Body-Focused Repetitive Behaviours, commonly known as BFRBs, involve compulsive actions such as hair-pulling, skin-picking, nail-biting, or cheek-chewing. While many people may occasionally engage in such habits, for some, these Behaviours become persistent, distressing, and disruptive to daily life. Understanding what leads to BFRBs and how to manage them effectively is key. In this blog, we’ll explore their root causes and share helpful treatment approaches to guide those on the path to recovery.

What Causes Body-Focused Repetitive Behaviours?

• Neurological Factors:-Research indicates that the brains of individuals with BFRBs may function differently in regions controlling sensory perception and habit formation. Chemical messengers in the brain, such as serotonin and dopamine, may be out of balance, increasing the likelihood of repetitive actions that feel comforting or necessary.
• Emotional Triggers:-Many people with BFRBs notice these Behaviours intensify during times of anxiety, boredom, or emotional distress. These actions often serve as temporary distractions or coping mechanisms to manage overwhelming feelings.
• Genetic Influences:-There is growing evidence that genetics contributes to the development of BFRBs. Family studies reveal that these Behaviours tend to appear more frequently among close relatives, suggesting a hereditary component.
• Sensory Sensitivities:-Individuals with BFRBs might experience uncomfortable sensations on their skin or scalp, such as itching or rough patches, that drive the urge to pick or pull. In some cases, people carry out these Behaviours almost automatically, with little awareness of their surroundings.
• Co-occurring Mental Health Conditions:-BFRBs frequently occur alongside other conditions like anxiety disorders, obsessive-compulsive disorder (OCD), depression, attention deficit hyperactivity disorder (ADHD), or autism spectrum disorder. These overlapping challenges can make managing BFRBs more complex.

Recognizing Body-Focused Repetitive Behaviors

BFRBs vary in presentation and severity but often share these characteristics:

• Persistent urges to perform a specific behaviour, such as pulling hair or picking skin
• Physical damage caused by the behaviour, such as bald patches, wounds, or infections
• Emotional discomfort, such as guilt, embarrassment, or frustration linked to the behaviour.
• Avoidance of social situations due to visible effects or fear of judgment
• Early recognition is key to effective intervention.

Effective Treatments for BFRBs

While BFRBs can be difficult to cope with, they are treatable with effective strategies. Treatments aim to increase awareness, reduce urges, and teach healthier coping skills.

1.Increasing Awareness and Tracking

The first step often involves learning to notice when and why the behaviour occurs. Self-monitoring can help identify patterns by recording triggers, feelings, and situations linked to the Behaviours. Keeping a journal can build this awareness and empower change. Awareness training, in particular, teaches individuals to recognize the subtle signs and urges before the behaviour happens, allowing earlier intervention.

2.Habit Reversal Training (HRT)

Among the various treatment options, Habit Reversal Training stands out as a highly effective approach for addressing BFRBs. It includes:

• Awareness Training: Building sensitivity to the early sensations or thoughts that precede the behaviour.
• Competing Response: Learning to substitute the behaviour with a less harmful or incompatible action, like clenching fists or using a stress ball.
• Social Support: Engaging friends, family, or therapists to provide reminders and encouragement.
• Generalization: Practicing these skills in different settings to strengthen control.

Many individuals experience significant reductions in symptoms with consistent HRT practice.

3.Comprehensive Behavioural Intervention for Tics (CBIT)

Originally developed for tic disorders, CBIT incorporates elements of HRT and adds:

• Environmental modifications to avoid or reduce triggers (such as wearing gloves)
• Relaxation techniques to manage stress and anxiety
• Ongoing support to maintain progress

This holistic approach can be particularly helpful for those whose BFRBs worsen during stressful times.

4.Cognitive Behavioural Therapy (CBT)

CBT helps individuals address negative thought patterns contributing to BFRBs. It teaches coping strategies to manage stress and anxiety without resorting to repetitive behaviours, often leading to improved emotional regulation and symptom reduction.

5.Mindfulness and Acceptance Techniques

Mindfulness practices encourage observing urges without immediately reacting, allowing the intensity of the urge to rise and fall naturally (“urge surfing”). Techniques such as body scans or breathing exercises enhance awareness and reduce impulsive behaviour.

6.Medication

Medication is not the primary treatment, but can be helpful, especially when BFRBs coexist with other mental health disorders:

• SSRIs (Selective Serotonin Reuptake Inhibitors): Can reduce anxiety and compulsive urges.
• N-acetylcysteine (NAC): A supplement showing promise in reducing the intensity of urges in some cases.

Practical Tips for Managing BFRBs Daily

Keep your hands busy with stress balls, fidget toys, or textured objects.

• Alter your environment to reduce triggers, like wearing gloves or increasing tactile distractions.
• Use visual reminders or sticky notes to pause before acting on urges.
• Reward yourself for small victories to maintain motivation.
• Practice relaxation techniques regularly to lower overall stress levels.

When to Seek Professional Help

If BFRBs lead to emotional distress, physical damage, or disrupt daily functioning, seeking guidance from a mental health professional is strongly recommended. Therapists trained in HRT, CBT, or CBIT can tailor treatment plans that best fit your needs. Additionally, a medical evaluation may be necessary if medication is being considered.

Support Is Available

Joining support groups—either in person or online—can reduce feelings of social isolation and provide valuable encouragement. Educating family and friends about BFRBs can also foster a supportive environment that promotes recovery.

Conclusion

Body-focused repetitive behaviours are complex conditions influenced by neurological, emotional, and genetic factors. While they can be difficult to manage, evidence-based therapies offer effective tools to reduce symptoms and improve quality of life. Awareness, professional support, and persistence are key steps on the path to healing.

If you or someone you know struggles with BFRBs, remember that you are not alone, and help is available at TalktoAngel through the best psychologists in India in online counselling mode. Taking the first step toward understanding and treatment can open the door to lasting change.

Contributed by: Dr (Prof.) R K Suri, Clinical Psychologist & Life Coach, &  Ms. Riya Rathi, Counselling Psychologist

References

• Feusner, J. D., Beatty, C. C., Murphy, C., McGrath, P. B., Farrell, N. R., Nuñez, M., … Rhode, A. (2025). Virtual therapy habit reversal training for body?focused repetitive behaviors: Clinical outcomes from a large real?world sample of youth and adults. medRxiv. https://doi.org/10.1101/2025.03.10.25323675 MedRxiv

• Woods, D. W., Piacentini, J., Chang, S., et al. (2011). The efficacy of habit reversal therapy for tics, habit disorders, and stuttering: A meta?analytic review. Clinical Psychology Review, 31(5), 865–871. https://doi.org/10.1016/j.cpr.2011.03.013 Psychiatrist.com+6PubMed+6ScienceDirect+6

• Grant, J. E., & Chamberlain, S. R. (2021). Body?focused repetitive behavior disorders: Behavioral models and neurobiological mechanisms. Comprehensive Psychiatry, 105, Article 152272.