Body-Focused Repetitive Behaviors (BFRB)

Body-Focused Repetitive Behavior (BFRB) is a term used to describe excessive self-grooming that leads to emotional distress and physical harm. BFRBs include biting, pulling, picking, or scraping one’s own hair, skin, lips, cheeks, tongue, or nails.  Many individuals with these behaviors may spend up to hours each day focused on grooming tasks. Others may do this while asleep at night. It is common for these behaviors and their outcomes to be hidden from family members due to shame and lack of awareness that treatment is available.

BFRB is currently classified as an Other Specified Obsessive-Compulsive and Related Disorder. This is a category of DSM-5 diagnoses that applies to those who have characteristic of obsessive compulsive disorders but do not meet the full criteria for any of them. 

CBIT Therapy utilizes sensory integration, Habit Reversal strategies, the TLC ComB protocol, and direct CBIT competing responses to help patients stop unwanted behaviors such as pulling and picking hair and skin. Our approach includes thoroughly researching antecedents and consequences of grooming behaviors, as well as what happens during the time of action. Factors addressed include the environments and people with whom the BFRB occurs, exact thoughts related to grooming, physical sensations felt at the sight of damage, Moods and circumstances that trigger behaviors, visual inspection of grooming sites, and the exact muscular action involved in removing unwanted skin or hair. Treatment also involves recognizing what is done with the products of BFRBs. For example, some people will rub eyelashes on their lips and then ingest them. Skin is also commonly consumed.

For those who pull hair or pick skin, therapy also involves finding ways to keep hands engaged in a safer way. Physical activities may include planks or push ups or yoga. Gardening, cooking or baking, doing household chores, painting and crafts, building with legos and construction materials can all be useful. Fidgets, and fidget rings and bracelets can also help.

There are often physical ways to block use of hands temporarily, such as crossing wrists behind the back, and then lacing hands together and pulling shoulders back for 1 to 3 minutes. This hold is called a competing response and is a component of habit reversal / CBIT training.

Some people with BFRBs also benefit from changing the environments in which they pull - such as rearranging a room , sitting in a different type of chair, or going outside for a walk,

Therapy is goal-oriented and patient centered. Typically a patient will have a telehealth session 3 weeks in a row, and then sessions will be spaced out to every 3 to 6 weeks or longer, depending on need. During the initial evaluation, patients typically share information regarding how the behavior began and methods that have been already tried to manage the situation. A plan will be set to better understand why the behaviors occur in regards to sensory input and stressful and underwhelming situations. Next, actions will be taken to decrease the occurrence of the BFRB with hands on strategies.

For more information about BFRBs click here. 

To request intake forms for a BFRB evaluation and treatment with CBIT Therapy click here.

Services are available via telehealth in MA, NH, NY, VT, and ME.