What are Common Myths about Body-Focused Repetitive Behaviors?
Body-Focused Repetitive Behaviors (BFRBs) refer to repetitive self-grooming behaviors resulting in physical damage as well as significant distress and interference with daily functioning. Behaviors may include hair pulling, skin picking, nail biting, or cheek chewing. This article is aimed at addressing the many misconceptions about BFRBs
Myth: BFRBs are a Rare
Research shows that 3% or more of the population lives with a BFRB. In other words, over 10 million people in the United States would meet diagnostic criteria for this disorder. In 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included hair pulling, skin picking, and other BFRBs as unique diagnostic categories, legitimizing BFRBs as more than just a simple habit. BFRBs appear rare because individuals with BFRBs often feel shame and embarrassment about their condition. They often go to great lengths to hide it, do not talk openly about it, and are less likely to seek treatment.
Myth: If You Have a BFRB, You are Also Anxious
It is true that someone can have both a BFRB and an anxiety disorder, however having a BFRB does not necessarily mean you also have anxiety. There is a large range of emotions someone may experience before and during a pulling/picking/biting episode. Some people feel stressed and the behavior gives them temporary relief. Others feel bored and the behavior stimulates them. Some feel angry and the behavior settles them down. As you can see, BFRBs have the ability to both soothe and stimulate.
Myth: BFRBs are Caused by Trauma/Abuse
Research has NOT shown greater rates of trauma, PTSD, or sexual abuse in individuals with BFRBs compared to the general population. Again, it is possible that an individual may have experienced a trauma and have a BFRB, but they are not causal linked. There are many people who develop BFRBs who have not had traumatic experiences in their past and many people who have had traumatic experiences and have not developed BFRBS. Research has shown a genetic component as BFRBs tend to run in families. However, the causes of BFRBs are complex and continue to be researched.
Myth: BFRBs are a Choice
Many individuals with BFRBs have been accused of just trying to get attention or not trying hard enough to stop. The reality is that most people with BFRBs have very little awareness of their behavior. Even when they are aware, it takes a tremendous amount of work to change this type of behavior. The definition of a BFRB includes having difficulty controlling their behavior after repeated attempts to stop. BFRBs are complex behaviors that are both genetically introduced and reinforced over time. Many individuals badly want to stop their behavior, but they don’t know how.
Myth: BFRBs lead to Self-Harm Behaviors
Individuals with BFRBs are just as likely or less likely to have a history of self-harm behaviors than the general population. While someone engaging in self-harm may intentionally produce pain to obtain relief from some negative state, individuals with BFRBs do not purposefully produce pain. Individuals with BFRBs report their behavior is not painful and oftentimes out of their awareness. BFRBs are used to sooth negative emotions or feel pleasure, while the physical damage is an unwanted result of the behavior.
Myth: There is No Treatment for BFRBs
Researchers and therapists have spent decades crafting evidence based treatment for BFRBs. Cognitive-behavioral therapy is considered the recommended treatment, which may include Habit Reversal Therapy (HRT), Comprehensive Behavioral Treatment (ComB), Dialectical Behavior Therapy (DBT), or Acceptance and Commitment Therapy (ACT). With proper treatment and support, many people are able to reduce or even stop their behavior.
It is accurate that no medications have been approved by the FDA for treating BFRBs, however medications are often used to treat co-occurring conditions such as anxiety or depression. Other treatments such as hypnosis, diets, massage, acupuncture, and electric stimulation have not had enough research to be used as stand-alone treatments.
Looking for treatment for your BFRB? Get connected with Dr. Umbach below.
Resources
Anxiety and Depression Association of America: www.adaa.org
The TLC Foundation for Body-Focused Repetitive Behaviors: www.bfrb.org
Mansueto, C. S., Vavrichek, S. M., & Golomb, R. G. (2020). Overcoming body-focused repetitive behaviors: A comprehensive behavioral treatment for hair pulling and skin picking. Oakland, CA: New Harbinger Publications.
Woods, D. W., & Twohig, M. P. (2008). Trichotillomania: An ACT-enhanced behavior therapy approach (workbook). New York, NY: Oxford University Press.