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What are body-focused repetitive behaviours?

We generally associate the likes of hair pulling and skin picking with childhood but, in recent years, these kinds of habits have been recognised as body-focused repetitive behaviours (or BFRBs) that can continue into your adult years.

What is a BFRB?

BFRB is a general term that refers to any repetitive self-grooming behaviour that results in damage to the body. They’re actually more common than you’d think with roughly 1 in every 25 people dealing with an BFRB.

It’s important to note that it involves more than just occasionally biting your nails when you’re anxious or stressed. A BFRB causes personal distress to the person suffering from it and can, in some cases, impede their daily life. Severity varies from person to person.

These behaviours tend to flare up when a person is engaged in another activity, such as driving, reading, attending a meeting or lecture, or simply lying in bed. Sometimes the person can be fully focused on their BFRB and at other times they may not be aware they’re doing it.

The two most common behaviours are recurrent hair pulling (trichotillomania) and recurrent skin picking (excoriation). There is a growing body of evidence that other behaviours like recurrent nail biting can be considered to be BFRBs.

Often, the person has tried unsuccessfully to stop the behaviour many times. That may be because the repetition feels satisfying or relieves stress. It has been incorrectly claimed that the behaviours are symptoms of obsessive-compulsive disorder or a sign of deep trauma. Most of the time, this is not true.


The causes of BFRBs are unknown but there is evidence to suggest your genetics play a role. Other factors that may cause a BFRB to develop include your environment, family-related stress and temperament.

A BFRB will generally present between the ages of 11-15, and occasionally in early childhood. Interestingly, 9 out of 10 adult hair pullers are women. This is compared to the roughly 50:50 ratio in childhood. Hair pulling and skin picking can also be seen in other species such as primates, birds and mice.


The most common treatment is cognitive behavioural therapy (CBT), which explores the situations where the behaviour manifests and attempts to reverse the response. Medication is rarely prescribed unless it is to treat consequences of the behaviour (antibiotics for infections from open wounds or steroids to reduce itching, for example).

With the right treatment, many people learn to manage their BFRB. Talk to your GP if you are concerned about your behaviour so they can advise you on the next steps to take.

Looking for more articles on mental health? Click here.