Body Focused Repetitive Behavior (BFRB)
Do You Experience Compulsive Skin Picking or Hair Pulling?
Do you find yourself unable to stop picking at your skin or pulling out your hair?
Have you felt intense shame, guilt, defeat, or stress due to compulsive picking or pulling?
Is your picking or pulling behavior causing unwanted physical changes to your body, such as scarring, scabs, bald spots, or scratches?
Have you ever promised yourself “this will be my last time”, only to fall back into picking or pulling hours or days later?
Having a body focused repetitive behavior (BFRB for short) such as compulsive skin picking, hair pulling, cheek biting, or knuckle cracking can be an excruciating experience. If you’re like other sufferers, you have made multiple attempts to get your BFRB under control and feel a sense of defeat or shame when it re-emerges. Not only is the physical toll heavy, but the emotional impact can feel even worse. You may be self-conscious or embarrassed of how your BFRB affects other people’s perception of you. You may even feel weak that you haven’t been able to kick this habit on your own.
Body Focused Repetitive Behaviors Are Misunderstood
BFRB’s can affect any part of your body, and the targets of picking or pulling behavior may change over time. One of the most painful things people with BFRB’s often hear from loved ones, doctors, or even from within themselves is the statement “just stop pulling/picking.” Most people don’t understand that a BFRB is a neuropsychological disorder that involves multiple parts of your brain that affect impulse control, awareness, movement inhibition, interception, and emotion regulation. You are NOT pulling or picking on purpose, and those who send these hurtful messages truly don’t understand the nature of BFRB’s.
There are two types of picking or pulling behavior, types where people tend to pick/pull in an unfocused, automatic way (e.g. pulling one’s hair while mindlessly scrolling through social media) and picking/pulling that occurs in a more intentional, focused way (e.g. picking at skin while looking closely in the mirror before a shower). Some people engage in more automatic pulling and others in more focused pulling, but usually people experience both types of picking/pulling behaviors BFRBs.
If you’ve had a difficult experience with a BFRB, it’s likely that you are interested in finding a way to break this habit and live your life without being constrained by picking or pulling. Fortunately, the highly specialized and targeted behavioral therapy we provide at Beachfront Anxiety Specialists can give you the tools and direction you need to feel empowered to finally get your BFRB under control.
BFRB’s and You
While it's common to feel isolated when you have a BFRB, you are not alone in your experience. While it’s a relatively under-studied disorder, studies tend to show that around 4-5% of people develop a BFRB in their lifetime. Typically the course is chronic and cyclical, where BFRB’s will increase and decrease in severity throughout one’s life unless it’s treated properly.
When you have a BFRB, you can think about it as your brain’s natural, mammalian grooming response misfiring. All mammals are programmed to groom themselves and others, it’s a way to keep our skin and hair in tip top shape and to bond with loved ones. However, with a BFRB, your mind is sending false signals that picking or pulling needs to occur. Picking or pulling at a spot sets into motion two processes.
First, you might feel a sense of relief as the tension under your skin is tightened and then released. Second, when you pick or pull at a spot over and over, that spot becomes sensitized may start feeling satisfying or stimulating to continue to pull. Over time, your brain learns that it gets a pleasant feeling from pulling or picking, leading it to send even more frequent and intense urges to engage in a BFRB.
If you have a BFRB, you might have also experienced a common cycle of pulling and shame. This cycle occurs when you inevitably give into the urge to pick or pull, feel an impending sense of shame or guilt, and then decide to give in even more because you already feel defeated. Unfortunately, due to the abundance of misinformation about BFRB’s, there are many non-specialized therapists who attempt to use unsupported treatment modalities to try to get at the core meaning behind one’s pulling behavior. The science is clear that BFRB’s don’t have anything to do with early childhood issues or unresolved needs. It’s a neuropsychological condition that responds well to specialized change focused treatment.
The good news is that by working with a BFRB specialist, you and your therapist will walk through a science-backed, change-oriented modality called Comprehensive Model for Behavioral Treatment (ComB). ComB is an incredibly powerful intervention that has been shown to provide relief of BFRB’s in adults and minors. You will learn how aspects of your picking/pulling such as strong physical urges, distorted thinking patterns, awareness, and emotion regulation lead to the development and maintenance of compulsive picking/pulling. Once you have a strong understanding how your specific BFRB operates, you will learn and practice tools to take the power away from the BFRB.
Specialized BFRB Therapy Will Give You Actionable Skills
You no longer have to try to manage your picking or pulling behaviors all by yourself. At Beachfront Anxiety Specialists, we have devoted our professional careers to helping our clients overcome OCD and OCD-related concerns such as BFRB’s. We are true specialists who use cutting-edge and psychologically validated interventions to help our clients attain the long-lasting relief they are seeking.
We combine our extensive experience treating BFRB’s with a warm, compassionate, and collaborative approach. Whether this is the first time you have sought help for your pulling/picking or you have been to therapy in the past, BFRB focused treatment can help you get your life back on track. Many of our clients have had years of failed talk therapy, which has led them to seek out our expertise in working with BFRB’s in a more targeted and strategic way.
What to Expect in Sessions with Us
In our sessions, you and your therapist will work closely together to uncover the various ways your BFRB has been affecting your life physically, emotionally, and socially. Our therapists are highly skilled at conducting thorough assessments to ensure you are receiving high quality and comprehensive treatment. Over the course of the first several sessions, you and your therapist will be getting to know each other, developing a trusting relationship, assessing your symptoms and background, and learning about the nature of BFRB’s.
Once we have a solid understanding of how your specific BFRB’s are presenting and how other neuropsychological conditions might be interacting with your symptoms (e.g. OCD, ADHD, tics/Tourette Syndrome, other anxiety disorders), we will work closely with you to develop a treatment plan that tailors high quality, science-based interventions to your specific goals, values, and background. When treating BFRB’s we use the gold standard behavioral based approach called Comprehensive Model for Behavioral Treatment (ComB). Using ComB, your therapist will assist you in developing awareness around the most subtle and nuanced facets of your BFRB. You will learn how to change your relationship with BFRB related urges and sensations and how to manage thoughts, feelings, and sensations that feed into aggressive BFRB cycles. You will also gain greater insight into the relationship between your environment and your BFRB symptoms, and come up with a plan to use your external space to help fight back against your BFRB.
Doing ComB is like developing a workout routine at the gym, although instead of working out your cardio or muscles, we are strengthening your brain’s connections on how to interrupt intrusive grooming signals. However, like a gym routine, it does take work and commitment to see improvement. For your BFRB to become better managed, it’s important that you are willing to practice anti-BFRB skills in between sessions. The goal of ComB is to help you become your own ComB therapist! That way, if other BFRB’s surface later in your life, you’ll already have the skills to quell them.
Customizing Therapy Techniques for Your Needs
At Beachfront Anxiety Specialists, we never take a cookie cutter approach to your treatment. We view our roles as active collaborators and coaches as much as we are therapists. Our job is to help you feel empowered to take down your BFRB by providing tools, insights, and gentle guidance. You are always in the driver’s seat of your treatment, determining where we go and how fast you’d like to get there.
While ComB is an essential ingredient to living a life that is not constrained by BFRB’s, our therapists are also highly trained in several other evidence-based modalities to help you meet your goals. We are able to weave in mindfulness, Acceptance and Commitment Therapy, and Cognitive Therapy which can assist you in managing concerns that are different from, but related to your BFRB such as anxiety, OCD, tics/Tourette Syndrome, stress, or depression. These approaches can be powerful supplements to ComB by helping you connect with closely held values, changing your relationship with your negative thoughts and painful feelings, and learning how to ground yourself in the present moment when you are spiraling into the past or the future.
You May Still Have Questions About ComB for BFRB’s...
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ComB is an investment in your long-term sense of self and peace of mind. The goal of ComB is to help you develop mastery over your BFRB, empowering you to become your own BFRB therapist. Unlike traditional forms of talk therapy, ComB is active, collaborative, and goal-driven. Typical courses of treatment usually last 6 months to 1 year, although this can vary from client to client (especially if there are other concerns you’d like to work on).
Our fees reflect the depth of our training and clinical expertise and allow our therapists to maintain smaller caseloads so we can devote more attention to each of our clients. While we are not in-network with any insurance company, we do offer superbills which you can submit to your insurance company for out-of-network benefits.
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Traditional talk therapy is typically non-directive and non-structured. People bring up problems and struggles into therapy, where they feel heard and validated. While this tends to help people feel better in the short term, traditional talk therapy can actually make BFRB’s worse by failing to address the underlying behavioral mechanisms that are keeping it going. At Beachfront Anxiety Specialists, not only will you feel truly heard and understood, but you will learn and practice actionable skills that you can begin applying immediately.
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Right now you can’t control the picking/pulling behaviors, but the goal of ComB is to help rewire your brain to strengthen the neuronal connections that will give you increased control. If you jumped into a pool but never learned how to swim, you couldn’t be expected to get out by yourself! However, once you learn the basics of swimming, you will be able to get out of the pool whenever you want to. ComB will teach you skills and tools to empower you to finally gain control back over your BFRB. Over time, the brain signal to engage in a pick or pull will lessen in intensity and your BFRB will become much more manageable.
You Can Learn How to Manage Your BFRB
If you would like to schedule an appointment or discuss any questions you may have regarding BFRB’s or ComB, contact us below. We try to get back to all voicemails and emails within 24 hours. Before starting therapy, we always offer free 20 minute phone consultations to make sure we’re a good fit to work together.