Body- Focused Repetitive Behaviors (BFRBs) is an umbrella term for any chronic behavior that causes a person to consistently cause physical damage to oneself unintentionally through a compulsive act in order to relieve anxiety. BFRBs are pathological grooming behaviors that are thought to be driven by similar impulsive urges, linking them together but manifesting differently in the following ways:
Dermatillomania/ Excoriation Disorder: Compulsive Skin Picking/ Chronic Skin Picking (CSP), Dermatillomania, Skin Picking Disorder, Acne Excoriee, Neurotic Excoriation, Pathological Skin Picking (PSP), Self Injurious Skin Picking (SISP) and Psychogenic Excoriation are all terms used to describe a psychological disorder that manifests by an overwhelming urge to pick at one’s own skin to the extent that damage is caused. (see more…)
Dermatophagia: This skin biting disorder often coincides with Onychophagia. Most sufferers with Dermatophagia bite the skin around their fingers compulsively. This disorder also includes those who compulsively bite their cheeks or their lips which can cause blistering and open wounds. Some sufferers of Dermatophagia also have Dermatillomania and feel compelled to pick at the healing or calloused skin (with teeth, nails, or “tools”).
Morsicatio buccarum: Derived from the Latin words, morusus meaning “bite” and bucca meaning “cheek”. While still a BFRB, a dental examination can rule out structural issues with the jaw as a root cause. One treatment includes wearing an acrylic prosthesis that covers the biting surfaces of the teeth while protecting the cheek, tongue, and labial mucosa.
Morsicatio labiorum: This condition is characterized by a person biting, chewing, or sucking their inner lip. When teeth scrape up against the inside of the cheek, our cells create a protective coating called keratin. In extreme cases, these calloused areas can be surgically treated by your dentist or oral surgeon. Laser treatments are one of the newer procedures that basically cauterize the keratinized tissue off leaving a smooth surface.
Morsicatio linguarum: Chronic tongue biting is a behavior often seen by dentists. Over an extended period of time, this condition can lead to difficulty in chewing and speech. As the skin thickens and enlarges, the individual may find it increasingly difficult to masticate or opening the mouth wide enough. The tissue damage may vary from minor to extensive abrasions, ulcers, and hyperkeratosis.
Onychophagia: One of the most common BFRB’s, Onychophagia is the medical term for compulsive nail biting. This disorder is socially acceptable and often deemed a “habit”. Complications may occur when nails are bitten down to the cuticle, causing debilitating pain and possibly infection.
Onychotillomania: Not to be confused with Onychophagia, Onychotillomania is the compulsive need to pick at or tear off one’s nails, named by Polish dermatologist Jan Alkiewicz.
Rhinotillexomania: While most common in children, Rhinotillexomania (compulsive nose picking) affects many adults on a universal scale. Most people who pick their nose habitually do not have a BFRB; however, it becomes problematic when a sufferer continually causes damage to his/ her nose and is unable to stop the compulsive behavior, much like Dermatillomania, and both are treated in the same manner. Rhinotillexomania has the additional risk factor of infections because the “danger triangle” consists of sharing the same blood flow from the bridge of the nose to each corner of the mouth making it easier for infections to travel to the brain.
Scab Eating Disorder: How Trichophagia relates to Trichotillomania is how Dermatillomania coincides with Scab Eating Disorder where a smaller percentage of those who pick their skin finish their picking ritual by eating the piece of skin that is removed from the body. If medically recognized, this problem should follow the Greek system of naming and be called “Dermaphagia”, although it has potential to be confused with “Dermatophagia”.
Trichophagia: This disorder, often a sub-category of Trichotillomania, is the term for the hair eating disorder. Some sufferers of Trichophagia eat hair off of brushes (their own or others) or chew their own hair and ingest it. It sometimes coincides with Trichotillomania after a pull as part of a ritual in order to achieve relief from anxiety. This disorder can be dangerous as hairs accumulate in the stomach which can result in surgery to remove the blockage it causes.
Trichotemnomania: This behavior is the conscious act of compulsively shaving or cutting one’s own hair. A sufferer can be drawn to these behaviors as stress relievers because it can signify a form of cleansing or need for perfection, which teeters into the OCD spectrum or Body Dysmorphic Disorder categories- it’s not a clear-cut BFRB. The media may play a role in influencing this behavior with western culture focused on the cleanliness and perfection surrounding a flawless image when pertaining to a lack of body hair.
Trichotillomania: A “sister syndrome” to Dermatillomania, this disorder most commonly causes a sufferer to pull out hairs from his/ her scalp, eyebrows, eyelashes, or facial hair. While these are the most known areas (due to the distress it can cause a sufferer) of focus Trichotillomania expands to the compulsive pulling of any bodily hair. Often times it crosses over with skin picking due to the fine line of relieving anxiety by a pick or pull, directly affecting a sensation on the skin.
Many people who have one BFRB find themselves with traits of others because of how interlinked they are due to how the impulse affects them. It is important to speak to your physician or therapist if you are concerned about having any of these BFRBs while keeping in mind the difference between having a habit or having a chronic condition.
While there are other behaviors that are considered to be harmful to the body when practiced compulsively, they fall under the Obsessive-Compulsive Spectrum, Impulse Control Disorder, or triggered by Body Dysmorphic Disorder, or other mental health afflictions instead of being BFRB’s. These behaviors may relieve anxiety in a person but when an external factor is brought into the equation causing it to not be a direct effect of body-to-body contact (although Trichotemnomania is in the “grey area”), it does not fall under the category of Body- Focused Repetitive Behaviors. This list includes:
- Excessive tanning
- Compulsive hand- washing and/ or showering
- Obsession/ Addiction to plastic surgery
- Excessive tattooing/ body piercing
- Weight Modification (turning into a disorder, such as Anorexia, Bulimia, or Muscle Dysphoria)
- Compulsive exercising
- Cutting/ Burning (see #3)
Smoking cigarettes, drinking alcohol, and addictive drugs/ medications all fall under the Addiction category; these are also separate from BFRB’s because they are chemically induced. Although not all addiction is purely chemical for some people (others have emotional/ psychological attachments to the drug), these substances contain elements that have an external influence, which BFRB’s do not.
Although OCD, Habits, Impulse Control Disorders, Addictions, and BFRB’s have similarities based on their effects on a person, they have components to their categorizations that separate them from each other, even if seemingly on an acute level. What can be agreed on is that each behavior listed in these categories can require counseling to overcome and people are able to benefit from support groups available for each affliction. There are a lack of supports available due to a lack of awareness, research, or training, which makes it vital for the community to band together and build onto the small lists of resources already available.