Body-Focused Repetitive Behavior (BFRB) Therapy in Los Angeles

What are BFRBs?

Body-Focused Repetitive Behaviors (BFRBs) are a collection of repetitive and habitual behaviors directed towards one’s own body, such as hair pulling, skin picking, nail biting, and cheek and lip biting. While BFRBs are different than self-harm behaviors, they may cause infection, tissue damage, pain, scarring, hair or nail loss, distress, embarrassment, and social challenges (e.g., bullying, avoidance of school or work).

Common BFRBs:

Hair Pulling (Trichotillomania)

Hair Pulling (Trichotillomania)

Hair pulling can occur on any part of the body with hair, such as the scalp, eyebrows, and eyelashes. It may lead to loss of hair or bald patches.

Skin Picking (Excoriation)

Skin Picking (Excoriation)

Excoriation is characterized by repetitive skin picking, touching, rubbing, scratching, squeezing, or digging. While some may pick to remove imperfections or smooth scabs or rough patches, this may result in skin lesions.

BFRB: Nail Biting

Nail biting

Habitual biting of nails or cuticles that may cause bleeding, soreness, and infection.

BFRB - Cheek or Lip Biting

Cheek or Lip Biting

Chronic cheek and lip biting or chewing may lead to redness, sores, and bleeding.

BFRB Treatment: Habit Reversal Training (HRT)

Research and clinical experience has indicated Habit Reversal Training (HRT), a form of cognitive behavioral therapy (CBT), to be helpful for BFRBs. HRT is composed primarily of two components - awareness training and competing response training:

  1. Awareness training involves learning to become aware of the urges, situations, and other warning signs to which pulling, picking, or biting is most likely to occur.

  2. This allows for a window of opportunity to use a behavior that is physically incompatible with the BFRB, called a competing response. For example, a competing response may include crossing arms or making fists whenever an urge or warning sign arises to prevent pulling or picking. Competing responses are tailored per individual so they target specific BFRB behaviors.

In addition to these primary components, social supports may be identified to encourage or gently remind you to use your competing responses.

Additional skills to HRT have also been found to be helpful. Stimulus control involves creating barriers to make BFRB behaviors more difficult. This may include changing the environment (e.g., removing tweezers), modifying activities (e.g., limiting bathroom time), keeping nails short, or substituting BFRB behaviors with fidget toys in high-pulling or picking situations. Coping skills may also be included to manage distress and support treatment.