It is a commonly utilized joke in the therapy world that there is an acronym for everything.
Well, here’s another one - BFRB’s, formally known as body-focused repetitive behaviors. BFRB’s are a range of behaviors that usually fall under the self-grooming category. They include trichotillomania (hair pulling), excoriation disorder (skin picking), and related behaviors.
It is estimated that 1 in 20 individuals are affected by BFRB’s. Even though BFRB’s are fairly common, finding evidenced-based treatment and accurate information about this phenomenon can be challenging.
BFRB’s fall under the category of obsessive-compulsive related disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which clinicians use to assist in the diagnosis of mental disorders. In practice, BFRB’s are not usually experienced in isolation but occur alongside other symptoms and presentations.
Trichotillomania, which refers to hair pulling, and Excoriation Disorder (skin picking) are two of the more common BFRB’s. As with most conditions we treat, a person might experience symptoms of both of these disorders without meeting diagnostic criteria.
According to the DSM-V, symptoms of trichotillomania include the following: recurrent pulling out of one’s hair resulting in hair loss, repeated attempts to decrease or stop hair pulling, the hair pulling causes significant distress or impairment in social, occupational, or other important areas of functioning, the hair pulling or hair loss is not attributable to another medical condition, and the hair pulling is not better explained by the symptoms of another mental disorder.
On the other hand, symptoms of excoriation disorder include, recurrent skin picking resulting in skin lesions, repeated attempts to decrease or stop skin picking, the skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, the skin picking is not attributable to physiological effects of a substance or another medical condition, and the symptoms are not better explained by symptoms of another mental disorder.
As with all treatment modalities, it is necessary and ethical to receive proper training and consultation to effectively treat clients that are experiencing BFRB’s. A major component of treatment of BFRB’s involves building motivation for treatment. Oftentimes BFRB’s have existed for a considerable amount of time and can be viewed as adaptive from the client's perspective.
A number of treatment modalities are utilized in the treatment of BFRB’s. Some of these include habit reversal training (HRT), Acceptance and Commitment Therapy (ACT), Comprehensive Model for the Behavioral Treatment of BFRBs (ComB), and Dialectical Behavioral Therapy (DBT). Utilizing these treatment modalities in collaboration with the client can help reduce symptoms, bodily harm and allow clients to experience the full and meaningful life they deserve.
While these treatments are helpful for BFRB’s, continued research will help to better understand how they can be applied in clinical settings.
