CW: This article pertains to mental health and bodily harm.
When I was young, as long as I can remember, I would pick my fingernails into non-existence. When middle school hit, and with it acne, I would sit in front of the mirror and pick my skin until it scarred. In high school, I began pulling out hair on my head, eventually leaving a visible bald spot. I couldn’t explain why I did it, other than the fact that it provided me with a strange sense of relief from everyday stress.
“Body-focused repetitive behavior” is the general term that encompasses this set of habits. The most common include trichotillomania (hair pulling), dermatillomania (skin picking) and onychophagia (nail biting), while other behaviors include cheek biting, lip biting and nail picking. At least 3 percent of the US population is living with a BFRB, with some studies showing over 10 percent, and yet they are rarely talked about. Many people don’t even know that a term exists for the behavior they engage in.
It is unknown what exactly causes body-focused repetitive behaviors, but they often co-occur with other mental health conditions like anxiety and obsessive-compulsive disorder. In the current Diagnostic and Statistical Manual, some BFRBs are currently categorized under ‘obsessive compulsive and related disorders’ due to the compulsivity of the behavior, but they are not the same as OCD. BFRBs are also not considered a self-harm behavior because most of the time the behavior is done without much conscious awareness, and the intention is not to harm the body but to soothe oneself or reduce anxiety. Interestingly, there is believed to be a genetic component for BFRBs, as they often run in families. Though they are found in both genders, it is reported that around 90 percent of people presenting with BFRBs are assigned female at birth.
BFRBs are complicated, and the lack of public discussion around these disorders often leave people feeling hopeless and embarrassed. They can significantly impact an individual’s self-esteem, especially when they result in noticeable hair loss or scarring of the skin. Because they are rarely discussed openly, many people feel the need to keep the disorder a secret, which only results in more anxiety and shame. I can personally remember being afraid to disclose my behaviors to a therapist because I had never even heard a mental health provider discuss BFRBs openly.
BFRBs are also complicated because there is no definitive treatment, and research has been minimal until recent years. Therapy, behavior replacement and certain medications have shown mild success, but there is no effective cure-all yet. Many people with BFRBs use fidget toys to keep their hands occupied, or wear gloves, bandaids on the fingers and hats to prevent the ability to pick or pull.
It is unfortunate how little BFRBs are discussed in our society, and how poorly they are understood. Phrases like “I’m so stressed I could rip my hair out” are commonplace, and completely invalidate the fact that people actually experience such behaviors. The longer we collectively disregard this class of disorders, the more embarrassment and shame they are going to cause for ourselves and future generations. If you are struggling with a BFRB, know that you are not alone. There are many others who are experiencing the same thing, but might not feel comfortable talking about it yet. There are also many strategies you can use to help reduce your behavior. Some of the strategies I have found to be most helpful include using fidget toys, getting rid of tweezers that can be used to pull eyebrows or eyelashes, crafts like crocheting and needlepointing and asking someone I trust to help hold me accountable when I engage in a behavior without awareness.
If you have not experienced a BFRB, I thank you for taking the time to read this article. Education is the first step towards opening the conversation for others. Writing this article was terrifying for me because it means others will know that I have BFRBs, but I only hope I can inspire others with my openness. As a community, one thing we should be aware of is how we talk about others’ appearances. Be conscious of how you are talking about someone’s hair, skin, makeup, wigs or nails because you never know if someone is hiding noticeable marks from a BFRB. And if someone comes to you and tells you that they are experiencing a BFRB, listen with compassion. It is not an easy thing to experience, but having support can make all the difference in the world.
Guest columnist Maddy McCue CM ’23 is studying psychology. She is passionate about increasing education surrounding mental health.