What are body-focused repetitive behaviours?
Often incorrectly considered “just a bad habit,” body-focused repetitive behaviours are intense urges sometimes described as a form of “over-grooming.” BFRBs can include a wide range of repetitive behaviours such as nail biting, skin picking, hair pulling, and teeth grinding.
Over time, some BFRBs can cause physical injuries, scarring, infections, or bald spots. Many body-focused repetitive behaviours cause emotional distress, embarrassment, shame or feelings of guilt, which can negatively impact your ability to spend time with others socialising or working.
You may feel like you have to hide what you are doing, like it’s not ‘serious’, or that it's ‘just a bad habit’. It’s important to remember that something that causes you distress or interrupts your day-to-day life can, given time, develop into something more serious. It’s never too early to seek help and support if you are worried about your compulsion cycle and the effects it is having on your well-being.
What causes body-focused repetitive behaviours?
Anyone can develop a BFRB, but experts have discovered that genetics play a part. If you have a family member who has experienced body-focused repetitive behaviours, you're more likely to develop one. Overall, women are more likely to experience BFRBs.
Other factors that can play a role include:
- your personality and temperament
- stress levels
- childhood influences
Older children and teens are most likely to develop body-focused repetitive behaviours, due to hormonal changes. It is much rarer for BFRBs to first develop as an adult or a younger child. Around 90% of those who seek help for BFRBs are female.
Engaging in BFRBs may be a conscious or unconscious way of trying to relieve stress, experience gratification or other specific sensations. They are not typically a way for someone to punish, harm, or distract from upsetting thoughts or feelings.
BFRBs typically occur in a cyclical pattern. Like all mental health conditions, individuals may experience BFRBs differently; however, this cycle is what gives these behaviours their repetitive nature:
- Trigger (may be emotional or physical)
- Urge (the compulsion to pick, pull, bite, chew, grind, etc.)
- Behaviour (the act itself)
- Relief (the satisfaction from the sensation the behaviour provides)
- Shame (guilt following the action according to compulsion)
- Repeat.
Outside of this cycle, people living with BFRBs often pick up behavioural patterns that mostly sit within either the ’trigger’ or ‘shame’ phase. These may include identifiers such as hiding bald patches through clothing or body language, scanning their skin for imperfections, repeatedly checking/feeling nails and their edges, or tactile feeling for rough skin. There is a common tendency within individuals that live with these compulsions to have a high-awareness of them, in all situations. Finding a way to distract the mind and break free of this cycle may be the first step toward freedom.
Researchers still don’t fully understand what causes BFRBs. Not all types of body-focused repetitive behaviours are a sign of deeper issues or unresolved trauma. According to experts, trichotillomania, dermatillomania (also known as excoriation), and nail biting do not typically indicate deeper issues.
Are body-focused repetitive behaviours mental illnesses?
Some body-focused repetitive disorders (skin picking and hair pulling) are currently categorised as obsessive-compulsive and related disorders in the DSM-5 for mental health disorders. While experts think BFRBs could be related to anxiety disorders, impulse control disorders, or obsessive-compulsive disorders, they do differ significantly and are not exactly the same thing.
If you're worried that you're unconsciously or consciously doing something that is causing you physical or emotional harm, stress, or upset, it's important to speak with someone and seek help.
Are body-focused repetitive behaviours self-harm?
BFRBs are different from self-harming rituals. Self-harm is typically a purposeful act, where someone hurts themselves, often as a way to express things they struggle to put into words. Body-focused repetitive behaviours are typically done with little or no conscious awareness. Some experts compare BFRBs to self-soothing behaviours people may unconsciously do to try and calm themselves or provide comfort.
Types of body-focused repetitive behaviour
Nail biting
Nail biting (onychophagia) is something that around 30% of adults and up to 45% of teenagers do, often without realising it. Often assumed to be a sign of anxiety or nervousness, it can also be a BFRB. While seeming harmless, biting your nails can lead to damage to your skin, nails, and teeth, and can even cause infections.
Some people also experience the urge to bite, pick, or pull at the skin around their fingernails or toenails, or may even try to pull their nails off completely.
Tips to break the cycle: Keeping your nails trimmed and using special nail products that you can apply like nail varnish to produce a bitter taste can help.
Cheek biting
Cheek biting refers to when you can’t stop biting the insides of your mouth. This can lead to sore skin, sores, and swelling, and can make your mouth feel more ‘bumpy’. This, in turn, can make you more likely to chew on the unusually textured skin.
Tips to break the cycle: Some people find that chewing gum or sucking on mints can help them to re-focus what they are doing with their mouths, providing the same or similar sensation, without the risk of accidental self-harm.
Teeth grinding (bruxism)
Also known as bruxism, grinding your teeth and clenching your jaw can lead to headaches, earache, and even dental damage. Affecting around one in 10, teeth grinding can happen when you are asleep or awake, and is often associated with depression, anxiety, stress, and sleep disorders.
Tips to break the cycle: A dentist might recommend a mouth guard or mouth splint for nighttime, to help protect your teeth from damage. This BFRB is closely linked to high stress levels, and so participating in stress-reducing activities may help toward the release of jaw clenching, and slow teeth grinding as a result.
Find out more about how hypnotherapy can help with bruxism.
Tongue biting
Tongue biting refers to the compulsion to bite, chew or suck your own tongue. When using pressure from your teeth to bite, it can result in tissue damage and potential pain on your tongue.
Tips to break the cycle: Some people find that chewing gum can replace the sensation that this compulsion brings, and give them something else to focus their mouth’s attention on.
Hair pulling (trichotillomania)
Trichotillomania (also called trich, or hair pulling disorder) refers to the urge to pull out your hair. This can be any hair, including eyebrows, eyelashes, arms, legs, or on top of your head. Most common in young adults and teenagers, you may experience the urge to pluck your hair using tweezers or your fingers. Those experiencing trichotillomania may pluck hair from a single spot until bald patches appear or may pull hair from a number of different places.
Many report a sense of relief when pulling their hair. Some may chew, bite (trichodaganomania), eat hair (trichophagia), or may play with the removed hair (e.g. rubbing it across your lips or face). If you experience an urge to pull your hair, it is also common to experience urges to pick your skin, bite your nails, or chew your lips. You may do this on purpose, as a way to relieve feelings of tension or stress. Or you may find yourself doing it automatically without thinking, as you do other things like work, read, or watch TV.
Hair removal (trichotemnomania) is another body-focused repetitive behaviour, where you have the urge to remove hair from your body.
Tips to break the cycle: Some individuals living with hair pulling and picking are able to reduce the urge by implementing barrier methods, including wearing gloves or bandages to reduce the grip on hair, which can make it harder to pull.
Skin picking and skin biting (dermatillomania and dermatophagia)
Also referred to as excoriation disorder, those who experience dermatillomania have the urge to pick at healthy and unhealthy skin. You may find yourself picking or scratching at spots, scabs, bumps, pimples, or regular patches of skin. Those who have obsessive-compulsive disorder (OCD) are more likely to be diagnosed with dermatillomania.
Those experiencing dermatophagia have the urge to chew their skin, and may chew and eat the skin or scabs that occur from this. Some experts believe that dermatophagia may be triggered by tension or worry.
Tips to break the cycle: Some people find that distracting themselves and keeping their hands busy with fidget toys (stimming) can help to reduce their picking. Others recommend wearing plasters or bandages on their fingers to remind themselves not to pick.
Nose picking (rhinotillexomania)
While many people will pick their nose occasionally, some people experience the urge to repeatedly pick their nose to the point of it becoming sore, breaking the skin, or bleeding. Over time, it can increase your risk of developing respiratory infections, damaging or perforating your nasal septum, spreading illness, or developing sinus infections. As nose picking is generally seen as socially unacceptable, this can lead to additional feelings of guilt and embarrassment.
Tips to break the cycle: Like other hand-based BFRBs, keeping your hands busy through the likes of fidget toys can reduce the compulsion to nose-pick. Additionally, keeping the nasal passage from crusting (such as through saline spray) may reduce the associated sensation, slowing the compulsions.
While researchers do not fully understand the reasons behind compulsive nose picking, genetics, anxiety, medication, and hormonal changes are all thought to contribute.
Eye mucus fishing (mucus fishing syndrome)
Mucus fishing syndrome is repetitive removal of mucus strings from the waterline of your eye. It can often be triggered by underlying irritation or allergies, where your body produces excess mucus as an immune response. When this is removed, it further irritates your eye, initiating the cycle again.
Tips to break the cycle: Some people find that using products, such as eye drops, to lubricate the eye surface, or antibiotics to heal the underlying irritation can help to break the cycle.
How common are body-focused repetitive behaviours?
Some body-focused repetitive behaviours are more common than others. It is thought that around one in 20 people experiences BFRBs, but often dismiss them as ‘bad habits’. Other BFRBs, such as bruxism, can affect up to one in 10 people, while trichotillomania is thought to affect somewhere between 0.5-2% of people.
What triggers or causes BFRBs?
The exact causes of body-focused repetitive behaviours are still widely unknown. Experts think BFRBs could be related to anxiety disorders, obsessive-compulsive disorder, or impulse control disorders, but generally agree that they are still distinctly different from each of these conditions.
While it can vary between individuals and different types of body-focused repetitive behaviours, many people report feelings of anxiety, boredom, or distraction.
How do you treat or get rid of body-focused repetitive behaviour?
There are a number of different ways you can manage or treat BFRBs. These can include:
Identify your triggers
Not all BFRBs have clear triggers, but some do. These could be physical triggers (e.g. when you see you have a broken or uneven nail you may feel the urge to bite it, or when you see a spot you may automatically pick at it or the skin around it) or emotional (stress, boredom, anxiety). Acknowledging your triggers can help you to recognise them, and may help stop the automatic behaviour, helping you to interrupt or even break the cycle.
Replace old habits with new ones
Stress balls and fidget toys can provide alternative ways to occupy your hands and keep them away from your skin, mouth, or hair. This can help you to break the initial, automatic ‘bad habit’ that may be causing you physical harm or discomfort.
Hypnotherapy for BFRBs
Hypnotherapy can help with a wide range of body-focused repetitive behaviours. By working with a qualified hypnotherapist, you can discover how to interrupt familiar, unhelpful or harmful urges.
Using hypnosis and the power of suggestion, they can guide you into a deep state of relaxation (a hypnotic state), and introduce healthier alternatives. This works by the hypnotherapist accessing your subconscious in this state – where the underlying urges and compulsions stem from. At this point, they can suggest and aid visualisations that form ‘competing responses’, ultimately replacing the triggered urge with something more positive/healthy. This means that the urges to act on your BFRB may be replaced with an alternate, positive action that could break the cycle.
As one hypnotherapist explains, hypnotherapy can be used to establish a sense of safety and security in both everyday life and during high-pressure situations. A hypnotherapist can help introduce new techniques to help promote relaxation, reduce anxiety, and manage stress. This, in turn, can decrease your likelihood of triggering a BFRB response.
Cognitive behavioural hypnotherapy
Cognitive behavioural hypnotherapy (also referred to as cognitive hypnotherapy) can be a particularly effective form of hypnotherapy to help reduce or stop body-focused repetitive behaviours.
Cognitive-behavioural hypnotherapy lets you explore your current habit in detail to help you make the environmental, emotional, cognitive and physical changes you need to effectively stop or manage your compulsion. It gives you the opportunity to imagine and experiment doing, feeling and thinking differently within the relaxing comfort of hypnosis.
- Morag Stevenson, cognitive behavioural hypnotherapist writes in How to effectively manage a BFRB habit with an elephant!
Similarly, cognitive behavioural (talking) therapy can be used to understand any underlying triggers that may be causing BFRB - particularly those that stem from trauma and past experiences. Both cognitive behavioural talking and hypnotherapy aim to make changes to the way you process connected thoughts, reducing urges and compulsions associated with BFRBs.
Stress management
While stress isn’t always a cause for body-focused repetitive behaviours, it can often be a trigger. Creating a sustainable self-care routine can help you to achieve a healthier work/life balance, find positive ways of releasing tension, and regularly make your well-being a priority.
Speak with your loved ones
Many who experience BFRBs express feelings of shame about their experiences. Talking with your friends or family can be an empowering experience and, as genetics often can contribute to BFRBs, you may find other family members have had similar experiences.
