What is a BFRB?

Body Focused Repetitive Behavior

If you pull, pick, or bite and can't stop, you might have heard it called a "nervous habit." There's a better name for it: a body-focused repetitive behavior, or BFRB. Knowing the name matters, because it points you to the treatment made for it.

By Nathan Peterson, LCSW, OCD and BFRB therapist

What is a body-focused repetitive behavior?

A body-focused repetitive behavior is when you pull, pick, bite, or scrape at your own hair, skin, or nails over and over, to the point of damage, and can't stop even when you try. A lot of BFRBs look like grooming that got stuck on repeat.

BFRBs often feel calming or satisfying in the moment, which is part of what makes them hard to stop. They can happen on purpose, like going after a hair or bump that feels wrong, or on autopilot, like while you scroll or drive. Nobody chooses to have one.

Types of body-focused repetitive behaviors

Hair pulling (trichotillomania) from the scalp, brows, lashes, or body
Skin picking (dermatillomania, or excoriation disorder), including finger and cuticle picking
Nail biting (onychophagia), and how to stop
Cheek biting or chewing the inside of the mouth
Lip biting or picking
Nose picking
Tongue chewing

It's common to have more than one. Someone might pick their skin and bite their nails, or pull hair and chew their cheek.

Theories on why we perform body-focused repetitive behaviors

There isn't one known cause. Researchers and clinicians point to a few things:

They run in families. Having a relative with a BFRB makes one more likely.
They change how you feel. Pulling or picking can take the edge off stress, fill a bored moment, or settle a sensation that feels wrong.
They get reinforced. That quick relief teaches your brain to reach for the behavior again, and over time it gets more automatic.
They often start young. Many BFRBs begin in the preteen or teen years.

Stress can make BFRBs louder, but pulling and picking also happen when you're calm and bored. So stress is one trigger, not the whole story.

What a BFRB isn't

It isn't a lack of willpower

Often the urge shows up before you've decided anything. Trying harder isn't the fix. Having a plan for your hands is.

It isn't OCD

BFRBs are related to OCD, and some people have both. But OCD rituals are usually about stopping a feared outcome, and BFRBs are usually about an urge or a sensation.

It isn't self-harm

BFRBs usually aren't about wanting to hurt yourself, even though some older articles describe them that way.

Best ways to cope with body-focused repetitive behaviors

Understand your triggers. Track where, when, and how you pull, pick, or bite for a few days. Triggers can be inside you (boredom, stress, a rough spot) or outside you (the mirror, bed, the car).
Give your hands a job. When the urge shows up, do something that makes the behavior hard, like making a fist or holding a fidget, until it passes.
Change your setup. Dimmer mirror light, bandages on your fingers, a hat while you study, fidgets where you scroll.
Get the right help. The main BFRB treatment is habit reversal training, often as part of the ComB model. See BFRB treatment explained.
Find other people who get it. Online and in-person BFRB support groups make it a lot less lonely.

I know, "hold a fidget" sounds too simple for something you've done for years. It is simple. It isn't easy, and doing it every time is the work.

Name your BFRB, or BFRBs, and pick the one that bothers you most. Start there.

If you want the treatment laid out step by step, see the BFRB program or the course below.

Common questions about BFRBs

Is a BFRB just a bad habit?

It can look like one from the outside. The difference is that a BFRB keeps going even when you want to stop and have tried hard to stop. It causes damage, takes up time, and comes with urges that are hard to ride out. That's why "quit" doesn't work, and why there's a treatment made for it.

Is a BFRB the same as OCD?

No, though they're related. The DSM-5 lists hair pulling and skin picking with OCD and related disorders. OCD rituals are usually about stopping a feared outcome. BFRBs are usually about an urge, a tension, or a sensation that the behavior settles for a moment. Some people have both.

Is a BFRB a form of self-harm?

Usually not. BFRBs aren't about wanting to hurt yourself, and a lot of it happens without noticing. If you are hurting yourself on purpose, talk with a professional, since that gets its own kind of support.

Do BFRBs go away on their own?

Sometimes they get quieter for a while, especially in kids. Without treatment they can come and go for years. Learning the skills in habit reversal training gives you a way to handle the urge whenever it shows up.