HomeHealth A-ZBody-Focused Repetitive Behavior (BFRB): Causes & Diagnosis

Body-Focused Repetitive Behavior (BFRB): Causes & Diagnosis

Body-focused repetitive behaviors (BFRBs) are intense urges such as picking, pulling and biting, which can cause damage to the body.Some common behaviors that a lot of individuals show include skin chewing, skin pinching, and nail-biting.

There are several factors that may play a role. These factors include your personality, genetics, your childhood experience(s), your age (when you first showed the symptoms of BFRBs), and how much stress there is in your life. BFRBs are more common in women as compared to men.

Skin pinching and biting may lead to skin infections and permanent scars. Whereas lip chewing, nail-biting, and nail chewing may lead to a gastrointestinal problem. This behavior also lowers the self-esteem of individuals and distances them from the society.

What is Body-Focused Repetitive Behavior?

BFRB is a set of disorders with repetitive behaviors like skin pinching, nail-biting, lip biting, cheek pinching, and hair-pulling. Studies have found that at least 1 among 20 individuals is suffering from one of the repetitive behaviors. Among repetitive behaviors, nail-biting has a higher prevalence rate than skin picking. But skin picking is more self-injurious than nail-biting. The reason for repetitive behavior is due to a significant level of stress. BFRB is related to anxiety management, self-grooming, or sensory stimulation.

A person bites their nails whenever they feel stress. Skin picking or lip chewing is due to anxiety. Repeating the behaviors more than two times a week makes it a habit, and if the frequency of repetition is more than five times a week, they must consult a physician.

The people with these disorders feel some pleasure in repeating these behaviors. They involuntarily perform these behaviors, though they want to stop this. Most of them are unaware of BFRB. Most of the patients with BFRB have poor impulse control, and they don’t have a stop mechanism. Though they know that it is harmful to their body, they cannot stop practicing it.

What causes Body-Focused Repetitive Behavior?

BFRB starts with the desire to eliminate an unwanted stimulus from the body. Obsessive-compulsive disorders are linked with BFRB.

We can see some pinching their pimples to remove them from their cheek. A few pinch their skin as if to remove acne or some hair. The practice continues and leads to a behavioral change.

The reason for behavioral change is due to overwhelming emotions and negative thoughts. BFRB patients spend hours practicing these behaviors until they feel relaxed. Social isolation is a common cause for the progression of BFRB.

The scientific terms for these conditions are:

  1. Trichotillomania (hair-pulling disorder): Trichotillomania is repetitive behavior among children and young people. Whenever they feel stressed or anxious, they pull their hair. Some pull hair from a specific area of the head. Patients pull the hair, and nearly 28% of them swallow the hair.
  2. Onychophagia (nail-biting): Nail biting is common among college students and adults.
  3. Excoriation (skin picking): There are no specific age criteria for the practice of skin picking. Skin picking leads to change in the shape of the fingers, and in some cases, it leads to infection.
  4. Dermatophagia (skin-biting): Patients bite their skin until they see blood; this condition is called Dermatophagia. It leads to infection.
  5. Rhinotillexomania (nose-picking): Nose-picking is the least practiced BFRB. It is a more automatic and voluntary action.

How is Body-Focused Repetitive Behavior diagnosed?

BFRB is hard to diagnose in the early stages. It can be diagnosed at the later stages when a person has:

  • Significant stress.
  • Repetitive body-focused behaviors.
  • Clinical symptoms.

When to see the doctor?

Nail-biting, skin picking, lip chewing, and nail chewing are common BFRBs among most individuals. Generally, they are not harmful, and most behaviors vanish in a few days. But few people practice self–harming repetitively, i.e., more than five times a week. It may lead to infections and gastrointestinal problems. So, these patients should consult a doctor for further treatment.


How is Body-Focused Repetitive Behavior treated?

There is no medication available for body-focused repetitive disorders. Some medicines of behavioral therapy are promising for some patients. Antidepressant medication reduces anxiety, and fluoxetine is also used. Clomipramine is beneficial for reducing hair pulling. Clomipramine is a tricyclic antidepressant that is effective in reducing obsessive thinking, and it also improves the patients’ mood.

More research is going on in this field, and some empirical studies have found that N-acetylcysteine is the best supplement for treating BFRB. The drawback of this treatment is its side effects. It should be used only under the guidance of physicians.

Various other treatment options for BFRB are:

  1. Habit reversal training: Habit reversal training (HRT) is the most prominent approach to treating BFRB. HRT has several components that help to overcome repetitive disorders. Engaging your hands and legs are the best strategies followed in HRT.
  2. Community support: Community support is an important method to reduce the severity of the condition. By providing awareness training and encouraging them to use positive strategies, you can increase positivity among the patients.
  3. Comprehensive behavior: Doctors assess the overall behavior of the patient and suggest individual treatment. Further, they identify suitable strategies that may work well for the patients. This treatment may help the majority of patients under individual care.
  4. Peer support: Recoveries from BFRBs have increased because of the support and encouragement from the patients’ peers. Sharing their conditions and using similar strategies that other patients have used for recovery improves the condition of BFRB in patients.

How to manage Body-Focused Repetitive Behavior?

BFRB is linked to personalized habit disorders. Sometimes it may work for some and not for all. The following concepts have shown promising effects for most of the people:

  • BFRB tracked with apps: Habit trackers are useful for some adults who have chosen to practice habit reversal training for BFRB. Reading, working out, or meditating has been found to reduce the rate of repetition.
  • Thinking less about the behavior: It may sound awkward, but it has proved to be useful for many. Remind yourself not to practice the behavior. It is similar to training your brain for a change in behavior.
  • Looking for positive ways to soothe your skin: Having pimples and blackheads are the initial causes of skin picking. You can reduce them by using skin-soothing treatments. It will reduce the pimples and blackheads and improve your mod.
  • Acupressure: Acupressure can reduce the feelings related to your repetitive behaviors.
  • Knowing more about BFRB: This works only for some. By understanding BFRB, your brain may trigger your stop mechanism and reduce the symptoms. Knowing that skin picking is not one’s fault, your stress level decreases, and you can reduce the behavior.
  • Peer groups and communities: Joining hands with patients experiencing similar problems is one way to reduce BFRB. Participating in the campaigns and conferences related to BFRB will help you to recover from this condition. It also increases the emotional support to overcome BFRB.
  • Involving yourself with art: Art is the best practice to reduce stress. It applies to everyone and has shown positive effects on BFRB patients. Art keeps your hands busy and diverts your focus onto something creative.
  • Listing your triggers: Make a list of the things that enhance your BFRB. Use some method to stay away from the enhancers.


The body-focused repetitive disorder is a condition that causes damage to the body. Behaviors like biting, skin picking, and scraping of hair become a problem when they interfere with your daily life. These symptoms also increase because of stress. Patients who want to overcome BFRB must look for ways to reduce their stress and undergo habit reversal training. HRT will help reduce your symptoms, as you will have more chances to overcome BFRB in the future.


Verified By Dr K Naga Jyothi
MBBS, MD(General Medicine), Consultant Physician and Diabetology, Apollo Hospitals, DRDO Kanchanbagh, Hyderabad
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