Body-Focused Repetitive Behaviors
Body-focused repetitive behaviors, or BFRBs, are repeated actions involving the hair, skin, or nails, including hair pulling, skin picking, nail biting, and cheek or lip biting. These behaviors may happen automatically or during stress, boredom, anxiety, uncomfortable sensations, or strong emotions.
Although they may provide brief relief, BFRBs can cause physical damage, shame, distress, and difficulty stopping without appropriate support.
Body-Focused Repetitive Behaviors (BFRBs): It is an umbrella term for a group of complex, compulsive behaviors where a person repeatedly touches, pulls, picks, bites, or scrapes their own hair, skin, or nails.
These behaviors go beyond standard habits like casual nail-biting; they are intense, difficult to stop, and often lead to physical damage, emotional distress, or social withdrawal.
Definitions:
Trichotillomania: Hair pulling
Dermatillomania/Excoration Disorder: Skin picking
Common BFRB Challenges
Many young people experience BFRBs but may hide them because of embarrassment or misunderstanding. CYMH provides accessible, evidence-based mental health care for children, teens, young adults, and their families across both counties today.
Hair Pulling
Hair pulling, also called trichotillomania, involves repeatedly pulling out hair from the scalp, eyebrows, eyelashes, or other areas of the body. Some young people feel a strong urge or tension before pulling, while others may pull automatically without realizing it. Over time, hair pulling can lead to noticeable hair loss, skin irritation, and embarrassment.
Skin Picking
Skin picking, also called excoriation disorder, involves repeated picking, scratching, squeezing, or rubbing of the skin. It may focus on blemishes, scabs, or perceived imperfections and can happen with limited awareness. Repeated picking may lead to sores, scarring, infection, shame, and avoidance of social situations and difficulties participating in everyday activities.
Nail, Cheek, or Lip Biting
Nail, cheek, or lip biting may happen automatically while concentrating, feeling bored, or experiencing stress. Some young people notice mounting tension before the behavior and relief afterward. Repetition can lead to pain, bleeding, damaged nails, mouth injuries, infection, and difficulty stopping despite repeated efforts or requests to stop independently.
Urges and Triggers
BFRBs are often connected to sensory experiences, emotions, situations, or routines. Common triggers include stress, boredom, fatigue, studying, screen time, and uncomfortable skin sensations. Understanding each young person’s patterns is important because triggers and behaviors can differ significantly from one person to another.
Comprehensive Behavioral Model (ComB)
Getting to know the "why" behind the pulling.
CYMH uses ComB, the gold-standard treatment for BFRBs.
One of our therapists will gently explore several areas with your child or teen, often including:
What it feels like...
Are there physical sensations involved, either that trigger pulling or that make it feel satisfying?
What they're thinking...
Are there certain thoughts, like "this doesn't feel right" or "I need it to be even," that show up beforehand?
What they're feeling
Does pulling tend to happen during stress, boredom, anxiety, or even relaxation (like watching TV)?
How it happens physically...
Is your child aware they're pulling, or does it happen almost automatically, without them noticing?
Where and when it happens...
Are there specific places or situations — the car, bedtime, homework — where it tends to come up?
How Can We Help?
If you have questions or would like to make an appointment, please complete this form, and we will get back to you as soon as possible. You can also email kerri@cymh.org or call our SLO Center at (805) 996-0535 or our Santa Cruz Center at (831) 222-0052.
Resources We Recommend
These resources are carefully vetted and align with the evidence-based treatments we provide at the Center for Youth Mental Health.
Body-Focused Repetetive Behaviors
Websites
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