBs are Habit Reversal Training and Comprehensive Behavioral (ComB) treatment which combines various therapeutic methods to help individuals better understand their behavior and find effective coping strategies. To increase awareness, barriers such as gloves, bandages or hats can be used. (Yes, that means you may be encouraged to wear winter gloves while you’re sitting on the couch watching your favorite show!) Acceptance and Commitment Therapy (ACT) is also commonly used alongside other methods.

Hopefully, gaining some information about BFRBs has pulled you to start working toward healing. Remember, you can do hard things, and I am cheering you on!