Body-Focused Repetitive Behaviors
Understanding What Body-Focused Repetitive Behaviors Really Are
Body-focused repetitive behaviors, or BFRBs, are more than just habits, and they definitely aren’t just bad nervous tics. They’re a type of behavior where a person repeatedly causes damage to their body—most often by pulling hair, picking skin, biting nails, or chewing inside the cheeks. Many people who deal with these kinds of behaviors don’t do it for attention or out of laziness, but rather as a way of coping with overwhelming emotions, anxiety, or even just zoning out during everyday activities like watching TV or working.
What makes BFRBs particularly frustrating is how damaging they can be not only physically, but emotionally and socially too. You might find it difficult to explain your actions to others, cover up visible signs, or feel ashamed after an episode. This can create a loop where the behavior leads to stress, and that stress adds fuel to the fire—so the behavior keeps happening. It can be incredibly discouraging when you want to stop but can’t seem to.
Here’s a quick list of some common types of BFRBs:
- Hair pulling (trichotillomania): frequently pulling hair from your scalp, eyebrows, eyelashes, or other parts of the body
- Skin picking (excoriation disorder): picking at healthy skin, scabs, or acne to the point of injury
- Nail biting (onychophagia): biting nails down to the quick, often causing pain or bleeding
- Cheek or lip biting: chewing the inside of your mouth until it becomes sore or damaged
It’s important to understand that these actions are not signs of weakness. They’re ways your brain has learned to manage discomfort or overstimulation. They can increase during stressful times or feel automatic when your mind is elsewhere. That doesn’t mean all hope is lost—it just means your coping strategies may need some adjustment.
If you’re dealing with this, you may have found yourself trying to stop many times—hiding your hands, throwing away tweezers, using barrier creams, or wearing gloves. One client even shared how she kept fidget toys in her purse everywhere she went, hoping it would help. And sometimes it did, but without addressing the emotional side of things, the need to repeat the behavior never really went away. That’s where therapy—especially when it’s aimed at anxiety and OCD-related symptoms—can offer a more effective path forward.
​Evidence-Based Treatments That Actually Work
Understanding where BFRBs come from is crucial, but knowing what can help you move forward is the next step. Therapy for body-focused repetitive behaviors doesn’t rely on one-size-fits-all advice. There are practical, structured approaches that meet you where you’re at and focus on the patterns you've developed over time. These methods build awareness and help retrain your brain to respond differently to stress, boredom, or emotional overwhelm.
One common strategy used is Habit Reversal Training, which focuses on helping you recognize what leads up to the behavior—like a sensation, emotion, or routine—and then guides you toward replacing it with a behavior that doesn’t cause harm. For example, someone who pulls hair when feeling anxious might learn to clench their fists or hold a textured object instead. Over time, this new behavior becomes the go-to response instead of the old one.
Another helpful approach is Cognitive Behavioral Therapy, which helps untangle the thought patterns feeding the behavior. This isn't about talking yourself out of it with logic—it’s about gently interrupting the loop that reinforces the action. CBT can also explore the perfectionistic thinking or shame cycles that often go hand-in-hand with BFRBs.
Some strategies people find effective over time include:
- Identifying your triggers—what time of day do BFRBs usually happen? What are you feeling beforehand?
- Creating competing responses—any action that keeps your hands busy in a way that doesn’t cause harm
- Modifying your environment—removing mirrors, excess tools like tweezers, or placing visual reminders around your space
- Developing self-soothing tools—deep breathing, sensory items, grounding exercises
- Keeping a log—tracking progress and patterns without judgment
These tools can sound basic on paper, but when they’re introduced in a thoughtful, supportive way, they build a real foundation for change. It’s not just about breaking the habit—it’s about building something new that actually supports your mental and emotional well-being.
Why Personalized Therapy Matters
There’s a big difference between reading advice online and sitting in a safe, one-on-one environment where you can unpack your experience without fear of being judged or dismissed. Personalized therapy tailors strategies to your unique life story and how the behavior shows up for you.
For adults living with BFRBs and anxiety or OCD-related symptoms, it can feel like you’re constantly juggling invisible pieces. Some days are better than others, and it’s easy to fall into the trap of thinking progress means having zero urges. But progress often looks like shorter episodes, fewer times a week, or being able to pause before acting. Those changes are real, and they add up.
Azra Kim works with adults who have been facing these behaviors for years—not because they haven’t tried, but because lasting change takes time, support, and the right kind of tools. What works for one person won’t always work for another, and therapy helps attract the solutions suited for you specifically.
It can be comforting to know that someone understands how messy this process can be. You’re not expected to show up fixed. You’re showing up to get curious, learn, and try again. That’s where the shift happens. Working alongside someone who focuses on body-focused repetitive behaviors means you don’t have to keep navigating it in the dark.
​Take the First Step Toward Healing
Living with body-focused repetitive behaviors doesn’t mean you’re broken or lacking discipline. It means your mind and body have formed a response to something deeper—something that once made sense, but no longer serves you.
There's no fixed timeline for change. But what does move the needle is making that first connection with someone who truly sees what you're going through and knows how to help. With the right support, what once felt automatic can become something you're in control of. Healing isn’t about perfection—it’s about creating more space in your life where this behavior isn’t calling all the shots.
If you're recognizing yourself in these patterns and you're ready for something to shift, you're not alone—and it's okay to ask for support. Azra Kim offers compassionate, targeted therapy for adults experiencing challenges related to body-focused repetitive behaviors, and reaching out could be the first step toward real relief.