Body-Focused Repetitive Behaviors (BFRBs)


Body-Focused Repetitive Behaviors (BFRBs) are disorders characterized by excessive ritualized grooming habits. Therapists at The Center for the Obsessive Mind provide specialized Therapy for BFRBs.



Trichotillomania (TTM), commonly referred to as “Trich,” is one type of a Body-Focused Repetitive Behavior (BFRB). It affects 0.5-2% of the population. Those with TTM pull their hair compulsively. They may pull from numerous locations, for instance their scalp, eyebrows, eyelashes, or any area where there is hair on the body. In addition, people with TTM will occasionally pull other’s hair or the the hair of pets.

As a result of pulling, individuals with TTM experience hair loss. In spite of this and even though individuals do make efforts to stop, people have a very hard time refraining from pulling. In fact, while some incorrectly assume compulsive hair-pulling to be a self-harming behavior, most who pull experience it to be pleasant and soothing. Indeed, people with TTM enjoy the experience and pulling often takes on an addictive quality for them. Individuals often pull to manage uncomfortable emotions or to achieve or avoid certain sensory experiences. Pulling can also be perpetuated by associations with certain postural positions and environments. For example, people maybe more prone to pull when driving if they tend to place their elbow on the window as this gives their hand easy access to their hair.



Excoriation Disorder (aka Dermatillomania) is another type of BFRB. Those with Dermatillomania, also called “Derm” for short, pick their skin to the point of causing lesions. Even though it is not often talked about, this disorder is not at all uncommon. In fact, a study found that 2.1% of 10,169 adults struggle from this disorder. When someone is struggling with compulsive skin picking, they have difficulty stopping despite adverse effects as well as attempts to stop.

As with TTM, people with Dermatillomania often find picking to be soothing and satisfying. Thus, while this behavior may appear to be a form of self-mutilation, those with compulsive skin-picking  generally do not pick as a means of self-harm. People may pick for many reasons – for example, to make their skin smooth or to achieve some other sensory experience. They may pick to perfect their skin, even when their efforts rarely lead to improvements and more often create damage. People with Dermatillomania also pick to manage uncomfortable emotions or to promote focus and quiet the mind. Excoriation Disorder is often perpetuated as a result of associations with certain locations and postural poses that contribute to the habit. Some will even pick in order to manage anxiety caused by picking.


People can relate compulsively to all sorts of grooming behaviors – for example, people can struggle with compulsive nail biting (Onychophagia) nose-picking (Rhinotillexomania) and hair cutting (Trichotemnomania). Moreover, your behavior need not fit neatly into a category to constitute a Body-Focused Repetitive Behavior. What’s most important in diagnosing the condition is that it is difficult to control and causes significant distress an impairment in your life. That is to say that if you find yourself compulsively performing a grooming behavior and your experience is upsetting to you or interferes with your life, you may be struggling with a BFRB. In order to learn more about different types of BFRBs you can visit the Trichotillomania Learning Center for BFRBs website.



Since most people do pull hairs from time to time, it’s important to note that those with TTM must experience distress or impairments as a result of their pulling. Oftentimes, people experience a great deal of shame because of bald spots that occur. In fact, people may avoid social situations because of their fear of judgment. In addition, those with Trichotillomania may pull in spite of physical pain or discomfort. Pulling can also be time consuming. Many individuals get lost for long periods of time pulling in trance-like states.

Likewise, most people pick their skin to some degree, but those with compulsive skin-picking, experience significant distress or impairment in functioning as a result of their picking. Individuals with the disorder may, for example, avoid social settings and even responsibilities after a significant episode of picking. Many also lose large chunks of time while picking in trance-like states. While living with this disorder can be very challenging, there is help available.

This can be an incredibly distressing disorder to live with, but there is help. If you or someone you know is struggling, you can read more about evidence-based Therapy for BFRBs here.



The ComB approach addresses many reasons people pick. The treatment identifies five reasons people pick using an acronym, SCAMP: Sensory, Cognitive, Affective, Motor and Place. In this therapy, people log when they do their BFRB and what motivated the behavior. Once someone knows which domain triggers the desire to pick, they can support themselves in a way that meets their specific needs. Someone who’s triggered when they feel a blemish might wear tape on their fingers. This can act as a barrier and prevent triggers. If the bathroom mirror is a trigger, a person might set a timer before going to the restroom to support awareness.


HRT also involves logging. That said, the main intervention, competing response training, is mostly meant to interfere with the ability to pick. In competing response training, people learn to tense their muscles in a way that precludes picking for one minute when the urge to pick arises. HRT Plus is a term used to describe traditional HRT with the addition of other approaches. Habit blockers, stimulation replacements and stimulus control are all incorporated into HRT Plus.

You can learn more about ComB and HRT here.


Are you or a loved one struggling with extreme picky eating and looking for help? Therapists at The Center for the Obsessive Mind use The Comprehensive Behavioral Model of Treatment (ComB) and Habit Reversal Training (HRT) to support Individuals with BFRBs. You can learn more about the treatments and services we provides here.


The Center for the Obsessive Mind offers

therapy in several states and internationally.

Learn more about where the staff practices, below.

Pastel skies and a pristine beach in Northern California, one of the areas where The Center for the Obsessive Mind helps people with BFRBs.


The Center for the Obsessive Mind’s staff therapists offer online therapy for BFRBs throughout California. Our Clients span from San Francisco down to Southern Orange County and San Diego. Whether you’re in Silicon Valley, Santa Barbara, Beverly Hills or Dana Point, the Center’s staff can support you in your recovery.

The red rock spires of Bryce Canyon in Utah, one of the states where The Center for the Obsessive Mind offers counseling for BFRBs.


Staff members at the Center for the Obsessive Mind offer treatment for BFRBs in the state of Utah. Since we provide teletherapy, we works with people who live in different areas of the Beehive State – from Salt Lake City and its suburbs, like West Jordan, Syracuse, Highland and Riverton, to Park City and St. George.

Clear turquoise waters in the Keys, one of the places where The Center for the Obsessive Mind offers online treatment for BFRBs in Florida.


Therapists at the Center for the Obsessive Mind also offer treatment for BFRBs online in Florida. We see people from all corners of the Sunshine state. Whether you’re from Naples, Orlando, Miami, or Boca Raton, we can provide specialized counseling remotely in your area.

The placid, clear waters of Sand Harbor in Lake Tahoe, one part of Nevada where The Center for the Obsessive Mind offers therapy for BFRBs online.


Therapists at the Center for the Obsessive Mind also practice teletherapy in Nevada. So if you’re seeking help in Glenbrook, Incline Village, Reno or Las Vegas, we offer specialized therapy for BFRBs online across the Grand Canyon State.

The Seven Sisters sea cliffs in Sussex, England, one international locale where  The Center for the Obsessive Mind provides counseling.


In addition to all of the locations previously listed, the staff at the Center for the Obsessive Mind offer teletherapy for BFRBs to a number of countries internationally.

Cozy couch and computer: all you need for teletherapy and what working with The Center for the Obsessive Mind could look like.


Online therapy isn’t right for everyone. An assessment must be done to determine if online therapy is appropriate for your needs. You can reach out here to learn more.


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Disclaimer: The information contained on this website is intended for informational and education purposes only and is not meant to be a replacement for therapy. If you are interested in treatment, you can email us and we will happily provide you with more information.