Most people engage in body-focused repetitive behaviors, but if these habits begin affecting your everyday life, you may want to get treatment.
Most likely, you or someone you know bites their nails or cracks their knuckles from time to time. Although these are common, everyday habits, they fall under a cluster of clinically defined behaviors called body-focused repetitive behaviors (BFRBs).
BFRBs are compulsive, body-focused actions such as:
- nail biting
- skin picking
- cheek chewing
- hair pulling
- bone cracking
BFRBs are very prevalent. A 2018 study found that 23% of participants engaged in at least one of these repetitive habits from time to time.
These actions aren’t typically a reason for serious concern. But when they interfere with your quality of life or otherwise harm you, you may want to get treatment.
An estimated 12% of people meet the criteria for a BFRB disorder, which may require professional treatment.
BFRBs involve repetitive self-grooming — even though the impulse typically isn’t due to concerns about how you look. Instead, the behavior might feel:
- stress, depression, or tension relieving
It usually involves repeatedly doing any of the following:
- grinding (teeth)
- “cracking” (bones)
This might take place on parts of your body such as:
- inner cheeks
Some common examples of these include:
- nail biting
- skin picking (such as scratching scabs and popping pimples)
- hair pulling (from your scalp, head, body, lashes, or brows)
- chewing on your lips, tongue, or inner cheek
- nose picking
- chewing, biting, or scraping your skin
In some cases, the behavior might feel difficult to stop, even if it causes you pain.
BFRBs can range from mild to much more serious clinical disorders.
A very common, less serious form includes nail biting. For instance, a 2021 report estimates that about 20% to 30% of the population bites their nails regularly.
Some more extreme diagnoses have clinical terms listed in the Diagnostic and Statistic Manual of Mental Disorders Fifth Edition Text Revision (DSM-5-TR), such as:
- Trichotillomania (repetitive hair pulling): This subtype of BFRB causes a person to pull out their hair compulsively. They might rip it out of their skull, lashes, brows, or from anywhere else on their body. This might temporarily ease anxiety or lend a feeling of control. It tends to be difficult to stop, even if it causes pain and loss of hair.
Excoriation disorder (repetitive skin picking): This disorder leads people to pick at their skin, even when it causes bleeding or harm.
If your BFRB reaches a point where it interferes with your day-to-day health or well-being, you may want to discuss treatment options with a healthcare professional.
BFRB is a mental health disorder without a known cause. Research strongly suggests that people have a genetic predisposition to BFRBs. Experts also think that temperament and environmental stressors likely play a role in its onset.
For instance, BFRB is linked to anxiety disorders, including:
Obsessive-compulsive disorder (OCD) involves engaging in compulsions or rituals that temporarily relieve anxiety and intrusive thoughts. These thoughts are often characterized by sudden, scary images or feelings that seem to arise from nowhere.
People with OCD tend to manage these thoughts by acting on these urges. These compulsions might involve counting, ordering, or checking things repeatedly. For instance, if a person has both OCD and BFRB, intrusive thoughts from OCD (such as, “There are germs all over me.”) might lead to compulsive behavior such as skin picking.
Generalized anxiety disorder
Generalized anxiety disorder (GAD) involves chronic anxiety about things and situations, often for no known reason. To cope with these constant concerns, someone might develop compulsive behaviors.
For that reason, GAD and BFRB often have an overlapping diagnosis.
There isn’t a proven treatment for BFRBs. Most of the time, treatment involves managing the issue that seems to provoke the compulsive behavior. For example, many people with BFRB report engaging in the habit when stressed or anxious. Therefore, treatment often involves developing healthier coping skills for stress or anxiety.
But because BFRB triggers are diverse, there’s no one-size-fits-all approach.
Clinical treatment options include:
- Therapy: Talk therapy such as cognitive behavioral therapy can help to reframe intrusive thoughts and develop healthier ways to manage emotions. Therapy can help you understand triggers and what makes these habits more likely to occur in the future. With professional support, you can find ways to relieve the behavior and feel better.
- Antidepressants: Treatment for BFRBs
sometimes includesantidepressants, such as selective serotonin reuptake inhibitors, which can help reduce anxiety symptoms. But, so far, the Food and Drug Administration (FDA) hasn’tapproved any drugs for treating BFRBs.
- Glutamatergic drugs: Glutamatergic drugs help regulate glutamate and aspartate, which might play a role in anxiety and OCD. Doctors or healthcare professionals
sometimes prescribethe amino acid N-acetylcysteine to help regulate glutamate.
Since everyone’s symptoms and triggers vary, finding a clinical professional who can tailor your treatment to your situation and needs is ideal.
Other ways to manage the behaviors
- Behavior blocking: Behavior blocking means setting up a barrier between you and the habit beforehand. For instance, you might tie up your hair or wrap it in a scarf to deter hair pulling, wear gloves to stop nail biting, or use a mouthguard to prevent teeth grinding.
- Stimulation substitute: You may also want to consider replacing a harmful habit with a healthier one. For example, playing with a fidget toy or chewing gum might help you channel the impulse elsewhere.
- Trigger identification: Keeping a trigger journal can help you notice when you’re most likely to feel the impulse. This can help you better manage it. A therapist can also help you identify, understand, and manage your triggers.
Outside of clinical care, there are also other ways to help manage your symptoms and live more fully.
Sharing your situation in a support group may help you find a sense of community and new ways to cope. The TLC Foundation has a helpful resource for finding online and in-person meet-ups for those with BFRBs.
Being present and mindful of your triggers can help manage your symptoms. When you get an urge, try to take a moment to observe your impulses without shame or judgment.
After a pause, you might find that the compulsion has already passed. Or perhaps you can now cope differently, such as calling a friend, journaling, or cuddling with your pet.
Mindfulness can be honed through meditation, yoga, breathing exercises, or being immersed in an activity you love.
Some people with BFRBs might feel shame about their behavior, which may cause them to avoid support. But by being kind to yourself, you can help release the emotions that may be blocking your well-being.
You can do this through:
Your words: How would you talk with a beloved friend dealing with a similar issue? Most likely, you’d be kind. You might say that their actions are common and understandable and there’s no reason for guilt or shame. You might say that they’re worthy of love, that you’re always there for them, and that there are steps they can take to overcome it. When you speak to yourself in a caring instead of self-critical way, you may find it easier to cope.
Physical touch: BFRBs are often marked by harsh or even self-harmful behaviors. Another way to be more compassionate with yourself is to treat your body with tenderness and care whenever possible. Consider actions such as gently rubbing your shoulders, running your hands softly through your hair, or massaging your body with an exfoliating scrub in a warm bath.
There are many more ways to practice self-love and kindness. When in doubt, consider talking with a mental health professional. Reaching out to anyone you love and trust is also always a compassionate choice.
BFRBs are typically acted on as a way to cope with distress. They include actions such as skin picking, hair pulling, and nail biting.
Mild BFRBs such as nail biting are very common and not necessarily a reason for major concern. But when these behaviors escalate, they may cause harm. If they interfere with your day-to-day life, it’s a good idea to get support from a doctor or mental health professional.
A combination of clinical treatment, coping strategies, and self-care can help you manage your disorder and help you live a happier, more fulfilling life.