Do you sometimes find yourself picking at your nails, pulling your hair, or biting your lips? You might think of these as just small, occasional "nervous habits." But they can be a little more complicated than that. Today, we're going to talk about these habits that we do to damage our own bodies without even realizing it. In medical terms, these are called Body-Focused Repetitive Behaviors (BFRBs).
What exactly are body-focused repetitive behaviors (BFRBs)?
Simply put, a ``(BFRB)`` is an action that you do repeatedly with something on your body. What happens is that, without you even realizing it, you cause small amounts of damage to your own body. Many people see these as just "nervous things." For example, things like biting the skin around your nails when you're bored or blowing your fingers.
But these are not just things we do to pass the time. Research shows that our genes, brain structure, and emotions influence these behaviors. You may have tried to cut down on these things, but you've probably found that they're hard to stop. A BFRB is a strong, uncontrollable urge. And, you may feel a little pleasure or satisfaction from doing it. But don't worry, there are treatments available if you need help.
What are the main types of these `(BFRB)`?
There are several types of `(BFRB)`. The two main and most common types are:
- Skin picking or skin picking: This is medically known as ``Excoriation'' or ``Dermatillomania.'' This involves repeatedly picking, scratching, and digging at areas of the skin.
- Hair pulling: This is called ``Trichotillomania.'' This involves pulling out hair from areas such as the scalp, eyebrows, and eyelashes.
These two types are also the main ones identified in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).
Are there other types of `(BFRB)`?
Yes, there are several other types of `(BFRB)`. They are:
- Teeth grinding: `(Bruxism)`
- Cracking of the fingers: `(Crepitus)` (This is usually harmless, but some people do it as a habit)
- Skin biting: `(Dermatophagia)`
- Finger sucking: `(Finger sucking)` (This is common among young children, but can also occur in some adults)
- Lip bite keratosis:
- Biting the inside of the cheeks: `(Morsicatio buccarum)`
- Nail biting: `(Onychophagia)`
- Nail biting/breaking: `(Onychotillomania)`
- Nose picking: `(Rhinotillexomania)` (This is also something that many people do as a habit)
- Hair-eating: `(Trichophagnia)` (Hair-pulling)
Although these other types are not specifically mentioned in the DSM-5-TR, a doctor may identify them by placing them in the appropriate BFRB category.
How common are these conditions?
According to various studies, doctors have officially identified between 0.5% and 4.4% of the population as having BFRB. However, the actual number is likely much higher. This is because many people do not seek medical advice for this condition. Perhaps because of embarrassment, or because they do not know that it is a disease.
What are the symptoms of `(BFRB)`?
Commonly seen ``(BFRB)`` behaviors are:
- Pulling, scratching, and breaking your hair, nails, and skin.
- Biting nails, lips, cheeks.
- Exploding fingers, exploding joints.
- Grinding teeth.
When you do these things, you may feel like:
- Before doing that behavior, you feel a lot of anxiety and pressure , and after doing it, you feel a temporary relief .
- It feels like you have no control when you do that (like you can't stop).
- Sometimes you do it consciously (consciously) , and other times you do it unconsciously (unconsciously) . Imagine, while you're watching TV or reading a book, you accidentally cut your finger or pull a strand of hair.
Why does this `(BFRB)` occur? What are the causes?
Doctors still don't know exactly what causes BFRBs, but research has found that these factors may contribute:
- Brain structure and genes: Our brains have parts that control things like happiness and satisfaction. And parts that control emotions. Some changes in the structure of these parts can cause BFRBs. Our genes determine how these parts of the brain are formed and how they work. Also, genes can affect whether the chemicals that control our mood and impulses, such as Serotonin and Dopamine, are not properly regulated in the brain.
- Controlling Emotions: Sometimes, these ``(BFRB)s'' can be a way we use our bodies to deal with or avoid negative emotions like embarrassment, shame, boredom, and sadness.
- Distraction: When you are feeling stressed or overstimulated, this ``(BFRB)`` can be a way to distract yourself. That is, these behaviors can seem to help you reduce stress, discomfort, and distract yourself from what is going on around you.
The important thing is that this `(BFRB)` is not caused by a desire to improve your image or change your appearance. There are other mental conditions that can be caused by such things, but `(BFRB)` is not like that.
Who is most at risk of developing BFRBs?
People with these factors may be at higher risk of developing BFRBs:
- Being a woman.
- Having been exposed to some form of abuse or severe trauma during childhood or later in life.
- Having a family member with a (biologically related) ``(BFRB)`` condition.
- Having low self-esteem.
- Having Obsessive-Compulsive Disorder (OCD)
- Having a substance use disorder or addiction to drugs or alcohol.
What complications can occur due to this `(BFRB)`?
Constantly chewing, picking, and pulling on various parts of your body can lead to complications such as:
- Bacterial infections: Infections can easily occur when the skin is injured.
- Bleeding: Sometimes, wounds can bleed.
- Hair loss: Frequent hair pulling can cause bald spots.
- Scarring: Damage to the skin can cause permanent scars.
When your appearance is unknowingly altered by your own actions, it can affect your mood, self-esteem, and confidence. You can seek help from a mental health counselor to manage these feelings.
How do you find out if you have `(BFRB)`?
Your primary care physician, dermatologist, or dentist may be the first to see you if you have a BFRB. For example, if you have a skin problem, your doctor may think that you are constantly picking at your skin. The doctor will ask you about your symptoms and how you are feeling. They may then refer you to a mental health professional, such as a psychiatrist or psychologist.
A mental health counselor will examine you to see if your symptoms fit the criteria for diagnosing BFRB:
- You engage in repetitive behaviors that are damaging to your body.
- You try to stop (or reduce) this behavior, but you can't.
- This behavior causes you stress or interferes with your ability to perform your daily tasks properly.
What are the treatments for `(BFRB)`?
One or both of these can be used as treatments for BFRBs:
- Therapy: A mental health counselor will teach you habit-reversal training through a treatment method called Cognitive Behavioral Therapy (CBT). This will help you become more aware of the triggers that trigger these behaviors. You will also be trained to find alternative ways to respond to them instead of doing them. Imagine that every time you feel like punching someone, you will learn to squeeze a small ball or do something else instead.
- Medications: There is currently no medication specifically approved by the US Food and Drug Administration (FDA) for BFRB. However, there are medications that can help manage symptoms. A doctor may prescribe antidepressants called Selective Serotonin Reuptake Inhibitors (SSRIs). A supplement called NAC (N-acetylcysteine) may also be helpful for some people.
The most important thing is to continue with your treatment plan, even if you feel better. Take your medications exactly as your doctor tells you to. Do not make any changes to your treatment plan without your doctor's approval.
What kind of experience does someone with `(BFRB)` have?
A BFRB can feel and look different to everyone. You may feel anxious, relieved, or stressed. It's hard to know exactly when you'll feel the urge to do it. Sometimes, you don't even realize you're doing it until someone points it out to you. Over time, these behaviors can damage your body, cause scarring, and lead to infections.
But don't worry. Treatment, usually a combination of counseling and medication, can help you manage your BFRB symptoms. It takes time and practice - you can't stop these behaviors overnight. If you have any questions about this treatment plan, talk to your doctor.
When should you see a doctor?
See a doctor if you have repetitive body-focused behaviors that you want to stop but are having trouble managing on your own. These can include skin picking, teeth grinding, and hair pulling.
Also, if you have signs of infection from a wound, such as pain, swelling, or pus, notify a doctor immediately.
What questions should you ask your doctor?
You can ask these questions when you see the doctor:
- How do I stop this `(BFRB)`?
- Should I talk to a mental health counselor ?
- Do you recommend that I take medication?
- Can taking medication cause side effects?
The message we should take from this
No one likes to feel out of control over their own actions. No matter how hard you try to stop these things, sometimes it feels like nothing is working. That's the reality for someone with a body-focused repetitive behavior (BFRB).
But the good news is, you don't have to continue to suffer with these behaviors. A doctor can help you find a solution.
Many people successfully manage these symptoms with counseling and/or medication. It may take several months for you to feel better and see results. But your medical team will help you manage this ``(BFRB)`` condition for the rest of your life. So it's never too late to ask for help, and don't be ashamed.
` Body-Focused Repetitive Behavior, BFRB, skin picking, hair pulling, nail biting, teeth grinding, mental health, behavioral therapy
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