Treatments for Body Focused Repetitive Behaviors
What are BFRBs?
Body focused repetitive behaviors (BFRBs) are any repetitive grooming activity that results in damage to a person’s body. Many different activities can fall into this category, such as
- Nail biting
- Skin picking
- Hair pulling
- Hair eating
- Nose picking
We focus on hair pulling, skin picking, and nail biting because they are among the most common, best researched, and most effectively treated with our devices. That said, BFRBs are extremely multifaceted, so don’t feel alone as much of this information may still be applicable to you. As much as 2 - 5% of the general public may suffer from compulsive hair pulling or skin picking, respectively. For a human take on BFRBs, check out the Trich Stories interviews over on our blog.
To learn more about BFRBs, check out BFRB.org, an authority and leading BFRB community organizer.
Trichotillomania, or compulsive hair pulling, is characterized by repetitive pulling of one’s hair from any part of the head or body. Hair pulling might fall anywhere on a spectrum from automatic (unconscious), where a person is completely unaware of the hair pulling, to focused (conscious) where a person is completely aware. Trichotillomania may be accompanied by related use of the hair after pulling, such as manipulating or ingesting it.
Excoriation disorder or dermatillomania refers to compulsive skin picking anywhere on the body. Like trichotillomania, skin picking behavior may be anywhere on a spectrum from focused to automatic. Skin picking may be focused on scabs, acne, or other imperfections on the skin and involve ingestion or other manipulation after picking.
What is it like living with a BFRB?
Like most mental health issue BFRBs can vary widely in severity. Many people find their BFRBs mild enough that they feel no treatment is necessary. However, often times BFRBs can cause significant physical, emotional, and social stress. The inability to quit the behavior can cause people to feel shame and guilt, which can be compounded by the embarrassment of going to school or work with damaged skin or missing hair. Some people make serious efforts like wearing wigs or heavy makeup to hide their BFRBs. Some try to keep their condition a secret even from friends and family for fear of judgement.
Body focused repetitive behaviors sometimes follow a cycle of trigger, action, relief, guilt. A trigger such as stress, boredom, or tactile sensation may prompt the person to engage in the habitual behavior. Possibly after some resistance, the person engages in the behavior, momentarily giving a sense of relief or comfort. However, this gratification quickly gets overtaken by a sense of guilt for engaging in the destructive behavior. This cycle may repeat many times a day or hours on end. People with BFRBs may make numerous attempts to quit or reduce their habitual behavior.
Who has BFRBs?
About 90% of hair pullers are female while skin picking appears to be more balanced, though it is possible that females tend to seek treatment more. Besides that, there seems to be little correlation with race or other demographic factors. Some research indicates genetics play a role in who develops BFRBs. Onset typically is age 11-15 but can begin earlier or later. Similar destructive grooming behaviors have been observed in primates and birds.
Traditional therapy has been shown to significantly reduce body focused repetitive behaviors and their negative impacts on quality of life. Therapy may fall into one or more categories including
- Cognitive behavioral therapy (CBT) which focuses on identifying and challenging problematic thoughts and feelings.
- Habit reversal training (HRT) which focuses on building awareness and replacing damaging activities with competing, less destructive ones.
- Comprehensive behavioral treatment (ComB) which is based on the assumption that BFRBs meet a personal need such as relaxing, falling asleep, or needing to accomplish a goal. ComB tries to teach people to achieve these goals without engaging in the BFRB.
- Acceptance and commitment therapy (ACT) which focuses on accepting and tolerating the urge to engage in the habitual behavior rather than trying to totally eliminate it.
- Dialectical behavioral therapy (DBT) which focuses on building mindfulness, emotional regulation, and distress tolerance.
To date, the Food and Drug Administration has not approved any drugs for treatment of BFRBs. Sometimes Selective serotonin-reuptake inhibitors (SSRIs) are prescribed to treat comorbid anxiety and depression, though studies observing reduction in hairpulling or skin picking behavior has had mixed results. N-acetylcystein (NAC), an amino acid has been shown to reduce some symptoms in some patients. Research on the food supplement Inositol is ongoing.
While treatments for BFRBs do exist, none are completely effective and all require a certain amount of time before effects may be noticeable. Therapy may be costly and difficult to attend consistently. Medications may have side effects or interact with other drugs. With these caveats, we strongly encourage people seeking treatment for BFRBs to consult licensed medical professionals and to research evidence-based treatments like psychotherapy and medications.
Our mission is to provide an awareness-enhancement device that can help people identify when and under what conditions they engage in a BFRB. We designed our device not to replace evidence-based treatments but to augment them or be available in situations where other options are unavailable. Many of our users report that merely becoming aware of the habit is the hardest part of getting better. We can make you aware but at the end of the day you are in total control.
A device similar to ours developed at the University of Michigan was tested on 20 people with trichotillomania. Despite multiple technical issues, researchers reported significant decline in symptoms and severity. While clinical research in this field is still sparse, what data exists is so far encouraging.
Himle, J. A., Bybee, D., O’Donnell, L. A., Weaver, A., Vlnka, S., Desena, D. T., & Rimer, J. M. (2018). Awareness enhancing and monitoring device plus habit reversal in the treatment of trichotillomania: An open feasibility trial. Journal of Obsessive-Compulsive and Related Disorders, 16, 14-20. doi:10.1016/j.jocrd.2017.10.007
The Slightly Robot Bracelet and associated app are not medical devices. Slightly Robot makes no claims or guarantees whatsoever that any product will treat or cure any body focused repetitive behavior in any way. Our products are only designed to enhance the user’s awareness of the motion and position of their hands.