Body-Focused Repetitive Behaviors (BFRBs): Understanding Hair Pulling, Skin Picking, and Related Conditions
More Than a "Bad Habit"
Do you find yourself pulling at your hair, picking at your skin, or biting your nails to the point of noticeable damage, often without fully realizing you've started? Have you tried to stop, only to find yourself doing it again during a stressful moment, or even while relaxed and distracted?
If so, you may be experiencing a Body-Focused Repetitive Behavior, or BFRB. These behaviors are often misunderstood as simple bad habits or a lack of willpower, but they are recognized, treatable conditions that involve much more than that.
At Chicago Counseling Center, we work with individuals who feel frustrated, embarrassed, or discouraged by BFRBs, and we help them understand what's actually happening beneath the surface.
The information on this page is provided for educational and informational purposes only and is not intended as medical, mental health, or legal advice.
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What Are Body-Focused Repetitive Behaviors?
Body-Focused Repetitive Behaviors are a group of conditions involving repeated actions directed at one's own body that result in physical damage, despite repeated attempts to stop. The most commonly recognized forms include hair pulling, known clinically as trichotillomania, and skin picking, known as excoriation disorder. Nail biting and cheek biting are also considered part of this category.
These behaviors are classified within the broader OCD-related spectrum of disorders, though they differ from OCD in some important ways.
Common Signs of a BFRB
BFRBs can look different depending on the specific behavior, but common patterns include:
Repeatedly pulling hair from the scalp, eyebrows, eyelashes, or other areas
Picking at skin, often targeting perceived imperfections such as bumps or blemishes
Noticeable hair loss or skin damage as a result of the behavior
Engaging in the behavior during moments of boredom, stress, or concentration
Feeling a buildup of tension before the behavior and relief or satisfaction afterward
Attempting to hide the resulting damage through hairstyles, makeup, or clothing
Repeated, unsuccessful attempts to stop or reduce the behavior
Many individuals describe the behavior as happening almost automatically, without full awareness it's occurring, especially during quiet or low-stimulation moments like watching television or driving.
Why BFRBs Are Often Misunderstood
Because BFRBs can look similar to nervous habits, they are frequently dismissed as something the person could stop "if they really tried." This framing often leads to shame, secrecy, and delayed treatment.
In reality, BFRBs involve a complex interaction between urge, tension, and relief that is not simply a matter of willpower. Many individuals describe wanting to stop and feeling unable to, which can be confusing and distressing on its own.
The Cycle Behind BFRBs
BFRBs often follow a pattern involving a buildup of tension, urge, or itch-like sensation, the behavior itself, and a resulting sense of relief or satisfaction, sometimes followed by shame or frustration once the person notices what they've done.
For some individuals, the behavior is more automatic, occurring during moments of low awareness. For others, it is more focused, often used intentionally as a way to manage difficult emotions like anxiety, boredom, or stress. Many people experience a combination of both patterns.
BFRBs and Co-Occurring Conditions
BFRBs frequently occur alongside anxiety, OCD, or difficulty tolerating uncomfortable sensations and emotions more broadly. Stress and boredom are commonly reported triggers, though BFRBs can also occur during calm or focused states.
A thorough assessment can help clarify how a BFRB may be connected to other symptoms you're experiencing, which supports a more complete and effective treatment plan.
How Treatment Can Help
Evidence-based, therapist-guided treatment can help individuals reduce the frequency and intensity of BFRBs over time. Effective treatment typically focuses on building awareness of the specific triggers, sensations, and situations associated with the behavior, along with developing alternative responses to the urge when it arises.
Because everyone's pattern looks a little different, treatment is highly individualized. A comprehensive assessment helps your therapist understand your specific triggers and patterns so that treatment can be tailored to what will actually be effective for you.
What to Expect During Treatment
Treatment usually begins with a detailed conversation about when the behavior tends to happen, what seems to trigger it, and how it has affected your life, including any current attempts you've already made to manage it.
From there, your therapist will work with you to build awareness of the behavior as it's happening, rather than only noticing it afterward, and to develop practical strategies for responding differently when the urge appears.
Progress often looks like a gradual reduction in frequency and severity, rather than an immediate, complete stop, and setbacks along the way are a normal part of the process.
Why Choose Chicago Counseling Center
At Chicago Counseling Center, our clinicians understand that BFRBs are complex, treatable conditions rather than simple bad habits. We approach every client with compassion and without judgment, recognizing how much shame often surrounds these behaviors.
Whether you've struggled with a BFRB for years or are just beginning to understand what's happening, our goal is to help you build a healthier relationship with these urges and reduce the hold they have on your daily life.
Frequently Asked Questions
Are BFRBs just bad habits?
No. BFRBs are recognized, treatable conditions involving a complex cycle of tension, urge, and relief. They are not simply a matter of willpower or discipline.
What is the difference between trichotillomania and excoriation disorder?
Trichotillomania refers specifically to hair pulling, while excoriation disorder refers to skin picking. Both fall under the broader category of Body-Focused Repetitive Behaviors.
Why do I do this without realizing it?
Many BFRBs occur during moments of low awareness, such as while watching television or driving. Building awareness of these moments is often an early focus of treatment.
Can BFRBs be connected to anxiety or OCD?
Yes. BFRBs frequently occur alongside anxiety, OCD, or general difficulty tolerating uncomfortable sensations and emotions.
Do you treat BFRBs in Chicago?
Yes. Chicago Counseling Center provides evidence-based treatment for BFRBs, both in-person in Chicago and via telehealth throughout Illinois.
Ready to Take the Next Step?
BFRBs can feel discouraging, especially after repeated attempts to stop on your own. With the right support and a personalized approach, it's possible to reduce these behaviors and feel more in control of your daily life.
Contact our team to schedule an appointment and learn more about treatment options for BFRBs and related concerns.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.
The TLC Foundation for BFRBs. (n.d.). About BFRBs. Retrieved from https://www.bfrb.org
Grant, J. E., Odlaug, B. L., & Chamberlain, S. R. (2016). Trichotillomania and skin-picking disorder: An update. Focus, 14(4), 456–460. https://doi.org/10.1176/appi.focus.20160016
Disclaimer
The content on this page is intended for educational and informational purposes only and should not be considered medical advice, mental health advice, diagnosis, treatment recommendations, or a substitute for professional care. Reading this content, submitting a contact form, or communicating with Chicago Counseling Center does not establish a therapist-client relationship. If you believe you may be experiencing symptoms of a BFRB or another mental health condition, consult with a qualified healthcare provider or mental health professional. If you are experiencing a mental health crisis or emergency, call 911, contact the 988 Suicide & Crisis Lifeline, or go to the nearest emergency room immediately.
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