April 18, 2023

All About BFRB Theraphy

Body-focused repetitive behaviours (BFRBs) refer to a group of mental health disorders characterized by repetitive self-grooming behaviours that result in physical damage to the body. Examples of BFRBs include skin-picking disorder, hair-pulling disorder, and nail-biting disorder. These behaviours can lead to significant distress, physical harm, and functional impairment. In this blog post, we will discuss what BFRBs are, their symptoms, causes, and available treatments.

What is body-focused repetitive behaviour?

A body-focused repetitive behaviour is an umbrella term that refers to a group of mental health disorders that involve repetitive and compulsive self-grooming behaviours that cause physical harm. These behaviours can be conscious or unconscious and may include picking at skin, pulling hair, biting nails, or biting the inside of the cheeks. BFRBs are different from normal grooming behaviours, such as shaving or brushing teeth, because they cause physical damage to the body.

Body-focused repetitive behaviour symptoms

The symptoms of BFRBs vary depending on the type of disorder. However, common symptoms include:

  • Repetitive and compulsive behaviour that is difficult to control
  • Feelings of tension or anxiety before engaging in the behaviour
  • Pleasure or relief when engaging in the behaviour
  • Physical damage to the body, such as scarring, hair loss, or skin irritation
  • Social or functional impairment, such as difficulty completing tasks at work or school due to the behaviour

Clinical types of BFRBs

There are several types of BFRBs, including:

  1. Trichotillomania (Hair-Pulling Disorder): This involves the recurrent pulling of hair from the scalp, eyebrows, eyelashes, or other body parts, resulting in noticeable hair loss and significant distress or impairment.
  2. Skin-Picking Disorder (Excoriation Disorder): This involves the recurrent picking of the skin, resulting in skin lesions, scabs, or scars and significant distress or impairment.
  3. Nail-Biting Disorder: This involves the recurrent biting of nails or cuticles, resulting in nail damage, infections, or bleeding and significant distress or impairment.

Is a BFRB a mental illness?

Yes, BFRBs are considered mental illnesses. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), classifies BFRBs as obsessive-compulsive and related disorders. This classification is based on the similarities between BFRBs and obsessive-compulsive disorder (OCD), including the presence of repetitive and intrusive thoughts or urges and the need to perform a behaviour to reduce anxiety or distress.

What causes body-focused repetitive Behaviours?

The exact cause of BFRBs is unknown. However, several factors may contribute to their development, including:

  • Genetics: BFRBs may have a genetic component. Studies have found that individuals with BFRBs are more likely to have family members with the same or similar conditions.
  • Neurobiology: BFRBs may be associated with changes in brain structure or function, particularly in regions involved in reward processing and impulse control.
  • Environmental factors: Stress, trauma, or anxiety may trigger or exacerbate BFRBs in some individuals. Environmental factors can also include social and cultural norms around grooming and appearance.
  • Learned behaviour: BFRBs may be learned through observation or as a coping mechanism for anxiety or other emotional distress. For example, a child may start nail-biting after witnessing a parent or sibling do the same as a way of coping with stress or anxiety.
bfrb therapy
Cheek biting

Treatment for body-focused repetitive behaviours

Several treatments are available for BFRBs, including therapy, medication, and self-help strategies. The most effective treatment approach depends on the individual's specific symptoms and needs.

  • Comprehensive Behavioural (ComB) Treatment: This is a type of therapy that first explores why, where and how a behaviour is occurring, by focussing on five domains: Sensory, Cognitive, Affective, Motor and Place (SCAMP). The therapy then implements specific strategies that targets the individual’s unique patterns of behaviours, using the domains as a guide.
  • Habit Reversal Training (HRT): This type of therapy has four main components: Awareness Training, Competing Response Training, Relaxation and Maintenance.
  • Acceptance and Commitment Therapy (ACT): Understanding an individual’s values is a key component of this type of therapy. Clients are taught to react differently to their urges, thoughts and emotions. Mindfulness-based strategies are used to assist clients in accepting internal experiences, instead of avoiding them.
  • Medication: Antidepressants or antipsychotic medications may be prescribed to individuals with BFRBs to help reduce symptoms. These medications can help regulate brain chemicals that may be contributing to the disorder. 
  • Self-help: Having a BFRB can feel very isolating, so talking to other individuals with BFRBs can be empowering. Searching Facebook forums or joining the Canadian BFRB Support Network or the TLC Foundation for BFRBs are some ways to connect with others.

How Archways can help you with your BFRB

Archways Centre for CBT, based in London, Ontario, is a private psychology clinic dedicated to using evidence-based therapies to provide specialized treatment for individuals with BFRBs. Therapists at Archways primarily use ComB treatment to work with BFRBs, but may also incorporate elements of the other approaches to tailor treatment to each individual's specific needs. Archways' treatment program includes:

  • Comprehensive assessment: Archways' team of experienced clinicians conducts a thorough assessment to determine the individual's symptoms and needs.
  • Individualized treatment plan: Based on the assessment, Archways develops a personalized treatment plan that may include therapy, medication, and self-help strategies.
  • Support and education: Archways provides ongoing support and education to individuals and their families to help them understand the disorder and develop coping strategies.
  • Teletherapy: Archways offers teletherapy services, allowing individuals to receive treatment from the comfort of their own homes.

In conclusion, BFRBs are a group of mental health disorders that involve repetitive and compulsive self-grooming behaviours that cause physical harm. These behaviours can lead to significant distress, physical harm, and functional impairment. BFRBs are considered mental illnesses and can be treated with therapy, medication, and self-help strategies. Archways is a Canadian psychology clinic that provides specialized treatment for individuals with BFRBs and offers teletherapy services for those who prefer to receive treatment from home. If you or someone you know is experiencing symptoms of BFRBs, we encourage you to seek professional help to receive proper diagnosis and treatment.

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