Entry #12: BFRBs
Image reads: Body-Focused Repetitive Behaviors (BFRBs); hashtag BFRBweek Oct. 1st – 7th;
For more information go to bfrb.org
BFRBs are related to self-grooming, anxiety management, or sensory stimulation. Today, we are going to go into further detail of the most common BFRB disorders.
Starting with the disorder that I personally have a first hand knowledge:
Trichotillomania (Trick-o-till-o-may-nee-uh)
What?
Trichotillomania (also known as TTM or trich) is a hair pulling disorder. TTM can cause people to pull out hair from their scalp, eyelashes, brows, pubic area, under arms, beard, chest, legs and other parts of the body – resulting in noticeable bald patches.
Trichotillomania is one of a group of behaviors known as body-focused repetitive behaviors (BFRBs), self-grooming behaviors in which individuals pull, pick, scrape, or bite their hair, skin, or nails, resulting in damage to the body.
The strong compulsion to pull exceeds the normal idea of a “habit” (one which can be controlled through simple will power). Hair pulling is not purely a nervous behavior (though stress is the biggest trigger). Surprisingly, hairpulling is just as often associated with boredom.
Why?
Trichotillomania is currently classified under ”Obsessive-Compulsive and Related Disorders”. It is known that people diagnosed with TTM generally have a neurologically based predisposition to pull their hair as a self-soothing mechanism. The pulling behavior serves as a coping mechanism for disorders such as anxiety, OCD, and other diagnosable difficult emotions.
People with TTM are not trying to hurt themselves as most of the time this compulsion isn’t painful in the same way a neurotypical person would expect.
Onset of TTM can be triggered by simple sensory events (such as an itchy scalp). Many individuals report noticeable sensations before, during, and after pulling. A wide range of emotions, spanning from boredom to anxiety, frustration, and depression can affect hair pulling, as can thoughts, beliefs, and values.
How Long?
It is impossible to predict the duration of Trichotillomania for any one individual as it affects everyone differently. In some cases, especially early childhood, hair pulling may be very temporary.
For others it may be a lifelong journey for which the urges may come and go. It is common to see these cases refer to these occurrences as relapsing.
Research indicates that about 1 or 2 in 50 people experience trichotillomania in their lifetime. It usually begins in late childhood/early puberty. In childhood, it occurs about equally in boys and girls. By adulthood, 80-90% of reported cases are women.
Treatment?
Just as this disorder is different per person, no one treatment has been found effective to everyone, but several treatment options have shown promise. It is key to not get discouraged and to experiment with different combinations of treatment until you find what works best for you.
Examples of options:
Anxiety Medication / Anti Depressants
Sharing your story. Advocating for awareness.
This allows you the opportunity to get ahead of your insecurities and take control of your story.
Fidgets are a great coping mechanism as they can help shift the urge to pull away from your hair and to an object.
Spinner Rings, Fiddle Bracelets, Stress Squeezers (ball), etc.
Emotional and Social Impact?
For some people, trichotillomania is a mild problem, merely a frustration. But for many, shame and embarrassment about hair pulling causes painful isolation and results in a great deal of emotional distress, placing them at risk for a co-occurring psychiatric disorder, such as a mood or anxiety disorder. Hair pulling can lead to great tension and strained relationships with family members and friends. Family members may need professional help in coping with this problem.
Due to shame and embarrassment, individuals not only try to cover up the effects of trichotillomania but may avoid activities and social situations which may lead them to feel vulnerable to being “discovered” (such as windy weather, going to the beach, swimming, doctor’s visits, childhood sleepovers, hair salon appointments and intimacy).
Physical Impact?
Physical effects such as itching, tissue damage, infection, and repetitive motion injuries to the muscles or joints are not uncommon.
For those who ingest the pulled hair may experience gastrointestinal distress or develop a trichobezoar (hairball in the intestines or stomach), which could lead to gastrointestinal blockage and require surgical removal. Although trichobezoars are rare, they are a serious risk for those who ingest hair.
Let me preface this by saying not all people with TTM eat the hair that they pull, and those who do – should not be shamed. It is very much part of the Obsessive-Compulsive effect from this disorder.
Are there signs?
Recurrent hair pulling, resulting in hair loss and repeated attempts to decrease or stop the behavior are two of the biggest symptoms.
Although the severity of hair pulling varies widely, many people with trichotillomania have noticeable hair loss, which they attempt to camouflage. Thinning or bald spots on the head may be covered with hairstyles, scarves, wigs, or makeup. Those with missing eyelashes, eyebrows, or body hair, may attempt to camouflage with makeup, clothing, or other means of concealing affected areas.
In other words, signs include but are not limited to excessive fiddling with one’s hair, excessive fidgeting, change of social behavior and/or change to ones physical appearance.
My Experience with Trichotillomania:
I was officially diagnosed with General Anxiety Disorder (GAD), Depression and TTM around the age of 15-16. It was my 10th grade year. I do remember a lack of eyelashes and thinning brows earlier, but it wasn’t until I had noticeable bald spots on my scalp that I was diagnosed.
Fortunately, a hairstyle change was able to cover the bald patches on the back of my head, but my most noticeable hair loss was just above my forehead. My high school didn’t allow wigs or hats, and to get a headband big enough to cover the area – I had to have a permission slip from the front office.
I was still sent to the principals' office weekly (if not daily) because my head band was a “distraction” or “it didn’t follow dress-code”.
For a while, I found treatment in a spinner ring – until that brought too much attention to my fingers. I also found treatment in advocacy. Raising awareness not only helped me take control of my side of the story but has helped me reach others by knowing that they are not alone.
My disorder is off and on for my scalp and completely on going for my eyelashes.
I relapsed in 2018 but found that when I dyed my hair cool and crazy colors – I was less likely to pull my hair. That did get expensive though so, it only lasted about a year and a half. In 2020, I made the decision to stop hiding behind haircuts, so June 2020, I buzzed most of my hair off (leaving about 1-2 inches on the top of my head). I have found that if I don’t have the ability to grip my hair, then I cannot pull my hair, and this has worked for me. I have been pull-free (on my scalp) for 13 months and 6 days as of Sept. 27th, 2021.
I found that I frequently pulled while in stressful situations or while doing mindless activities like talking on the phone, watching tv, working on the computer and sleeping. Personally, I am unaware I am pulling until I either find the wad of hair or feel the bald patch.
Onychophagia (On-ah-coff-age-ah)
Also known as Chronic Finger and Nail biting.
20%-30% of the general population engages in chronic nail biting although prevalence estimates greatly vary, with estimates ranging from 12% to 44%.
Nail biting is often associated with visible nail damage, tension prior to or when attempting to resist nail biting, feelings of pleasure after biting, nail eating, and psychological distress. Many describe the behavior as “automatic.”
For more information visit:
My experience with Onychophagia:
This is one I also struggle with but am VERY less vocal about. I am more self conscious about it and there is a lot of shame behind it.
Unfortunately, my nail biting is tied to my Trichotillomania. Once I found a way to stop pulling my hair, the anxiety and stress needed to go somewhere, and that led to fingernail biting for me. It most often happens when I am mindlessly doing something or when I am in a stressful/anxious situation.
Although it exceeded past the normal nail biting and became accompanied by Dermatophagia (skin eating). Yes, I do bite my cuticles and down my fingers. Dermatophagia can and often do accompany all the other BFRB’s.
Most often then not, my fingers are very sensitive to touch (especially when picking up warmer objects).
Excoriation Disorder
Also known as Skin Picking Disorder or Dermatillomania.
Individuals who struggle with this disorder touch, rub, scratch, pick at, or dig into their skin in an attempt to improve perceived imperfections, often resulting in tissue damage, discoloration, or scarring.
2% - 5% of the population picks their skin to the extent that it causes noticeable tissue damage and marked distress or impairment in daily functioning. 75% of people affected are female.
For more information (like Signs & Symptoms and Impact & Effects) visit:
Morsicatio Buccarum (Mar-si-kay-she-ah Buh-kah-rum)
Also known as Chronic cheek biting or cheek chewing.
Redness, painful sores, and tears can occur in the mucosa, which is the inner lining of the mouth. For some, after repetitive biting occurs, the lining of the cheek can start to feel irregular, increasing the urge to continue to bite in order to create a smooth surface.
While cheek biting is less studied than other BFRBs, it is thought to share a similar complex etiology. It is likely that biologic predisposition, acting through genetic mechanisms, activates the repetitive behavior.
For more information visit: