7 Ways to Help Stop Body-Focused Repetitive Behaviors

Body-focused repetitive behaviors (BFRBs) are a group of disorders that usually center on self-grooming practices. They usually involve picking, pulling, or biting one’s skin, hair, or nails. 

BFRBs can be extremely disruptive to your life. It’s common to feel like you can’t stop them. But it’s possible to get control over them. Here are some treatments and coping strategies for these behaviors. 

What are BFRBs?

There are several different types of BFRBs. Common ones include:

• Trichotillomania (hair pulling)

• Dermatillomania (skin picking)

• Onychophagia (nail biting) 

Some people are aware when they are doing them. But sometimes people have these behaviors without even realizing it — like while they are watching television or browsing online.

Even though people don’t try to harm themselves, the behaviors can lead to damage of the skin or bald patches that may cause embarrassment or shame. Understandably, BFRBs also often cause frustration since they are repetitive and hard to control or stop. But with new insight, there are now improved strategies and ways to manage these behaviors.

7 ways to treat BFRBs 

There are many different ways to approach BFRB treatment. And many of them can be used together. We will review these options below, starting with the strategies that you can start to develop right away.

1) Identify triggers

Not everyone with BFRBs is triggered by the same thing. And different triggers may lead to different BFRBs. Common triggers for BFRBs include:

• Stress

• Fatigue

• Boredom

• Skin blemishes or ingrown hairs

• Negative emotions

• Hormonal changes

The first step in changing the trigger-behavior cycle is to identify your triggers. By increasing awareness of your personal triggers, you can then start to find ways to avoid them — or change the way you respond to them. 

Some triggers can’t be avoided, and that’s OK. But accepting that triggers are inevitable may help relieve the anxiety that comes when you experience them. In this way, you can start to shift your emotional response to a trigger. 

Keep a log in a journal or on your phone of times you find yourself using your BFRBs. This can help you identify patterns and triggers. You can also use this method to help track progress, which is another helpful tool in decreasing the behaviors.

2) Track your progress

If you choose to track your triggers in a notebook or diary, you may want to record your progress in the same place. Recording can be a powerful source of positive feedback and reward for day-to-day changes. It’s also a good reminder that any progress is meaningful progress. Online applications are a helpful way to keep track of your streaks. 

BFRBs, like any habit, can take some time to break. Change happens over time with small steps. It can be helpful to remind yourself of that if you have a setback or break your streak. It is easy to feel defeated during these times. But remind yourself that a setback does not have to derail your progress. 

Keep tabs on periods when you’ve gone a while without picking or pulling. This way you can look to see which methods helped you manage stressors or triggers during those periods. Use these periods as reminders of what you are capable of when it comes to minimizing your BFRBs.

3) Use distractions

Some people find it helpful to replace their BFRBs with a different behavior. This can help satisfy any urges in a way that does not cause you harm. For example, fidget spinners are popular gadgets that can keep your hands occupied. Crocheting or knitting can also serve as substitutes for stimulation. The TLC Foundation for BFRBs has a list of 100 stimulation substitutes or behavioral blockers and other useful resources.

4) Try cognitive behavioral therapy 

Mental health professionals can guide you through cognitive behavioral therapy (CBT). CBT is a type of therapy that can help you understand how your thoughts and behavior patterns are related to one another. By understanding this cycle better, you can use this therapy to lessen BRFBs. There are various types of CBT for BFRBs:

• Habit reversal training (HRT) helps people identify and manage triggers.

• Comprehensive behavioral treatment focuses on understanding why, where, and how a person engages in BFRBs.

• Dialectical behavior therapy (DBT) uses mindfulness to help regulate negative feelings.

• Acceptance and commitment therapy (ACT) helps people experience urges but avoid acting on them.

5) Explore medications

There are currently no approved medications for BFRBs. But certain antidepressants and antipsychotic drugs may help with symptoms, especially for people who also have depression, obsessive compulsive disorder, or anxiety. These include:

• Clomipramine (Anafranil)

• Naltrexone (Revia)

• Olanzapine (Zyprexa)

If you are interested in pairing your treatment with medication, talk to your provider to identify the one that is best for you. And don’t hesitate to let your provider know if a certain dose or drug is not leading to any improvement. Sometimes it can be a trial-and-error process.

6) Ask about supplements

In addition to medication, there is some evidence that N-acetylcysteine (an amino acid) can help decrease BFRBs. This supplement is usually well-tolerated by people, but it’s still a good idea to discuss this with your provider before you start taking it. 

7) Visit support groups

It is easy for others to see BFRBs as bad habits that can be controlled or easily stopped. But this misperception can lead to unnecessary stigma and feelings of shame for many with BFRBs. 

Because of this, you may feel like you need to hide your BFRBs from your family and loved ones. But you don’t need to face this condition alone. There are many people in a similar situation. Consider joining a support group to talk about your experience. While difficult at first, opening up about your symptoms can be empowering — and positive thoughts and feelings are a powerful treatment in themselves.

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Written by:

Cherilyn Davis, MD

Cherilyn Davis, MD, is a board-certified pediatrician in New York City. She has held local and national roles at the American Medical Women’s Association including board member of the physician division and physician chair of social media.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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