Body-Focused Repetitive Behaviors

Body-Focused Repetitive Behaviors (BFRBs) involves a person causing harm or damage to themselves or their appearance.

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It can occur when a person experiences feelings such as anxiety, fear, excitement or boredom.

BFRBs include:

  • Trichotillomania – Pull out the hair from their scalp, eyelashes, eyebrows, pubic area, underarms, beard, chest, legs or other parts of the body, resulting in noticeable bald patches.
  • Dermatillomania - Repetitively touch, rub, scratch, pick at, or dig into their skin, often in an attempt to remove small irregularities or perceived imperfections. This behavior may result in skin discoloration or scarring. In more serious cases, severe tissue damage and visible disfigurement can result.
  • Onychophagia – Continually bite their nails past the nail bed and their cuticles until they bleed resulting in red, sore, and sometimes infected fingers.
  • Dermatophagia - Chew their skin out of compulsion, and can do so on a variety of places on their body.  Sufferers typically chew the skin surrounding their fingernails and joints. They could also chew on the inside of their mouth, cheeks, and/or lips, causing blisters in and outside of the mouth.

There are a number of treatments options to explore.


  • Acceptance & Commitment Therapy (ACT) – Experience urge, and accept urge without acting on it.
  • Habit Reversal Training (HRT) – Recognize the impulse, and redirect this impulse.
  • Stimulus Control – Identify and eliminate triggers.
  • Dialectic Behavior Therapy (DBT) – Awareness and tolerance of uncomfortable emotions and urges.
Psychiatric Medication
  • Please read the article “Medications for Trichotillomania and Pathologic Skin Picking” by Jon Grant, MD – TLC
  • Dopamine antagonist (medication that blocks dopamine receptors) or a Dopamine-blocking neuroleptic/antipsychotic have been examined in the treatment of ICD
  • Dopamine agonist (medication that activates dopamine receptors) have been questioned to cause or aggravate an ICD
  • Medications that affect (inhibits the release of) the neurotransmitter, Glutamate.  Proposed mechanism of action of meds, such as:
    • riluzole (Rilutek) - has a inhibitory effect on glutamate release - FDA approved for ALS
    • lamotrigine (lamictal) – inhibits voltage-sensitive sodium channel, thereby stabilizing neuronal membranes and consequently modulating presynaptic transmitter release of excitatory amino acids (eg. glutamate)  - FDA approved for bipolar disorder

Quoted from Sources:
TLC – Trichotillomania Learning Center – Body-Focused Repetitive Behavior – Glutamate – Inositol – Rilutek.html – Lamictal.pdf

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