Body-Focused Repetitive Behavior (BFRB) Treatment in Sycamore and North Aurora IL
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If you are interested in counseling for body-focused repetitive behaviors, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.
What Are Body-Focused Repetitive Behaviors?Body-focused repetitive behaviors (BFRBs) are a group of related conditions that involve repeatedly pulling, picking, biting, or scraping at one's own hair, skin, or nails in a way that causes damage to the body. The behavior is usually not intended to cause harm. Most people who struggle with a BFRB have tried to cut back or stop many times and find that the urge returns anyway.
A BFRB tends to follow a pattern. There is often a building sense of tension, an urge, or a physical sensation that something is not quite right, followed by the behavior itself, and then a brief feeling of relief or satisfaction. Some people pull or pick with full awareness, often during moments of stress. Others do it automatically, while reading, watching television, or sitting at a desk, and only notice afterward. Many people experience both. BFRBs are recognized in the DSM-5-TR within the category of obsessive-compulsive and related disorders, which reflects their overlap with OCD in both features and family history. They most often begin in adolescence, frequently around the time of puberty, though they can start earlier or later and can continue for years when left untreated. Because the physical evidence is visible, many people carry a great deal of shame and go to significant lengths to hide the behavior, which can add to a sense of isolation. This is worth naming clearly: a BFRB is not a bad habit, a phase, or a lack of discipline, and it is not something a person can simply decide to stop. It is a recognized clinical condition, and it responds to treatment. Types of Body-Focused Repetitive BehaviorsTrichotillomania (Hair-Pulling Disorder). Trichotillomania involves recurrent pulling of one's own hair, resulting in hair loss. Pulling most commonly involves the scalp, eyebrows, and eyelashes, though it can involve hair anywhere on the body. It affects an estimated 1 to 2 percent of adolescents and adults. Trichotillomania is one of two BFRBs formally recognized as a diagnosis in the DSM-5-TR.
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Excoriation Disorder (Skin-Picking Disorder). Excoriation disorder, also known as dermatillomania, involves recurrent picking at one's own skin, resulting in lesions or tissue damage. People often pick at healthy skin, minor irregularities such as pimples or scabs, or areas they perceive as flawed. Current estimates suggest it affects roughly 2 percent of adults. Like trichotillomania, it is a formally recognized diagnosis in the DSM-5-TR.
Onychophagia (Nail Biting) and Onychotillomania (Nail Picking). These behaviors involve chronic biting or picking of the nails and surrounding skin to the point of damage, which can include bleeding, infection, or changes to the nail bed. Nail biting and nail picking are not listed as separate diagnoses in the DSM-5-TR, but a clinician can diagnose and treat them as a related body-focused repetitive behavior.
Cheek, Lip, and Mouth Biting (Morsicatio). This involves repeated biting of the inside of the cheeks, lips, or tongue, which can cause sores and ongoing irritation to the tissue inside the mouth. As with nail biting, it is addressed clinically as a related BFRB rather than a standalone DSM diagnosis.
Other Body-Focused Behaviors. Less common presentations include dermatophagia (biting or chewing the skin, often around the fingers) and behaviors that accompany pulling or picking, such as examining or playing with what has been removed. When any of these behaviors causes physical damage, distress, or interference with daily life, it is worth evaluating, regardless of whether it fits neatly into a single diagnostic label.
Onychophagia (Nail Biting) and Onychotillomania (Nail Picking). These behaviors involve chronic biting or picking of the nails and surrounding skin to the point of damage, which can include bleeding, infection, or changes to the nail bed. Nail biting and nail picking are not listed as separate diagnoses in the DSM-5-TR, but a clinician can diagnose and treat them as a related body-focused repetitive behavior.
Cheek, Lip, and Mouth Biting (Morsicatio). This involves repeated biting of the inside of the cheeks, lips, or tongue, which can cause sores and ongoing irritation to the tissue inside the mouth. As with nail biting, it is addressed clinically as a related BFRB rather than a standalone DSM diagnosis.
Other Body-Focused Behaviors. Less common presentations include dermatophagia (biting or chewing the skin, often around the fingers) and behaviors that accompany pulling or picking, such as examining or playing with what has been removed. When any of these behaviors causes physical damage, distress, or interference with daily life, it is worth evaluating, regardless of whether it fits neatly into a single diagnostic label.
How Are Body-Focused Repetitive Behaviors Treated?
BFRBs are treatable, and the strongest evidence supports behavioral therapy rather than willpower or simply trying harder to stop. Treatment works by helping a person understand the specific conditions that drive their behavior and then building skills to interrupt it. The following approaches have the most research support.
Habit Reversal Training (HRT). HRT is the most studied treatment for BFRBs and forms the core of most behavioral approaches. It has three central components: awareness training, in which a person learns to recognize the behavior and the cues that come before it; competing response training, in which the person learns to engage in a different, incompatible action when the urge arises; and social support, which enlists trusted people to help reinforce progress. HRT is often strengthened by adding other strategies, since using awareness and competing responses alone can make lasting change harder to sustain.
Comprehensive Behavioral (ComB) Treatment. ComB builds on HRT and organizes treatment around understanding why, where, and how a person engages in their BFRB. It examines five domains, sometimes remembered by the acronym SCAMP: sensory, cognitive, affective, motor, and place. Rather than treating every case the same way, ComB identifies which of these domains most drive a given person's behavior and targets interventions accordingly. The model was developed by clinicians at the Behavior Therapy Center and is used widely in specialty practice, with research support continuing to grow.
Acceptance and Commitment Therapy (ACT). ACT is often integrated with behavioral treatment for BFRBs. It helps a person make room for uncomfortable urges and sensations without acting on them, and it anchors the work in the person's own values rather than in a struggle to suppress the urge directly. Dialectical Behavior Therapy skills, particularly around distress tolerance and emotion regulation, can add value in a similar way.
Our clinicians at OakHeart are proud to offer evidence-based treatment options for depression. Call 630-570-0050 to schedule an appointment today. Our team of psychologists, licensed counselors, and social workers in North Aurora and Sycamore, Illinois provide evidence-based treatment for depression to clients throughout Kane County, DeKalb County, DuPage County, and the surrounding Chicago suburbs, including in-person and telehealth options
Habit Reversal Training (HRT). HRT is the most studied treatment for BFRBs and forms the core of most behavioral approaches. It has three central components: awareness training, in which a person learns to recognize the behavior and the cues that come before it; competing response training, in which the person learns to engage in a different, incompatible action when the urge arises; and social support, which enlists trusted people to help reinforce progress. HRT is often strengthened by adding other strategies, since using awareness and competing responses alone can make lasting change harder to sustain.
Comprehensive Behavioral (ComB) Treatment. ComB builds on HRT and organizes treatment around understanding why, where, and how a person engages in their BFRB. It examines five domains, sometimes remembered by the acronym SCAMP: sensory, cognitive, affective, motor, and place. Rather than treating every case the same way, ComB identifies which of these domains most drive a given person's behavior and targets interventions accordingly. The model was developed by clinicians at the Behavior Therapy Center and is used widely in specialty practice, with research support continuing to grow.
Acceptance and Commitment Therapy (ACT). ACT is often integrated with behavioral treatment for BFRBs. It helps a person make room for uncomfortable urges and sensations without acting on them, and it anchors the work in the person's own values rather than in a struggle to suppress the urge directly. Dialectical Behavior Therapy skills, particularly around distress tolerance and emotion regulation, can add value in a similar way.
Our clinicians at OakHeart are proud to offer evidence-based treatment options for depression. Call 630-570-0050 to schedule an appointment today. Our team of psychologists, licensed counselors, and social workers in North Aurora and Sycamore, Illinois provide evidence-based treatment for depression to clients throughout Kane County, DeKalb County, DuPage County, and the surrounding Chicago suburbs, including in-person and telehealth options
Frequently Asked Questions About Body-Focused Repetitive Behaviors
Are BFRBs just a habit?
No. While BFRBs share some surface features with ordinary habits, they are recognized clinical conditions that are difficult to control and that cause real physical damage and distress. Most people with a BFRB have tried repeatedly to stop on their own without lasting success. This is not a matter of willpower, and treatment addresses the specific mechanisms that keep the behavior going.
Are BFRBs a form of self-harm?
Generally, no. Self-harm involves an intent to cause pain or injury, while BFRBs are typically not driven by that intent. People pull, pick, or bite in response to urges, sensations, or emotional states, and the physical damage is usually an unwanted consequence rather than the goal. That distinction matters for both understanding the behavior and treating it.
Are BFRBs related to OCD?
They are related but distinct. BFRBs are grouped with OCD in the same category of the DSM-5-TR because they share certain features and tend to run in the same families. They differ in an important way, though. OCD compulsions are usually performed to relieve anxiety tied to an obsession, while BFRBs are more often linked to physical urges, sensations, or emotional states such as boredom, tension, or frustration. This is part of why treatment for BFRBs looks different from standard OCD treatment.
Will my hair or skin recover?
In many cases, yes. Hair and skin often recover once the pulling or picking is reduced or stopped, though recovery can take time and, in some cases where damage has been long-standing, may be incomplete. The more important focus in treatment is on reducing the behavior and its impact on daily life, which also gives the body the chance to heal.
How do I know if I need therapy for a BFRB?
If you are pulling, picking, or biting to the point of causing damage, if you have tried to stop and have not been able to, or if the behavior is causing you distress, taking up significant time, or leading you to avoid activities or hide from others, it is worth reaching out to a mental health professional. You do not need to wait until the behavior is severe to seek help.
No. While BFRBs share some surface features with ordinary habits, they are recognized clinical conditions that are difficult to control and that cause real physical damage and distress. Most people with a BFRB have tried repeatedly to stop on their own without lasting success. This is not a matter of willpower, and treatment addresses the specific mechanisms that keep the behavior going.
Are BFRBs a form of self-harm?
Generally, no. Self-harm involves an intent to cause pain or injury, while BFRBs are typically not driven by that intent. People pull, pick, or bite in response to urges, sensations, or emotional states, and the physical damage is usually an unwanted consequence rather than the goal. That distinction matters for both understanding the behavior and treating it.
Are BFRBs related to OCD?
They are related but distinct. BFRBs are grouped with OCD in the same category of the DSM-5-TR because they share certain features and tend to run in the same families. They differ in an important way, though. OCD compulsions are usually performed to relieve anxiety tied to an obsession, while BFRBs are more often linked to physical urges, sensations, or emotional states such as boredom, tension, or frustration. This is part of why treatment for BFRBs looks different from standard OCD treatment.
Will my hair or skin recover?
In many cases, yes. Hair and skin often recover once the pulling or picking is reduced or stopped, though recovery can take time and, in some cases where damage has been long-standing, may be incomplete. The more important focus in treatment is on reducing the behavior and its impact on daily life, which also gives the body the chance to heal.
How do I know if I need therapy for a BFRB?
If you are pulling, picking, or biting to the point of causing damage, if you have tried to stop and have not been able to, or if the behavior is causing you distress, taking up significant time, or leading you to avoid activities or hide from others, it is worth reaching out to a mental health professional. You do not need to wait until the behavior is severe to seek help.
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*BFRB Resources at the bottom of this page
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Click here to learn more about Postpartum Depression
Click here to learn more about Insomnia
Click here to learn more about Self Esteem
*BFRB Resources at the bottom of this page
BFRB Resources
Organizations focused on BFRBs
- The TLC Foundation for Body-Focused Repetitive Behaviors: the leading nonprofit dedicated to BFRBs, with education, research, and a provider directory. https://www.bfrb.org/
- International OCD Foundation (IOCDF): BFRB overview, background on hair pulling, skin picking, and related behaviors. https://iocdf.org/about-ocd/related-disorders/body-focused-repetitive-behaviors/
- Anxiety and Depression Association of America (ADAA), BFRB information. https://adaa.org/understanding-anxiety/co-occurring-disorders/body-focused-repetitive-behaviors
- Cleveland Clinic, Body-Focused Repetitive Behavior overview — a clear, patient-friendly summary. https://my.clevelandclinic.org/health/diseases/body-focused-repetitive-behavior-bfrb
- TLC Foundation, Find Support (provider directory): search for clinicians who treat BFRBs. https://www.bfrb.org/find-support/medical-providers
- TLC Foundation, Support Group Directory: peer and professional support groups. https://www.bfrb.org/support-group-directory
- IOCDF Find Help directory: search by location and specialty. https://iocdf.org/find-help/
- The TLC Foundation's BFRB Books list: a curated reading list of self-help books, workbooks, and titles for parents, covering hair pulling, skin picking, and related behaviors. https://www.bfrb.org/bfrb-books
- HabitAware Keen: a wearable awareness bracelet designed to help notice pulling and picking as it happens. https://habitaware.com/
- National Alliance on Mental Illness (NAMI). https://www.nami.org/
- Mental Health America (MHA). https://www.mhanational.org/
- 988 Suicide and Crisis Lifeline — call or text 988, available 24/7. https://988lifeline.org/
- Crisis Text Line — text HOME to 741741. https://www.crisistextline.org/
