Self-grooming habits that harm us
Most of us have habits that we would like to change or stop, such as compulsively checking messages on our phone, or chewing the end of our pen. Luckily, for most of us our habits are simply annoying, rather than actually harmful. But for around 2-5% of the population, their habit is highly problematic, and harms their body. These habits include picking at their skin (excoriation disorder or compulsive skin picking), pulling (out) their hair (trichotillomania), biting the inside of their cheeks, and biting their nails (onychophagia).
The term body-focused repetitive behaviour (BFRB) is used to refer to this group of self- grooming behaviours that are performed with a loss of control, and harm the person’s body. While there is a wide rang of BFRB severity, most people with a BFRB cannot stop the behaviour despite multiple attempts to decrease or stop, and these disorders result in distress and interfere with daily functioning.
BFBRs often first emerge in early-mid adolescence, although they can occur at any age. Perhaps surprisingly, given the prevalence of BFRBs, these behaviours are under-researched and poorly understood. However, experts have established that BFRBs are not a form of obsessive compulsive disorder (OCD), and are not due to previous trauma or bad parenting. BFRBs are also not considered to be a form of self-mutilation or self-harm. So what may account for the onset and maintenance of these habits? It appears that some people are genetically predisposed to developing a BFRB, and it is also thought that stress may play a role for some people as their habit can be experienced as soothing or providing a relieving function. However, for others the only significant stress they experience is due to their BFRB. Overall, BFBRs are acknowledged as being highly complex behaviours.
As well as causing hair loss, skin lesions, scarring and other visible effects, BFBRs can potentially have more serious physical consequences. For example, skin picking and nail biting can result in infections if the exposed wounds are not allowed to heal. Similarly, if hair is pulled from the eyelashes or the pubic region, infections may also occur. More rarely, if people who pull their hair also eat the removed hair, this hair can build up in the gastrointestinal tract, with very serious health implications.
While BFBRs can potentially result in medical complications, they also result in significant psychological distress and impacts on the person’s quality of life. Most people struggling with a BFRB hide their disorder because they feel intense shame and embarrassment, which can prevent them from seeking medical or psychological help. These disorders often negatively impact the person's self-esteem and social relationships, contributing to them feeling hopeless and isolated. BFRBs can also affect their ability to engage effectively in education, work, or other activities that they would like to pursue.
A large part of the negative psychological impact of a BFRB can stem from the belief that the disorder is the sufferer’s fault, and that they should be able to address it on their own. They are often not aware that, contrary to common belief, BFRBs are not trivial habits that a person should be able to change with a bit of willpower – they are highly complex behaviours that result in real and significant challenges. Expecting someone to simply stop such a complex behaviour will only add to the burden of shame and confusion felt by the person struggling with the BFRB.
Most people who seek help for a BFRB, only do so when they reach a point of desperation. The shame and secrecy associated with BFRBs not only prevents timely support and treatment, but also contributes to the lack of awareness of the problem more generally. Fortunately, there is increasing awareness of BFRBs, and there are now a number of recommended psychological treatments for these disorders, which all fall into the broader approach known as Cognitive Behaviour Therapy (CBT). These CBT treatments may be applied in conjunction with other psychological approaches, such as Dialectical Behaviour Therapy (DBT) or Acceptance and Commitment Therapy (ACT). While CBT is considered the most effective treatment for BFRBs, medication may also be considered prior to, or while, engaging in CBT.
