Mental Health Awareness Month – BFRB’s

Mental Health Awareness – Body Focused Repetitive Behaviors

Over the last decade, I’ve watched as mental health issues have been brought more to the forefront of society than ever before as millions fight to destigmatize living with various diseases and disorders. It is truly fantastic to see the rise in education on these matters and the outpouring of support. Just knowing others struggle with the same thing you do can, at times, be a huge help. With that, I’m taking this month to discuss a few things I don’t see brought up much. I hope these posts reach someone who needs to hear they are not alone. 


Body-focused repetitive behavior (BFRB) is a general term for a group of related disorders that includes hair pulling, skin picking, and nail biting.  These behaviors are not habits or tics; rather, they are complex disorders that cause people to repeatedly touch their hair and body in ways that result in physical damage.

As a pre-teen, I began pulling out the hair on my legs. In a fairly short amount of time, this behavior grew into pulling out the hair on my head and in my eyebrows. I was already the quiet kid everyone picked on, and the growing bald spots didn’t help. Eventually, I was forced by my parents to cut my hair short in an attempt to curb the pulling – next to nothing was known about this disorder back then.

Even the wide variety of therapists and counselors I saw over the next six years didn’t know about them. I was told I “just needed to want to stop.” I was told I was doing it for attention, or as a form of self-harm similar to cutting. I was teased mercilessly, and I wanted desperately to be able to stop. But I couldn’t. I still remember the day I finally looked it up online, after almost a decade of dealing with these uncontrollable urges, and saw that word. 


The beast had a name. Other people dealt with the same thing. And it wasn’t something I could “just stop” through sheer willpower. The relief I felt in that moment had me in tears. I spent days pouring over the research and though much of it was still young, I relished the simple fact that it existed. I found things to try and put them in motion immediately.

I don’t remember exactly when it stopped. I wish I did. What I do remember is standing in my bathroom days before Christmas in 2006, getting ready to go to some holiday gathering or another. I’d become so used to ignoring the hot spots on my scalp that I didn’t notice at first. Not until I’d dried and straightened my hair and noticed this one odd chunk that wasn’t laying flat. That’s when I realized not only had I stopped, but the hair in a spot that had remained largely bald for years had grown back and was now a couple of inches long. 

I still pull from other, less noticeable places. I’ve gotten better at preventing it and at making myself stop when it starts. The hair on my head has grown back fully and the painful memories of years spent hiding bald patches keep me from doing that again. However, it isn’t uncommon for BFRB’s to come in groups and trich isn’t the only one I have. As the weather warms and the summer clothes come out of storage, the other one I struggle with becomes glaringly obvious.


Skin picking. More than the hair pulling ever did, this one scares me. Even with a known name and wonderful resources for help and education on the subject. It scares me because picking at one’s skin is also a common side effect of several illegal drugs and I’m constantly afraid someone will see and think that’s what is going on. I’d wager there are others with derm who share this or similar fears.

In the winter, it is much easier to hide with warm clothing. In the summer, you either suffer through wearing pants and long sleeves in the oppressive heat or the stares and strange looks when you don shorts, t-shirts, tanks and bathing suits. Sometimes, when the urges have been exceptionally bad, it is obvious even at a distance. Other times, you’d have to look closer.

For ages, when people asked what was wrong with my arms (my major derm hot spot), I’d blame the mosquitos. Eventually, I got sick of hiding the truth and making excuses. The rapid rise in mental health awareness gave me the boost I needed to begin speaking out about what was really going on and I’ve been blown away by the support of friends and loved ones. Along the way, I’ve learned a lot and come to accept things about myself that I’ve been trying to change for most of my life.

BFRB’s have been in my life for almost twenty years now. I still don’t see them openly discussed much, as the major push for awareness centers on things like depression, anxiety, PTSD and other similar issues. In no way do I wish to take away from important discussions on those topics – I simply want to add this to the mix. If you’ve found this post in a search to explain behaviors you can’t control, please know you are not alone.

Research indicates that 1-2 out of every 50 people deal with trichotillomania in their lifetime. A large majority of sufferers are women. Between 2% and 5% of the population pick at their skin to the point it causes noticeable tissue damage and marked distress or difficulty in daily functioning. 75% of these are women. There are others who understand what you’re going through, methods proven to help and professionals trained in dealing with these things. 

Body Focused Repetitive Behavior Resources

Psychology Today article on BFRB’s – Covers more than just dermatillomania

 Support Groups

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Mental Health Awareness: Body Focused Repetitive Behaviors