Hair pulling, nail-biting, acne picking, skin picking, scab picking, lip biting? You’re not alone.

Updated: Oct 8


Credit: pic: The TLC Foundation for BFRBs


This week is BFRB awareness week – but what is BFRB?

Body-focused repetitive behaviour (#BFRB) is the result of an intense urge to behaviour that can include hair pulling, skin picking, and nail-biting, to the extent that the repetitiveness causes physical damage.


They are not ‘bad habits’ and it is not OCD.


I know from clients that they have often felt they were the only ones to pull out their hair, pull out their eyelashes or eyebrows, or pick around their nails so much it damages the skin and causes bleeding and pain, and they were surprised when they realised it’s something other people do too. So, I’m putting this post out to raise awareness.


Below is a list of some of the behaviours that are classed as BFRB:


Trichotillomania (pronounced: trik-oh-till-oh-may-nee-uh. Trich for short) – hair pulling

Dermatillomania – skin picking

Onychophagia – nail biting

Dermatophagia – skin biting

Rhinotillexomania – nose picking

Cheek biting

Joint cracking


You might be surprised to find that there is something you do on that list; if so, check whether it is an issue or manageable without causing you discomfort, damage or feelings of self-isolation and shame.


BFRB affects around 5% of people. At 1 in 20 people, that’s not an insignificant number.


People who suffer with BFRB often try to hide it, feeling isolated and ashamed.


One of the aspects of BFRB is that the behaviour is difficult to stop and there is often hair loss and damage to the scalp and skin. It can also cause the person to feel extremely self-conscious, not just that others might see the damage to the skin or the bald spot on their scalp, but that they have done this to themselves.


Why people suffer with BFRB is not fully understood, but is thought to be an anxiety management issue, or a sensory stimulus, but it can also arise from self-grooming too.


My own experience with family, friends, as well as clients, is that there is often underlying anxiety that will increase, if not start, the behaviour.


In my experience, feeling bored is a key factor.


When I ask people how they felt in the moments before they started to engage in a BFRB behaviour, they often say they felt bored, even though to the outside world they looked like they were engaged in an activity, which is often TV, or gaming, particularly during a long period of gaming where the game doesn’t allow you to be particularly active, or phone scrolling on platforms such as YouTube.


Do you ever sit down to watch a long program or film that you’re keen to watch and then find yourself checking and scrolling on your phone repeatedly? There’s something about the body’s need to keep active, to fidget, and so you might find that these are times when you pick your skin, your nose, your scalp, or hair pull.


Help is available


There is a helpful organisation, TLC, who are based in the US, and they have a lot of helpful information and resources https://www.bfrb.org.


If you suffer with BFRB, therapy can be helpful and some people also find medication helpful which you can get from your GP.





Below, I set out my 3 top tips for feeling easier about the behaviour and reducing it:


1. It can be helpful to just raise your awareness of the feeling you have when you notice you are about to or are engaging in the BFRB behaviour.


Don’t judge yourself, just notice the feeling in you at that moment and whether there is discomfort in you. Notice what you do to relieve the feeling. You don’t need to do anything else, just notice it for now.


Breathe. And try not to give yourself a hard time for the way you feel or if raising your awareness doesn’t immediately stop you from doing the behaviour. This can take a lot of practice.


2. It is often helpful to have something planned in advance, so that you know what you will do instead.


But don’t judge yourself if you don’t stick to your plan or if you find it difficult to.


3. A fidget toy is a great tool that will give your fingers something else to do. I have heard stories of some schools not allowing fidget toys.


If you are in school or college, make sure they know that this is something you need to be able to use, especially if certain classes are a trigger.


If you need some ideas, the TLC Foundation has a great list of tools and ideas for alternative stimulation/behaviour blockers https://www.bfrb.org/learn-about-bfrbs/treatment/self-help/680-the-great-big-list-of-favorite-fiddles


Know that you are not alone.


For more information about BFRB and the benefits of therapy, visit www.annechristiecounselling.co.uk


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