Body Focused Repetitive Behaviors
Hello Everyone,
I hope you’re all doing well and that Spring is coming soon to wherever you live.
What are Body Focused Repetitive Behaviors?
Most people have heard of Obsessive Compulsive Disorder (OCD), but many are unaware of what are called “OCD Spectrum Disorders”. One category of “OCD Spectrum Disorders' ' is called Body Focused Repetitive Behaviors or BFRB’s. The BFRB’s that we see most often at our anxiety clinic are Trichotillomania and Dermatillomania (or more recently Excoriation Disorder), which most people have never heard of. These two disorders are, respectively, pulling out one's hair and picking one's skin. BFRB’s can also include other repetitive behaviors such as nail biting or biting the skin inside of one's mouth, though Trichotillomania and Dermatillomania are by far the most common BFRB’s that we see.
The hair pulling can be from any part of the body, but is most often from the head, eyelashes or eyebrows and occasionally from the legs or pubic area. Skin picking can, likewise, be at any location on the body but face, scalp, legs and arms are most common. These are called “OCD Spectrum Disorders” because they co-occur frequently with OCD.The hair pulling/skin picking can range from occasionally pulling out a stray hair or two to pulling out entire eyebrows, eyelashes or large patches of hair on one’s head. Skin picking can have similar variations ranging from removing a few “bumps” on the skin to creating large sores/scabs from all the picking. Individuals suffering from a BFRB are universally extremely frustrated by their inability to stop these behaviors that appear so self-destructive. BFRB can either be focused (you are aware of what you’re doing) or unfocused (you don’t realize you’re pulling until you happen to look down and see the pile of hair on the floor next to you).
Some Treatment Options
Treatment often begins by keeping a diary of pulling/picking episodes over the course of several weeks to become more and more aware of when and--with some luck--why you pull/pick. The diary also has the effect of making you more aware – so that what was “unfocused” behavior becomes more and more “focused”. This is a necessary step because if you are unaware of what you’re doing it is virtually impossible to stop. Becoming aware is, unfortunately, often only the first step. Some people will find that the diary helps them stop their pulling/picking, but most people will find it is a necessary but not sufficient condition for change. Besides raising awareness, the diary helps us pinpoint where, when, how and even sometimes why we pull/pick. If we know where and when we pull/pick then when we go “there” at that “time” we can be especially careful to not start the BFRB in the first place. Of course this is much easier said than done, but it is a start. Knowing “how” we pull/pick can also be very useful. If we know, for example, we usually use the thumb and first finger on our right hand to pull out the hair, then we can cover those fingers (band aids or gloves) and thus reduce the probability we will pull/pick. In fact, using “barriers'' is one of the more effective and easily implemented treatment methods. Implementing the use of barriers may sound simple, but my experience is that it can be complicated and take quite a while to work into a daily schedule. The “why” we pull/pick may be an attempt to regulate our emotions. If we are upset it may be an attempt to calm ourselves down and vice versa, if we are bored it may be an attempt to rev ourselves up a bit. Searching for the “why” of picking/pulling may be pointless beyond simply recognizing that it is an attempt by your nervous system to regulate your emotions. Some people believe that if I can figure out why I pick/pull then I can stop…unfortunately I’ve never seen that work.
Once we have kept and used a diary and applied the barriers technique, we are then usually left with situations where there isn’t any way to use a barrier. For example, perhaps you chose to wear gloves but you work in a job that requires lots of typing. Beyond barriers there are always situations where it is you against the urge and success at this stage depends primarily on your willingness to sit with the urge to pick/pull and not respond…and you can imagine how difficult that can be!. Though this is quite challenging, I have found that most clients, with enough patience and practice, can master this step. You might find this book helpful with this aspect of treatment. If one of your children suffers from a BFRB, you might have a look at this book.
Few people have ever heard of BFRB’s and know that these disorders even exist, and fewer still realize that there are treatment methods for these disorders. An excellent source of information and resources for BFRBs is the Trichotillomania Learning Center for BFRB’s (www.bfrb.org). It is full of very useful information. There is even a therapist locator service to help you find a therapist in your area who is qualified to treat BFRB’s.
Let me know if you find this post helpful and if you have any questions. I’m always happy to help. If you know of someone who might benefit from reading this post please forward it to them and If someone forwarded this post to you and you wish to subscribe, you can go here.This post is educational and is not intended as a substitute for therapy. If you struggle with any of the above, please consult a qualified therapist.
Stay Safe,
Dr Bob
