What Are BFRBs? Body-Focused Repetitive Behaviours Explained

If you pull your hair, pick your skin or bite your nails and can’t stop, there’s a name for what’s going on. These are body-focused repetitive behaviours, or BFRBs. Trichotillomania (trich), the urge to pull out your own hair, is one of them, and it’s rarely the only one a person has.

This guide explains what a BFRB is, the main types, where trich fits in, how common BFRBs are, and what helps. It’s for anyone who has just come across the term, whether for yourself or for someone you care about.

What is a BFRB?

A BFRB is when you repeatedly pull, pick, bite or scrape at your own hair, skin, nails, lips or cheeks, you’ve tried to stop and can’t, and it causes damage to your body. That’s how the International OCD Foundation (IOCDF), a US charity for obsessive-compulsive and related conditions, defines it.

The name breaks down simply:

Body-focused: it’s aimed at your own body.
Repetitive: it happens again and again, sometimes for minutes or hours at a time.
Behaviour: it’s something you do, often with an urge or tension beforehand and relief or satisfaction afterwards.

BFRBs aren’t a lack of willpower, and they aren’t vanity. They can happen with full attention, such as picking at a spot in the mirror or hunting for a hair that doesn’t feel right. They can also happen on autopilot while you read, study or scroll. Most people do both at different times.

Our glossary explains other terms you may come across.

What are the types of BFRB?

The two best-known BFRBs are hair pulling and skin picking. Others involve the nails, lips, cheeks and skin. Many have long medical names, but they describe simple actions.

Type	What it involves	Medical name
Hair pulling	Pulling out hair from the scalp, brows, lashes or anywhere else on the body	Trichotillomania
Skin picking	Picking or scratching at skin, most often the face, hands or arms, causing wounds or scars	Excoriation disorder (also called dermatillomania)
Nail biting	Biting the fingernails	Onychophagia
Nail picking	Picking or tearing at the nails	Onychotillomania
Cheek biting	Biting or chewing the inside of the cheeks	Morsicatio buccarum
Lip biting	Biting or chewing the lips	No common single name
Skin biting	Biting or chewing your own skin	Dermatophagia
Eating hair	Chewing or swallowing pulled hair, usually alongside hair pulling	Trichophagia

Some researchers also include teeth grinding during the day.

In the DSM-5, the main US manual doctors use to diagnose mental health conditions, only hair pulling and skin picking are named as conditions of their own. Nail biting, lip biting, cheek chewing and similar behaviours can still be diagnosed. The manual calls this body-focused repetitive behaviour disorder and lists it as an “other specified” condition in the obsessive-compulsive group.

Is trichotillomania a BFRB?

Yes. Trichotillomania is a BFRB, and together with skin picking it’s one of the two most common. The manuals doctors use to diagnose it group it this way.

DSM-5 lists trichotillomania in its chapter on obsessive-compulsive and related disorders, next to skin picking disorder.
ICD-11, the World Health Organization’s classification of diseases, puts trichotillomania (code 6B25.0) and skin picking disorder (6B25.1) in their own group, called body-focused repetitive behaviour disorders.
ICD-10, the older version, lists trichotillomania as F63.3, under habit and impulse disorders.

Knowing trich is a BFRB can help. It explains why you might also pick or bite, and it points you towards treatments made for this family of behaviours. Our complete guide to trichotillomania covers hair pulling in full.

How common are BFRBs?

Very common. Most people do a mild version at some point, and a sizeable minority have a BFRB at the level of a disorder. The numbers depend on who was asked and how each study defined a disorder, so treat them as estimates.

What was measured	Finding	Who was studied
Trichotillomania at the time	1.7%	10,169 US adults (published 2020)
Skin picking disorder at the time	2.1% (3.1% at some point in life)	10,169 US adults (published 2020)
Any BFRB at disorder level, past month	12%	4,335 US college students (published 2018)
Any milder BFRB, past month	60%	4,335 US college students (published 2018)
Occasional nail biting	34% to 64%	Earlier studies, reviewed in 2018

In a survey of 4,335 US college students, about 12 in 100 had a BFRB at the level of a disorder and about 60 in 100 had a milder one.

The student survey found that cheek biting was the most common BFRB and that most had gone on for more than a year. Many students with a BFRB disorder felt distressed about it, but few had asked anyone for help. Both big surveys relied on people describing themselves, and students may not reflect everyone.

For more figures on hair pulling, see our trichotillomania statistics page.

When does a habit become a BFRB disorder?

It becomes a disorder when you’ve tried to stop and can’t, it causes damage, and it causes you real distress or gets in the way of your life. Plenty of people bite a nail now and then without any of that.

Distress doesn’t have to mean a crisis. The DSM-5 counts feelings like shame, embarrassment and a sense of losing control. Hiding the damage is common too: covering skin with make-up or long sleeves, or hair with hats and scarves.

If you’re not sure where you fit, a doctor or therapist can help you work it out. You don’t need a diagnosis to start trying the strategies below.

Can you have more than one BFRB?

Yes, and it’s common. The DSM-5 notes that most people with trichotillomania also have at least one other BFRB, such as skin picking, nail biting or lip chewing. In the large US survey, about 1 in 8 adults with skin picking disorder also said they had trichotillomania.

Researchers increasingly see BFRBs as one family. They look alike, they often turn up in the same person, and they respond to similar treatments. So the skills that help with one BFRB often help with the others.

Our guide to having both skin picking and hair pulling goes into more detail.

Is a BFRB the same as OCD or self-harm?

No to both, though people often mix them up.

BFRBs and OCD (obsessive-compulsive disorder, where unwanted thoughts drive repeated actions) are related. They share some genetic risk and tend to run in the same families, which is why the manuals group them together. According to the IOCDF, 22% to 29% of people with trichotillomania and 10% to 15% of people with skin picking disorder also have OCD. But BFRBs aren’t usually triggered by obsessive thoughts. They’re often preceded by tension and followed by relief or a sense of satisfaction. Our guide to trichotillomania and OCD explains the difference.

BFRBs are also different from self-harm. People with a BFRB are not usually trying to hurt themselves, and the damage is an unwanted result, not the aim. Some people have both, and both deserve care.

What helps with BFRBs?

Behavioural therapy, especially Habit Reversal Training (HRT), has the most research behind it, and a few medicines have shown promise. Most of that research is in hair pulling and skin picking. Much less has looked at nail, lip or cheek biting.

Habit Reversal Training is a talking therapy with three main parts:

Awareness. You learn to spot when, where and how the behaviour happens, including the feelings and sensations just before it.
A competing response. You practise something your hands can do instead that makes the behaviour hard or impossible, such as clenching your fists gently or holding an object, until the urge passes.
Support. People you trust encourage you when you use your new response, in a way you’ve agreed with them.

Habit Reversal Training in three steps: notice the urge, give your hands something else to do, and get support.

Two related approaches build on it. The Comprehensive Behavioural Treatment (ComB) model looks at everything that drives your BFRB, including places, thoughts, feelings, movements and physical sensations, and builds a plan around your main triggers. Acceptance and commitment therapy (ACT) teaches you to notice urges and uncomfortable feelings without acting on them, and it’s most often studied combined with HRT.

The evidence is encouraging but still limited. A 2019 review found 10 randomised trials of habit reversal: 8 in hair pulling and 2 in skin picking. All showed some benefit, but the trials were small and the reviewers had concerns about their quality. For nail, lip and cheek biting, habit reversal may help, but high-quality studies are lacking.

No medicine is approved in the US specifically for BFRBs. In a 2023 trial of 100 adults with hair pulling, skin picking or both, 60.5% of those taking memantine (an Alzheimer’s medicine that acts on glutamate, a brain chemical linked to compulsive behaviours) were much or very much improved after eight weeks, compared with 8.3% on a dummy pill. The trial was short and needs repeating. The supplement N-acetylcysteine (NAC) reduced symptoms in separate trials in hair pulling and skin picking. Always speak to a doctor or pharmacist before trying any medicine or supplement.

Some practical steps also help across BFRBs. The UK’s NHS suggests keeping your hands busy, noticing when and where the behaviour usually happens, keeping your nails trimmed, and keeping tools like tweezers out of easy reach.

Our guide to Habit Reversal Training walks through the steps in detail. For every option and the evidence behind it, see our guide to trichotillomania treatment. Our trichotillomania research roundup summarises recent studies in plain English. For BFRBs other than hair pulling, the IOCDF’s BFRB information pages are a good next stop.

When should I get help?

Get support if you can’t stop, if the behaviour is damaging your hair, skin, nails or mouth, or if it’s causing you distress or affecting your daily life. You don’t need to wait until it’s “bad enough”.

Many doctors and therapists know little about BFRBs, so it helps to find someone who does. Everyone in our directory has told us they understand trichotillomania and already help people who pull, in person or online. You can search the directory.

If you’re a parent reading this for your child, start with The Parent’s Guide to Trichotillomania: understanding what your child is going through.

If you’re feeling very low or hopeless, please talk to someone today.

In an emergency, call your local emergency number or go to your nearest emergency department.

Find a helpline (international directory) (findahelpline.com)

Questions people ask

Is nail biting a BFRB?

Yes. Nail biting is a BFRB, and so is nail picking. Occasional nail biting is very common and usually harmless. It counts as a BFRB disorder when you’ve tried to stop and can’t, it damages your nails or fingers, and it causes you distress or gets in the way of your life.

Is skin picking the same as dermatillomania?

Yes. Skin picking disorder, excoriation disorder and dermatillomania are three names for the same condition. Excoriation disorder is the medical name used in the diagnostic manuals. Dermatillomania is an older name that many people still search for.

At what age do BFRBs usually start?

Trichotillomania most often starts around ages 10 to 13, but it can begin at any age. Skin picking has a less clear pattern and can start in the teenage years or later in adulthood. Hair pulling in babies and toddlers is different and often stops on its own.

Are BFRBs genetic?

Genes seem to play a part. BFRBs and OCD share some genetic risk, and BFRBs tend to run in families. That doesn’t mean a child of someone with a BFRB will have one. Most won’t, and nobody has found a single gene that causes them.

Is a BFRB a type of anxiety?

No. BFRBs are not anxiety disorders, although anxiety often comes with them and stress can make them worse. Boredom, tiredness and quiet activities like reading or scrolling are common triggers too, so plenty of pulling and picking happens when people feel calm.

Do BFRBs go away on their own?

Sometimes, but usually not quickly. For most people they last for years and come and go in waves, often getting worse during stressful times. A minority stop within a few years. Treatment and practical strategies help many people pull, pick or bite much less.