Body-Focused Repetitive Behaviours (BFRBs)
Body-Focused Repetitive Behaviours (BFRBs) are a group of complex mental health disorders that are characterised by the uncontrollable urge to pull, pick, scratch, cut, or bite one’s own hair, skin, or nails.
People with BFRBs often experience high levels of emotional distress as a result of these behaviours which can severely impact everyday life, causing avoidance and disruption at work, school and social situations. The behaviours can also lead to damage to the body, such as thinning hair or bald patches, skin lesions, scarring, and infection.
Despite affecting an estimated 4 million people in the UK and Ireland alone, these conditions are still incredibly stigmatised and misunderstood, resulting in many people with BFRBs living in secrecy and shame. In fact, only 50% of people with BFRBs seek help from a healthcare or therapeutic provider. Our main objective is to lessen the shame surrounding BFRBs, by providing a warm and welcoming community that thrives on acceptance.
The most common BFRBs are Hair Pulling Disorder (Trichotillomania), Skin Picking Disorder (Dermatillomania/Excoriation) and Nail Biting Disorder (Onychophagia) - however, there are many more forms of BFRBs.
What Causes BFRBs?
BFRBs are among the most poorly understood, underdiagnosed, stigmatised, and undertreated group of psychiatric disorders. BFRBs may result from a combination of genetics and acquired behaviours. Risk factors related to BFRBs include:
Genetics
Skin or hair-related conditions causing discomfort
Age - BFRBs commonly arise in late childhood or early puberty. Babies may also pull their hair out (often called “baby trich”) but they usually outgrow the condition.
Mental health-associated conditions, trauma, and childhood adversity.
Diagnosis of a neurodevelopmental disorder, such as autism or ADHD.
Impacts and Effects
For some, a BFRB may be a mild problem that causes little-to-no distress. But for many, the disorder(s) can cause intense emotional distress, shame, and embarrassment, increasing the risks of a co-occurring psychiatric disorder, such as depression or anxiety. Physical effects such as thinning or balding hair, infection, scarring, and repetitive strain of hand and wrist muscles are common. In severe cases, the behaviours can lead to life-threatening infections or, in the case of trichophagia, gastrointenstinal blockages. BFRBs can also result in social effects, such as tension and strained relationships with friends and family.
Treatment
There are a number of treatments on offer for BFRBs. Evidence-based treatments include Cognitive Behavioural Therapy, Habit Reversal Therapy, and ComB Therapy. Acceptance and Commitment Therapy (ACT), Hypnotherapy, Dialectical Behavioural Therapy (DBT), and Psychomotor Therapy, can also have a positive effect on symptoms. Attending support groups can help to lessen the internalised shame caused by BFRBs - sometimes connection is the best medicine. No medications have been approved by the NHS or HSE for the treatment of BFRBs and there is limited research on the use of medications for these behaviours. However, healthcare providers often use specific over-the-counter supplements and prescription medications “off-label” to help manage symptoms and treat co-occurring conditions such as anxiety, depression, or OCD. Treatments and medication results vary from person-to-person, and oftentimes a combination of treatments is needed to see an effect. The first step to accessing treatment is to contact your GP for assessment.