Body-Focused Repetitive Behaviors (BFRBs) are often misunderstood, misdiagnosed, or dismissed as “bad habits.” But for the individuals who live with them—many of whom begin at a young age—these behaviors can be distressing, isolating, and deeply tied to emotional regulation and identity. Whether you’re a parent, therapist, teacher, or someone with lived experience, understanding BFRBs through a compassionate, clinically informed lens is a powerful step toward reducing stigma and offering healing pathways.
This guide will help you better understand what BFRBs are, how they differ from non-suicidal self-injury (NSSI), why they develop, what they may look like, and how to support someone—of any age—who may be struggling. We’ll also explore therapeutic and community-based tools for recovery, with a holistic perspective that honors the emotional energy underneath each behavior.
What Are BFRBs? (DSM-5 Definitions and Emotional Understanding)
Body-Focused Repetitive Behaviors are a cluster of compulsive grooming behaviors in which a person repeatedly damages their body—often unintentionally—through actions like hair pulling, skin picking, or nail biting. They are not a form of self-harm intended to express emotional pain or suicidal ideation. Instead, BFRBs are compulsive behaviors driven by a buildup of tension, anxiety, boredom, or sensory need, followed by a sense of relief or satisfaction.
According to the DSM-5, two specific BFRBs are formally recognized as mental health disorders under the Obsessive-Compulsive and Related Disorders category:
- Trichotillomania (Hair-Pulling Disorder) – Recurrent pulling out of one’s hair, resulting in noticeable hair loss.
- Excoriation (Skin-Picking Disorder) – Recurrent picking at one’s own skin, often resulting in sores, lesions, or scarring.
Other common BFRBs, while not officially classified as distinct disorders in the DSM-5, are widely recognized in clinical and research communities:
- Onychophagia (chronic nail biting)
- Dermatophagia (skin biting, often around fingers or lips)
- Morsicatio buccarum/labiorum/linguarum (cheek, lip, or tongue biting)
- Rhinotillexomania (compulsive nose picking)
These behaviors may seem minor or even socially normalized at first. But for many, they become disruptive to daily life, causing pain, shame, physical damage, and emotional exhaustion. It’s estimated that at least 1 in 20 people lives with a BFRB in some form—though the actual number is likely much higher due to underreporting and stigma.
How BFRBs Differ from NSSI (and Why They’re Sometimes Misunderstood)
While both BFRBs and NSSI involve damage to the body, they stem from different psychological mechanisms, intentions, and emotional outcomes. It’s essential to distinguish them in order to avoid harmful mislabeling or ineffective treatment approaches.
Key Differences:
| Aspect | BFRBs | NSSI |
|---|---|---|
| Intent | Not intended to cause pain or express distress | Often intended to relieve emotional pain or self-punish |
| Awareness | Often unconscious or automatic | Usually intentional, sometimes ritualized |
| Function | Sensory regulation, tension release, soothing | Emotional release, punishment, communication of pain |
| Diagnosis Category | OCD-related disorders (DSM-5) | Conditions for further study; related to mood/emotion regulation |
| Emotional Impact | Often neutral or temporarily satisfying, followed by guilt or shame | Typically intense emotional relief followed by guilt/shame |
It’s worth noting that some clinicians misidentify BFRBs as self-harming behavior, especially when wounds or scarring are visible. And some individuals with BFRBs may also engage in NSSI. But the two are not the same, and conflating them can lead to inappropriate interventions. Understanding that BFRBs are often compulsive—not willful acts of distress—allows us to support recovery with more accuracy and compassion.
Why People Engage in BFRBs (Emotional and Behavioral Insights)
People who live with BFRBs often describe a feeling of building tension or discomfort that is temporarily soothed by the behavior. The act of pulling, picking, or biting becomes a self-regulating mechanism—one that may begin in childhood or adolescence and continue into adulthood, especially if untreated.
Common reasons include:
- Sensory soothing: The repetitive act of pulling or picking provides a tactile or visual reward (like seeing a “perfect” hair removed).
- Relief of tension: During moments of stress, boredom, or anxiety, the behavior creates a temporary sense of release or calm.
- Emotional regulation: For individuals who struggle with identifying or verbalizing emotions, BFRBs can be an unconscious way to cope.
- Perfectionism or control: Some describe a need to remove “imperfect” hairs or blemishes, tied to control or obsessive thinking.
- Dissociation or autopilot: Many people enter a kind of trance state where they aren’t even aware they’re engaging in the behavior until afterward.
Importantly, BFRBs are not about attention, punishment, or self-hate—a crucial distinction from self-injury or suicidal behavior. However, they can still carry deep emotional consequences, including shame, low self-esteem, and social withdrawal.
What BFRBs Can Look Like (Signs, Variations, and Prevalence)
Because BFRBs are often hidden or minimized, it’s helpful to know the signs:
- Bald patches or thinning hair on the scalp, eyebrows, eyelashes, or body
- Open wounds, scabs, or scars from repeated skin picking (especially on arms, face, or back)
- Chewed nails, bleeding cuticles, or calloused fingers
- Frequent lip or cheek biting, especially during stress or concentration
- Avoidance of situations where the body is visible, like swimming, hair salons, or close-up interactions
- Increased time spent alone, often “zoned out” during grooming routines
- Tools used for grooming, such as tweezers, needles, or mirrors kept in secret
BFRBs can begin as early as age 8–12, with many people reporting their first urges around puberty. These behaviors often peak in the teen years and can persist into adulthood if untreated. All genders are affected, although some BFRBs (like trichotillomania) appear more frequently in females according to self-report data.
BFRBs often coexist with anxiety, depression, perfectionism, ADHD, or OCD traits, though not always. Because they’re internalized and often done in secret, many people never tell anyone—even close loved ones.
How to Gently Approach BFRBs (By Age and Stage)
Whether you’re a parent, clinician, or loved one, knowing how and when to bring up a BFRB makes a difference. Shame is a powerful barrier to support, so the key is gentle, nonjudgmental awareness.
With Children (8–12):
- Approach with curiosity, not correction: “I noticed you’ve been picking at your skin a lot—does it hurt or feel better when you do it?”
- Normalize emotional discussions: “Sometimes when we feel nervous or bored, our bodies do things to help us feel better. That’s okay—we can learn new ways too.”
- Avoid punishment or forcing behavior to stop. Focus instead on building emotional vocabulary and offering safer outlets (like fidget toys, calming routines, or sensory-friendly spaces).
With Teens:
- Validate first: “You’re not gross or weird. This is something a lot of people go through.”
- Ask open-ended questions: “When do you notice the urges are strongest? After school? When you’re alone?”
- Offer information about BFRBs as a real, treatable condition. Teens often feel broken or ashamed—naming the behavior can relieve some of that burden.
- Introduce support gently. Ask if they’d like to talk to someone who understands (therapist, support group, or even a peer who’s been through it).
With Adults:
- Respect autonomy while offering presence: “I noticed your fingers seem sore lately—no pressure to talk, but I care and I’m here if you want support.”
- Ask if they’ve ever heard of BFRBs. Many adults don’t realize their lifelong habits have a name—or that help exists.
- Share resources only if they’re open to it. Support often means sitting with someone, not fixing them.
How to Offer Support (Without Shame, Pressure, or Fixing)
Supportive responses center around understanding, education, and emotional safety. Here’s what that can look like:
- Lead with empathy: “I know this isn’t easy. You’re not alone in this.”
- Avoid moralizing: Refrain from saying things like “Just stop doing that” or “You’ll ruin your skin.” Instead, explore underlying feelings or stressors.
- Be aware of triggers: Some individuals experience urges in response to certain textures, lighting, social anxiety, or sensory overload.
- Offer alternatives collaboratively: Ask, “Would it be okay if we tried to find something that feels good without hurting your skin?” Options could include fidget tools, weighted blankets, sensory-safe fabrics, or breathing exercises.
Recovery is not about stopping the behavior immediately, but gaining insight and finding healthier coping strategies. Even small shifts—like noticing triggers or reducing time spent in front of mirrors—can make a big difference.
Paths to Recovery (Therapeutic and Holistic Support)
While there’s no one-size-fits-all treatment, many people find relief through a combination of therapy, community support, and personalized tools.
Evidence-Based Therapies:
- CBT (Cognitive Behavioral Therapy): Helps identify thought patterns and behaviors associated with the urge, and teaches strategies to change them.
- Habit Reversal Training (HRT): A behavioral technique that teaches awareness of the behavior, identifies triggers, and replaces it with a competing response.
- ACT (Acceptance and Commitment Therapy): Encourages mindfulness and acceptance of urges while aligning actions with personal values.
Peer and Community Support:
- Support groups—online or in person—offer powerful solidarity. Knowing “I’m not the only one” can reduce shame dramatically.
- Podcasts, such as those hosted by people with lived experience, can help normalize the healing journey and offer helpful tools.
Holistic and Complementary Tools:
- Hair tattoos or microblading can be empowering options for those healing from trichotillomania-related hair loss.
- Mindfulness, breathwork, and grounding techniques help with sensory and emotional regulation.
- Creative outlets (art, journaling, movement) can provide non-verbal forms of emotional expression.
Above all, the goal is not perfection—it’s progress, awareness, and self-kindness.
Final Thoughts: Supporting Healing with Understanding and Hope
BFRBs are real. They are valid. And they are treatable.
Whether you or someone you love pulls, picks, bites, or hides their habits in shame—know this: you are not broken. You’re navigating a complicated world with a behavior that once served you but no longer needs to define you.
Healing begins when we stop asking, “Why are you doing this to yourself?” and start asking, “What do you need right now? How can I help?”
At End Self-Harm, we believe in meeting people where they are—with compassion, community, and access to trustworthy resources. You don’t have to go through this alone. Every scar, every strand, every step forward matters. And it all counts toward healing.