Body Focused Repetitive Behaviors (trichotillomania, skin picking, nail biting, cheek biting, etc.) 

Body Focused Repetitive Behaviors (BFRB’s for short). BFRB’s can look like skin picking, hair pulling, nail biting, cheek biting and more. Anxiety can make us do many things, often mindless things, to comfort ourselves. Habit Reversal training is a type of therapy focused on learning relaxation exercises and increasing awareness of cues for body-focused behaviors.

Sometimes these behaviors can feel embarrassing and are easily misunderstood. People often blame themselves and feel like they should just “stop it.” Many people suffer in silence, but you are not alone.
Good news, there is help for these behaviors! Through a technique called habit awareness training (HRT), a trained clinican can help you, or your child, develop alternative responses.


It is very possible to feel free from these behaviors. Give us a call and we can develop a plan for you so these behaviors don’t cause physical damage to your appearance or emotional damage to your confidence.

Treatments Available

A psychotherapy approach called Cognitive Behavior Therapy (CBT) is the treatment of choice for BFRBs. Existing studies suggest that CBT is superior to medication in treatment outcomes. However, some individuals may need medication first or in conjunction with CBT. CBT is a therapeutic approach that focuses on identifying thoughts, feelings, and behaviors that are problematic and teaches individuals how to change these elements to lead to reduced stress and more productive functioning. An emphasis is placed on matching the treatment to the unique symptoms of the individual.

There are a number of different treatment approaches for BFRBs that fall under the umbrella of CBT: Habit Reversal Training (HRT) and Comprehensive Behavioral treatment (ComB). Acceptance and Commitment Therapy (ACT), and Dialectical Behavior Therapy (DBT) are two treatment approaches that may bolster the effectiveness of other cognitive behavior therapies.

Understanding Body Focused Repetitive Behaviors (BFRB)s

There are several things that can cause BFRB’s, including temperament, age of onset, environmental stress factors and an inherited predisposition. More than likely BFRBs are caused by a variety of factors that interact with each other, resulting in the behavior. When a person starts experiencing a BFRB, it is not helpful to blame any one aspect of that person’s life that is happening at that time, but one might assume that the behavior most likely would have come to light at some point in the person’s life.

One interesting point is that other species engage in similar behaviors. Primates such as the great apes or certain types of monkeys will pull hair, over-groom, and pick at nits and insects on their own fur and the fur of others. Birds will pull out their feathers; mice will pull fur or “barber” themselves and their cage mates; dogs and cats may lick their skin or bite at an area, removing fur until there are bald spots. Researchers interested in animal models of BFRBs are trying to understand these behaviors in animals in order to shed some light on the complex neurobiology that underlies the human experience of BFRBs. What these animal studies tell us is that BFRBs are likely, in part, hard-wired behaviors that are not solely the result of environmental factors.