Body Focused Repetitive Behavior (BFRB) is a general term for a group of related disorders that cause people to repeatedly touch their hair and/or body in ways that may result in physical damage (e.g., scabs, scarring, tissue damage, and infection). Common BFRBs include: Hair-Pulling Disorder (Trichotillomania), Skin-Picking Disorder (Excoriation) and Nail-Biting Disorder (Onychophagia). Some individuals engage in BFRBs when bored (e.g., lying in bed, sitting at a desk), when anxious, or while fully focused (e.g., looking in the mirror while picking acne). Individuals may engage in BFRBs to relieve stress or to experience gratification or other sensations.
Treatment of BFRBs includes a specific cognitive-behavioral therapy called habit reversal training (HRT) and an enhanced HRT protocol – the Comprehensive Behavioral Model (ComB). HRT includes awareness training to help the person focus on circumstances during which pulling or picking is most likely to occur, and competing response training to teach the person to substitute another response for the pulling or picking behavior that is incompatible with the BFRB. For example, when someone has an urge to pick their hair, they could ball up their hands into fists and tighten their arm muscles to make pulling/picking impossible in that moment.
The comprehensive behavioral (ComB) model, developed by Dr. Charles Mansueto and his colleagues, is based on the assumption that a person engages in their BFRB because it meets one or more need in the individual (e.g., helping to relax, to fall asleep, or to feel like a goal was accomplished). This model focuses on understanding why, where and how a person engages in their BFRB so that individualized interventions can be selected to help the person achieve what they want to achieve without engaging in the BFRB. For more information on BFRBs, visit https://www.bfrb.org/