– By the BFRB Special Interest Group
Introduction
Body-focused repetitive behaviors (BFRBs), including hair pulling (trichotillomania), skin picking (dermatillomania), nail biting, lip/cheek biting, and more, remain among the most misunderstood mental health experiences by both the general public and healthcare providers alike. To capture the full reality of living with these complex behaviors, members of the IOCDF’s BFRB Special Interest Group (SIG) shared their lived experiences, insights, and perspectives. We explored what BFRBs really feel like from the inside out and how our collective understanding of these behaviors is shifting away from outdated stigma and toward true nervous system awareness.
What’s it like to have a BFRB?
When the BFRB SIG was asked what it’s like to have a BFRB, the response was sobering. Some of the terms used included confusing, embarrassing, frustrating, helpless, and exhausting. They spoke of fatigue from constant internal and external assessment, and how resisting the behavior can feel like denying yourself air. Some mentioned that it felt like a separate entity, urging them toward action against their better judgment, often leaving them feeling weak, powerless, and critical of themselves for not being able to stop.
But there’s another side to BFRBs: one that acknowledges the self-soothing aspect. People also describe the behavior as enjoyable, relaxing, hypnotic, and even pleasurable. Some describe a sense of entitlement to it, feeling they “deserve” this escape after a challenging day. Others celebrate the satisfaction and relief that comes with pulling the perfect hair, popping a prime pimple, or “fixing” some other nagging problem.
This intrinsic gratification is what sets BFRBs apart from OCD. In OCD, the compulsive behavior is unwanted and driven purely by a desire to relieve anxiety. With BFRBs, the behavior is functional; the act itself brings genuine sensory pleasure or soothing. A helpful test to demonstrate this distinction is to remove the consequences: if pulling or picking caused zero physical damage, shame, or embarrassment, most people with BFRBs wouldn’t care to stop or would actually feel free to engage in the behavior more often, because the behavior feels good in the moment. In other words: those with OCD dislike the behavior and crave the result, and those with BFRBs crave the behavior and dislike the result.
The most profound burden, however, is the heavy shame and isolation that comes from repeatedly engaging in a behavior that you (and the people around you) don’t understand. Those with BFRBs spend a significant amount of time trying to hide or shrink so they’re not “discovered” and then judged by others. Simple activities such as getting ready in the morning, going out in wind or rain, swimming, or riding roller coasters can risk extreme embarrassment. Some with BFRBs make painstaking efforts to hide it from their spouse or partner, or avoid dating altogether.
The pain is real and the solution is not simple. The urges and behaviors are complex, deeply rooted, and highly individualized. Those with BFRBs are intelligent, creative, and deeply caring people, navigating sensitive nervous systems or unique sensory needs. They are complicated, but certainly not broken.
Understanding and Interpreting BFRBs
How should we interpret BFRBs, and why do those with BFRBs repeatedly engage in this behavior that they desperately want to stop? Our understanding of the forces driving BFRBs is continually evolving, varying widely depending on who you ask.
Many view their BFRB as a chronic behavioral or willpower problem, leaving them exhausted from constantly battling their urges. Others experience a love-hate relationship, acknowledging the physical damage and social toll while benefiting from the sensory soothing, stimulation, or satisfaction it provides, what one person called “a misled offering to solve a heightened or lowered state.”
There are others who have come to view the behavior as an internal alarm system. Rather than an enemy to fight, they interpret the urges as a message from their dysregulated nervous system alerting them to an unmet need, and the behavior as “an attempt to return the nervous system to baseline.” This interpretation allows them to relate to their behavior with less opposition, and tends to support long-term recovery. As one person put it, “Your BFRB is trying to tell you something! Are you ready to listen?”
People with BFRBs may move between these perspectives over time. Because no two profiles are identical, BFRBs require an individualized lens. Equally important is dispelling common misconceptions: BFRBs are not simply bad habits, self-harm, trauma responses, or the result of poor parenting. They are complex, deeply rooted behaviors centered on nervous system regulation and meeting unmet needs.
Conclusion
If there is one truth to hold onto, it is this: you are not broken, lazy, or lacking willpower. BFRBs are complex responses to a nervous system doing its best to regulate in a noisy world. Living with a BFRB takes an immense amount of daily resilience and recognizing that the behavior is an internal attempt to self-soothe (rather than a character flaw) opens up space for genuine grace and self-compassion. You are so much more than the urges you fight and help is available when you’re ready to take the next step in your BFRB journey.
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