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  • Writer's pictureKristy Ambrose, Master's Practicum Student

A Common Struggle That’s Rarely Spoken About

Many people have body focused repetitive behaviours (BFRBs) they engage in when they feel nervous, anxious stressed, or overwhelmed. Nail biting, hair pulling, skin picking, pulling at ears, and biting lips are common BFRBs people engage in at times of emotional discomfort. Most of the time these behaviors don’t cause concern and are dismissed as just a bad habit. 


Sometimes, however, these behaviors become problematic. BFRBs can cause significant harm to a person’s body and their self-confidence. A person with BFRB’s feels a loss of control and significant distress about the behaviour. The behaviours not only impact their body and self-confidence, they also can impact social, occupational, or academic functioning.

Examples of how BFRBs can cause physical harm include;


·       Onychophagia: a compulsion to constantly bite nails till they bleed

·       Excoriation: a compulsion to pick at own skin and scabs until they bleed possibly leading to scaring and infections.

·       Trichotillomania: pulling out own hair and leaving bald patches.

·       Morsicatio Buccarum: a compulsion to bite cheeks which can cause sores in the mouth

·       Trichophagia: a compulsion to chew on and swallow own hair which can lead to a large ball of hair in the stomach causing digestive issues.

Examples of how BFRBs can negatively impact self-confidence;


  • Worry about what people will think if they notice the behaviour

  • Worry about what people will think if they see the physical harm such as bitten nails, bald patches on their head, scabs and scars.

  • Feelings of embarrassment and/or shame.

  • Feeling of being out of control because you cannot stop doing the behavior despite best efforts to stop.

Symptoms can range from mild to severe.

Research suggests that BFRBs are caused by a variety of factors, including;


·       Genetics

·       Obsessive Compulsive Disorder (OCD) symptoms

·       Stress & Anxiety


How Can You Help?


If you or someone you know has BFRBs these are some things you can do to help.


1)     First, reassure the person that this is a common challenge that many people struggle with, yet, it is under reported and not spoken about as commonly as other challenges such as anxiety and OCD.


2)     Secondly, it is important for the person to understand it is not their fault they have not been able to stop doing these behaviors on their own. It is not because they are weak-willed or a failure, it is because their brain has associated the BFRB with a way to release tension and so it is natural they would continue to do this behavior. Let them know there are counsellors that treat this condition.


3)     Habit Reversal Training is a type of CBT that is a research based therapeutic treatment for BFRBs. Some of the strategies utilized by CBT counsellors to support clients to cease BFRBs include:


  • Support the client to find a replacement behavior, for example, with hair pulling and skin picking the replacement behavior could be having something to keep their hands busy such as a fidget toy.

  • Help the client to recognize the triggers for the BFRBs, often the triggers are stress and anxiety inducing situations, and build positive coping strategies for these times.

  • Teach the client tools to help manage and regulate unwanted feelings.


If you would like to access Habit Reversal Training to reduce BFRBs, heal your body, and restore self-esteem, contact the North Shore CBT Center at (778) 928-9069 or



Morand-Beaulieu, S., O'Connor, K. P., Richard, M., Sauvé, G., Leclerc, J. B., Blanchet, P. J., & Lavoie, M. E. (2016). The impact of a cognitive-behavioral therapy on event-related potentials in patients with tic disorders or body-focused repetitive behaviors. Frontiers in Psychiatry, 7, 81-81.

Roberts, S., O'Connor, K., Aardema, F., Bélanger, C., & Courchesne, C. (2016). The role of emotion regulation in body-focused repetitive behaviours. Cognitive Behaviour Therapist, 9

Rogiers, R., Van Parys, H., Baeken, C., Van den Abbeele, D., Remue, J., De Raedt, R., & Lemmens, G. M. D. (2022). Treatment experiences during a cognitive behaviour therapy group intervention targeting repetitive negative thinking: A qualitative study. Psychology and Psychotherapy, 95(2), 447-466.



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