Body-focused repetitive behaviors (BFRBs) are a general term for a group of complex self-grooming disorders. This involves pulling, picking, biting or scraping one’s own hair, skin or nails. About 3 percent of the population, both children and adults are affected.
In the past there was little research and much misunderstanding. BFRBs were thought to be some sort of anxiety disorder, impulse control disorders and even obsessive compulsive disorders.
With more information on what may cause the disorders and the connections, treatment approach can be determined. Experts also think there are different subtypes.
Recent years have brought more awareness. BFRBs have been a challenge for a longtime as how to categorize them. Most experts have agreed there are significant differences with all three. Some BFRBs currently are categorized in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) as ‘obsessive compulsive and related disorders’. (Celebrities).
What are BFRBs
Body-focused repetitive behaviors typically start during late childhood or with the teen years. Rarer cases may develop in adults or even younger children.
Men can also be affected, although, the disorders seem to be more common in women. Around ninety percent of adults seeking help are female.
There may be triggers with the behaviors. Individuals may pick or pull when feeling anxious, saying it is a temporary relief.
Still others may pick, pull or scratch not noticing, or while distracted in an activity such as reading or watching TV. It is done without planning or thinking as if it is an automatic process. Those with BFRBs usually feel they have no control with their picking and pulling habits.
Some people may find themselves pulling out their eyelashes, biting their nails to the quick, squeezing the skin until it bleeds and this is a daily routine going to the point where it interferes with their life.
BFRBs are ongoing behaviors that continue even though attempts are made to stop. To help individuals decrease the frequency of these behaviors or stop completely, they must seek treatment and self-compassion. There is no cure. This is a BFRB disorder.
- Trichotillomania disorder
- Excoriation disorder
- Onychophagia disorder
- 2-4 percent of population trichotillomania
- 2-5 percent of population dermatillomania The above two usually occur together
- 20-30 percent of population onychopagia Most common especially in children
With 1 out of 20 people who live with BFRBs almost half do not receive treatment. Few mental health professionals have received the training at a graduate level for BFRBs. Patients often suffer a relapse.
Management and Treatment for BFRBs
It is important to find a doctor who specializes in body-focused repetitive behaviors. Most living with the disorder will need to manage and treat it throughout their life. Although, having some improvement is a start. Many have created treatment plans and ways to cope thus greatly reducing or even stopping their need of picking and pulling.
Recommendations for BFRB treatments include; cognitive behavioral therapy, medications and certain supplements.
CBT (cognitive behavioral therapy) has been shown to be the most helpful by identifying the triggers causing the picking or pulling. A form called Habit Reversal Training can also be effective to determine the patterns and negative feelings that go along with BFRBs.
Medication is not considered as effective as the behavioral treatments. However, some medications (selective serotonin reuptake inhibitors (SSRTs), clomipramine, naltrexone and olanzapine) have been promising in those who have co-occurring anxiety, depression or OCD.
Something like having an object (fidget toy) to keep hands busy during times that pulling happens is beneficial. The aid of little ways to make picking and pulling difficult like wearing gloves or mittens, or placing tape or bandages on a few fingers may help.
Joining a support group to connect and share with others who have BFRBs is a great relief in knowing others relate to the disorder.
It can also be an empowering experience to tell friends and family especially when the person has been in hiding for years. Because it runs in families, it’s possible to find another member who has also coped with the disorder. Through sharing the experiences families may become closer.
The Effects of BFRBs
BFRBs can cause physical injuries this is the danger, resulting with scarring, discoloration, and infections (MRSA) also bald spots. There may be bleeding and bruising. The affected tissue may never heal properly or develop calluses. Hair follicles; on the scalp, eyebrows and eyelashes can be permanently damaged. There may be the loss of the nail bed.
This often leads to high emotional distress, especially if the condition is undiagnosed or it is being kept secret. With a severe case, this can impair the person’s chance to socialize or function while working.
Associated Shame and Stigma
Millions are affected by BFRBs, although they are not well understood. The behaviors are considered just bad habits and that they could be stopped with some willpower. Due to this misconception, those living with BFRBs report debilitating shame. They may beat themselves up not being able to stop and going to great lengths in order to hide what they are doing to themselves.
Because of this they may resort to using wigs or makeup, not allowing anyone to see their body parts where they pick and pull. This intense shame can affect their relationships, intimacy and daily activities.
For those with BFRBs there may have been stares, grimaces, maybe even “eews” from others who find the actions appalling or just don’t understand. This can drive the picker or puller more into hiding. Can you blame them (sometimes people can be so cruel) who wants to admit she caused the bald spot on her head? Or that he made the scab on his arm?
Being able to share feelings of guilt and shame with loved ones or a therapist can be extremely helpful. There is comfort in realizing that they are not alone. Support groups and online resources are available.
Back to School Tips
Especially during this pandemic, going back to school can be stressful. It may be harder even for those with BFRBs. Here are some tips to make the year better, hopefully.
Don’t be afraid to ask for help. It’s important to have someone or a group for support, trust and to confide in. Being able to go to a guidance counselor who has to keep information confidential may be beneficial. Having a great group of friends who understand when you need somewhere to go for comfort.
Wear Makeup. It is not necessary but this can work as a tool to relieve stress, build your self-esteem and self-confidence as well as drawing attention away from your BFRB. If you are a skin picker or hair puller and have visible damage, the makeup will discourage you because it will come off or get smudged.
Say you pull your eyebrows or eyelashes, if you do you will end up with makeup or mascara on your fingertips.
Pack your fiddle Toys. You may need to inform teachers of your situation if you think this may be a problem. You may talk to them in private, by email or letter. This is best to do before school starts. There may be varieties of AKA fidget toys.
Teacher pats or taps. If you are comfortable telling your teacher about your BFRB, ask if they could help by making you aware of any picking or pulling in their class. The teacher could simply pat your back, tap your desk or give you a nod. If you are uncomfortable asking the teacher to do this, you could have a parent or guidance counselor ask for you.
Study with a group. If you don’t pick or pull in front of people, try to spend more time with others. When a test is approaching and stressing you out, study with your friends. This option will prevent you from picking or pulling due to the big trigger, stress.
Talking to class. If your hair pulling is noticeable (being bald) asking your guidance counselor to talk to your class about your condition and having students not mention it to you can relieve some stress.
Take care of yourself! This is always important no matter where you are in life. School can be very stressful with so much going on. So keep in mind to take little breaks for your health. Yoga is great for breathing and stretching. Taking a walk can help clear your head and enjoy nature. Make sure you are getting enough sleep, 8 hours a night. Eat a healthy diet. Start each morning with a good breakfast, include plenty of protein, which can help if you pick or pull when hunger pains strike.
Lastly, as humans we are not perfect. You are not alone.
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https://www.bfrb.org/ accessed 09/25/2020
https://www.psychologytoday.com/us/basics/body-focused-repetitive-behaviors#: accessed 09/25/2020