We’ve got an Acronym for that. An overview of BFRB’s

In the therapy world, we have an acronym for just about everything. CBT, ACT, ERP, OCD, GAD, CBIT, PTSD, DBT, EMDR - I could go on for days.

BFRB’s, formally known as Body-focused repetitive behaviors, are a range of behaviors that fall under the category of obsessive-compulsive related disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which clinicians use to assist in the diagnosis of mental disorders. Furthermore, they fall under a specific section of the DSM-V, the self-grooming category in the DSM V. They include trichotillomania (hair pulling), excoriation disorder (skin picking), and related behaviors.

In practice, BFRB’s are not usually experienced in isolation but occur alongside other symptoms and presentations. It is fairly common for BFRB’s to accompany several other conditions that we commonly treat. These can include, but are not limited to, obsessive-compulsive disorder, generalized anxiety disorder, social anxiety disorder, eating disorders, panic disorder, and hoarding disorder to name a few.

It is estimated that roughly 1 in 20 individuals are affected by BFRB’s. Even though BFRB’s are fairly common, finding evidence-based treatment and accurate information about this phenomenon can be challenging.

As with most conditions, individuals can experience and receive treatment for symptoms of BFRB’s without meeting diagnostic criteria.

According to the DSM-V, symptoms of trichotillomania include the following: recurrent pulling out of one’s hair resulting in hair loss, repeated attempts to decrease or stop hair pulling, the hair pulling causes significant distress or impairment in social, occupational, or other important areas of functioning, the hair pulling or hair loss is not attributable to another medical condition, and the hair pulling is not better explained by the symptoms of another mental disorder.

On the other hand, symptoms of excoriation disorder include, recurrent skin picking resulting in skin lesions, repeated attempts to decrease or stop skin picking, the skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, the skin picking is not attributable to physiological effects of a substance or another medical condition, and the symptoms are not better explained by symptoms of another mental disorder.

As illustrated by both of those definitions, the challenge is not the behavior itself, but the frequency, intensity, and function of the behavior, along with distress and impact on an individual's life and functioning.

As with all treatment modalities, it is necessary and ethical to receive proper training and consultation to effectively treat clients who are experiencing BFRB’s. A major component of treatment of BFRB’s involves building motivation for treatment. Oftentimes BFRB’s have existed for a considerable amount of time and can be viewed as adaptive from the client's perspective.

We are trained and experienced in the treatment modalities that are best practice for the treatment of BFRB’s. Some of these include habit reversal training (HRT), Acceptance and Commitment Therapy (ACT), Comprehensive Model for the Behavioral Treatment of BFRBs (ComB), and Dialectical Behavioral Therapy (DBT). Utilizing these treatment modalities in collaboration with the client can help reduce symptoms, bodily harm, and allow clients to experience the full and meaningful life they deserve.