What are BFRB's?

The information shared in this article is an amalgamation of my own research and personal experiences. It is a mix of opinion and fact. I encourage you to visit Trichotillomania Learning Center and Canadian BFRB Support Network for more detailed information.

BFRB stands for Body Focused Repetitive Behaviors. BFRBs are exactly as described: the repetitive movement of a body part (usually the hands), concentrated to another part of the body and typically causing physical damage. Some examples of BFRBs include:

  • Onychophagia is the most common BFRB and the most socially acceptable. Those with onychophagia sufferer from the urge to compulsively bite their nails.
  • Excoriation Disorder (previously dermatillomania) is the compulsive desire to pick at one's skin. Severe skin picking can result in noticeable red blemishes, scarring and infection.
  • Trichotillomania is compulsive hair pulling of the scalp, eyebrows, eyelashes, underarms, pubic hair and/or other areas, resulting in bald patches. 
  • Trichophagia is when a hair puller eats the hairs they pull. This can cause life-threatening harm because the stomach cannot digest hairs. The hairs collected in the stomach can only be removed by surgery.
  • Dermatophagia is when someone compulsively bites their skin, like chewing on lips or the inside of one's cheeks. This may not seem like a big issue, but can cause serious infection if left untreated.

These compulsive and automatic behaviors are often misperceived simply as "bad habits." In reality, BFRBs are much more than bad habits. They are a group of psychological disorders in which people are unable to resist the urge to behave in one (or more) of the manners described above. Although more than 50 million people in the US have at least one of these disorders, not much is known in the mainstream about BFRBs. Because of this lack of education, BRFBs often go unreported and undiagnosed.  

Even medical and mental health experts are still learning about BFRBs. Many studies have been conducted in an effort to understand more about BFRBs and find effective methods of treatment. The exact cause has yet to been determined.  Some studies have found that there is a genetic pre-disposition and other studies hint that environmental factors trigger the onset of the behaviors.

A person with BFRBs will engage in the behavior after experiencing the emotional states of boredom, stress, or anxiety as a way to release the tension and self-soothe. The action "feels good" momentarily. But, most people with BFRBs then quickly experience shame, anger and embarrassment as a result of the physical damage done and their inability to control these automatic actions.  These feelings, coupled with the subsequent bullying that may follow reduces a sufferer's self confidence and self worth further, and increases their internal negative self-speak. In short, the problem is made worse and a person may engage in further BFRB activity to attempt to further self-soothe.

Varying in severity, having a BFRB makes it difficult to lead a normal life. If severe and left untreated, it can destroy a person's capacity to function at work, at school or even to lead a comfortable existence in the home. Consumed by their BFRB, a person may miss out on sharing positive life experiences with their family and friends. It is a double-edged sword in that this behavior provides the reward of fleeting relief but also causes so much personal anguish.

Despite this, all hope is not lost. There are many ways to cope with BRFBs. Due to the societal pressure placed on physical appearance, most people with BFRBs are driven to hide the damage done using make up or wigs. Professional treatment options, such as behavioral therapy guided by a licensed psychologist, hypnotherapy, or medications prescribed and monitored by a psychiatrist may be cost prohibitive for many. Changes in diet, regular exercise and stress-reducing activities like meditation or yoga are also methods to help reduce the behavior.

If you have a BFRB, the most important thing to know is that you are not alone. There are many organizations, like Trichotillomania Learning CenterCanadian BFRB Support Network and HabitAware that are ready to help you when you are ready.