Body focused repetitive behaviours (BFRBs)
BFRB's are the collective name for problematic picking, pulling or biting of skin, hair or nails. We all do these things a bit because these are normal primate grooming behaviours, but some people experience ongoing powerful urges that make it very difficult to stop. BFRBs are under-recognised, and underestimated in terms of the distress and functional impairment they can cause. Individuals can spend decades of their lives blighted by behaviours they cannot control, and for which there is little/no understanding or support available. As such, these are some of the most highly stigmatised of all mental health conditions. More research is needed to understand the mechanisms and develop interventions for BFRBs.
Normal behaviour or a disorder?
Two BFRBs are officially recognised in the diagnostic manual for mental health disorders (DSM V):
Trichotillomania is hair pulling disorder
Dermatillomania, or excoriation disorder, is skin picking disorder.
In both cases the criteria for diagnosis include persistent pulling or picking that feels difficult to control, and a 'clinically significant' level of distress. Other BFRBs can cause similar distress, but are not currently recognised.
These behaviours are often confused with, or assumed to be an aspect of, another diagnosis. BFRBs share features with anxiety, self-harm, trauma, OCD and addiction, and are more commonly observed in people with autism or ADHD, but also sometimes occur in the absence of any other condition.
lived experience science
Professor Clare Mackay is @thetrichprof and has suffered with trichotillomania since she was 12 years old.
Together with a growing team of collaborators and students, she is investigating mechanisms that will hopefully underpin new interventions for body-focused repetitive behaviours. A vital component of this is to raise awareness and reduce stigma, so that those suffering with these disorders feel empowered to ask for help.
In September 2024, in collaboration with BFRB UK & Ireland, we held the first Oxford BFRB Conference. Recorded talks are available on the @thetrichprof YouTube channel
Follow @thetrichprof on Instagram, Facebook, YouTube, LInkedIn, and BlueSky
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For those seeking information and support for pulling/picking/biting disorders (either for yourself or a loved one), BFRB UK & Ireland is a good resource. There are also a number of good Facebook support groups (including BFRB UK&I) where you can stay anonymous if you prefer. |
© Clare Mackay