Body-focused repetitive behavior

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Body-Focused Repetitive Behavior (BFRB) is an umbrella name for impulse control[1] behaviors involving compulsively damaging one's physical appearance or causing physical injury.[2]

The main BFRB disorders are:[3]

BFRB disorders can also include Dermatophagia (compulsive skin biting), biting the insides of the cheeks, lip picking, blemish squeezing, and Rhinotillexomania (compulsive nose picking).[2] BFRB disorders are not generally considered obsessive-compulsive disorders.[3]


Dermatillomania of the knuckles (via mouth) illustrating disfiguration of the distal and proximal joints of the middle and little fingers.

The cause of BFRBs is unknown. Emotional variables may have a differential impact on the expression of BFRBs.[4] Researchers are investigating a possible genetic component.[1][5]


BFRBs most often begin in late childhood or in the early teens.[2]


BFRBs are among the most poorly understood, misdiagnosed, and undertreated groups of disorders.[6] BFRBs may affect at least 1 out of 20 people.[2] Trichotillomania alone is believed to affect 10 million people in the United States.[7]


Treatment can include behavior modification therapy, medication, and family therapy.[1][2] The evidence base criteria for BFRBDs is strict and methodical. [8] Individual behavioral therapy has been shown as an “probably effective” evidence-based therapy to help with thumb sucking, and possibly nail biting. [8] Cognitive behavioral therapy was cited as experimental evidence based therapy to treat trichotillomania and nail biting. [8] However, no treatment was deemed well-established to treat any form of BFRBDs. [8]

See also[edit]


  1. ^ a b c Scientific Advances in Trichotillomania and Related Body-Focused Repetitive Behaviors, November 4, 2004, National Institute of Mental Health
  2. ^ a b c d e AAMFT Consumer Update - Hair Pulling, Skin Picking and Biting: Body-Focused Repetitive Disorders, American Association for Marriage and Family Therapy
  3. ^ a b Trichotillomania (TTM) & Related Body-Focused Repetitive Behaviors (BFRBs), The Center for Emotional Health of Greater Philadelphia
  4. ^ Teng; et al. (2004), "Body-Focused Repetitive Behaviors: The Proximal and Distal Effects of Affective Variables on Behavioral Expression", Journal of Psychopathology and Behavioral Assessment 
  5. ^ ABC News 20/20 Hair Pulling, 2006
  6. ^ Families & Health, American Association for Marriage and Family Therapy
  7. ^ Diefenbach, G.J., Reitman, D. & Williamson, D.A., (2000). "Trichotillomania: A challenge to research and practice". Clinical Psychology Review 20 (20): 289–309. doi:10.1016/S0272-7358(98)00083-X. PMID 10779896. 
  8. ^ a b c d Woods, Douglas W.; Houghton, David C. (13 July 2015). "Evidence-Based Psychosocial Treatments for Pediatric Body-Focused Repetitive Behavior Disorders". Journal of Clinical Child & Adolescent Psychology: 1–14. doi:10.1080/15374416.2015.1055860.