Body Focused Repetitive Behaviors

If you or a loved one struggles with Body-Focused Repetitive Behaviors (BFRBs)—such as hair pulling (trichotillomania), skin picking (excoriation disorder), nail biting, or cheek biting—you’re not alone. BFRBs affect millions of people and can cause significant emotional distress, physical damage, and shame. At Compassionate Healing Institute, we offer specialized therapy for BFRBs using evidence-based approaches that foster healing, self-compassion, and long-term change.

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What Are Body-Focused Repetitive Behaviors?

 

BFRBs are compulsive self-grooming behaviors that result in damage to the body. These behaviors are not habits or nervous tics—they are complex disorders that fall under the Obsessive-Compulsive and Related Disorders category in the DSM-5.

 

Common BFRBs include:

 

• Trichotillomania – compulsive hair pulling from the scalp, eyebrows, eyelashes, or other body parts

• Excoriation Disorder (Dermatillomania) – repetitive skin picking, often leading to scabs, scars, or infections

• Onychophagia – chronic nail biting

• Cheek or lip biting – often occurring unconsciously or during periods of stress

• Nail picking (onychotillomania) – damaging cuticles or nail beds through picking or pulling

 

These behaviors often serve as a temporary coping mechanism for stress, anxiety, boredom, or sensory discomfort—but over time, they can severely impact mental health, self-esteem, and quality of life.

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Signs You May Be Struggling with a BFRB

 

• You feel unable to stop the behavior even when you want to

• You experience shame, embarrassment, or try to hide the behavior

• You notice bald spots, skin wounds, or dental issues as a result

• You feel tension before the act and relief afterward

• The behavior interferes with your daily life, relationships, or self-image

 

If this sounds familiar, seeking professional BFRB therapy can help you understand your triggers, reduce the urges, and regain control.

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Evidence-Based Models of Treatment for BFRBs

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1. Habit Reversal Training (HRT) – The Gold Standard

 

Overview:

Habit Reversal Training is the most established and widely researched treatment for BFRBs. It focuses on increasing awareness of the behavior and teaching concrete strategies to interrupt the pattern.

 

Core Components:

 

• Awareness Training: Clients learn to identify when, where, and how they engage in the behavior, including physical sensations, emotional states, and environmental triggers.

• Competing Response Training: Once a trigger is identified, clients are taught to substitute the behavior with a “competing response”—a behavior that is physically incompatible with the BFRB (e.g., clenching fists, sitting on hands, squeezing a stress ball).

• Motivation Building: Clients explore the negative impact of the BFRB and create reminders or visual cues to reinforce their goals.

• Generalization Training: Skills are practiced in multiple environments to build consistency and long-term change.

 

2. Comprehensive Behavioral (ComB) Model - A Flexible, Individualized Approach 

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Overview:

The ComB model was developed specifically for BFRBs and expands on HRT by addressing multiple domains that influence the behavior. It is highly personalized.

 

Core Domains:

 

• Sensory: How the behavior feels physically—does it provide a tactile or visual “reward”?

• Cognitive: What thoughts or beliefs drive the behavior (e.g., “I’ll never stop doing this”)?

• Affective: How emotions (stress, boredom, anxiety) fuel the urge to engage in BFRBs.

• Motor: The physical automaticity—how “automatic” the behavior feels.

• Place: The environmental context—specific places, routines, or objects that trigger the behavior.

 

Treatment Process:

 

• A therapist works with the client to assess how each domain plays a role in their behavior.

• Targeted interventions are then introduced for each relevant domain. For example, someone with high sensory involvement might use fidget tools, while someone with strong emotional triggers might focus on emotional regulation skills.

 

3. Cognitive Behavioral Therapy (CBT)–  Changing Thoughts, Changing Behaviors

 

Overview:

CBT helps individuals recognize how their thoughts, emotions, and behaviors are interconnected. While it is not BFRB-specific, CBT can be effective in addressing the underlying emotional and cognitive patterns that maintain BFRBs.

 

Key CBT Strategies:

 

• Identifying and challenging unhelpful thoughts (“I can’t control this” or “I need to pick to feel calm”)

• Emotion regulation strategies for anxiety, shame, or perfectionism

• Exposure techniques to reduce anxiety around stopping the behavior

• Behavioral experiments to test out new coping skills in real-life scenarios

 

4. Mindfulness-Based Interventions– Learning to Sit with Urges

 

Overview:

Mindfulness and acceptance-based approaches help individuals observe urges without judgment, creating a “pause” between impulse and action.

 

Common Techniques:

 

• Urge surfing: Learning to ride out the urge without acting on it

• Body scanning and sensory awareness: Tuning into sensations that precede the behavior

• Self-compassion practices: Reducing shame and harsh self-talk often tied to BFRBs

• Acceptance and Commitment Therapy (ACT): Helping clients take values-based actions even when discomfort is present

 

5. Supplemental Supports & Tools 

 

• Fidget tools, putty, and textured objects for sensory substitution

• Stimulus control (e.g., wearing gloves, placing bandages, altering lighting/mirrors)

• Tracking apps or journals to build awareness

• Family therapy for children/teens, including training parents in supportive strategies

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Most effective BFRB treatment is integrative—combining elements from HRT, ComB, CBT, and mindfulness depending on your unique needs. At CHI, we tailor treatment plans to you, whether you’re just beginning your journey or have been struggling with BFRBs for years.

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Why Choose Compassionate Healing Institute?

 

• Specialized BFRB clinicians with expertise in trichotillomania and excoriation

• Trauma-informed, inclusive, and affirming environment

• Teletherapy in all PsyPact states and New York. In-person sessions available in Coral Springs, FL

• Collaborative care for teens, adults, and families

 

We believe that healing from BFRBs is possible, and we are here to guide you every step of the way.​

 

You Deserve Support and Healing

 

Living with a BFRB can feel isolating, but you don’t have to navigate it alone. With the right tools and a compassionate therapist, you can develop greater awareness, reduce the urges, and find relief from the emotional toll of these behaviors.

 

If you or someone you love is struggling with skin picking, hair pulling, or another BFRB, reach out today. Our team at Compassionate Healing Institute is here to help you begin the healing process.

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