Focusing in on Body Focused Repetitive Behaviors

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Biting your nails, picking at your skin and other repetitive behaviors may seem like just bad habits, and sometimes they are, but for many people they are actually a class of chronic disorders called BFRB’s, or Body Focused Repetitive Behaviors. BFRBs most often begin in late childhood or adolescence. They are among the most poorly understood, misdiagnosed, and under treated groups of disorders. These OCD-related disorders affect more than 1 in 30 people and some of them, such as nail biting, affect up to 60% of student populations.

BFRBs can be embarrassing to talk about, but there are many effective ways to reduce and even eliminate these time consuming, guilt-inducing disorders from our lives.

Some BFRB’s include:

Dermatillomania/ Excoriation Disorder: Compulsive Skin Picking

Dermatophagia: Skin biting disorder. Most sufferers with Dermatophagia bite the skin around their fingers compulsively. This disorder also includes those who compulsively bite their cheeks or their lips.

Onychophagia: Compulsive nail biting.

Onychotillomania: The compulsive need to tear off one’s nails.

Scab Eating Disorder: A smaller percentage of those who pick their skin finish their picking ritual by eating the piece of skin that is removed from the body.

Trichophagia: Hair eating disorder.

Trichotemnomania: Compulsively shaving or cutting one’s own hair.

Trichotillomania: Pulling out one’s own hair, eyebrows, eyelashes or facial hair.

Rhinotillexomania: Compulsive nose picking, to the point there skin is damaged and infections can start.

 

While similar in their effects on a person, other types of behaviors fall under the Obsessive-Compulsive Spectrum because they involve more than just the body. These include:

  • Compulsive tanning
  • Obsession with or Addiction to plastic surgery
  • Excessive tattooing or body piercing
  • Weight Modification (turning into a disorder, such as Anorexia, Bulimia, or Muscle Dysphoria)
  • Compulsive exercising
  • Compulsive hand- washing and/ or showering
  • Cutting/ Burning

Many academics and psychiatrists have spoken out against including nail biting and other behaviors in the OCD spectrum because it ignores the difference between symptom and structure, between neurosis and psychosis. In neurosis, a behavior can be used to ward off and distract from anxiety, fear, anger or affection. In psychosis, a repetitive behavior may take up a lot of time and energy, but can actually help prevent a person from doing greater harm to themselves or keep deeper, acute beliefs and fears at bay. In neurosis there is no personality change or break from reality.

Also important to note, just because you bite your nails or have other BFRBs doesn’t mean you have OCD, it may simply be a bad habit you learned over time. You can learn about the difference between a bad habit, compulsion and addiction here.

It can be extremely difficult to stop BFRB and OCD behaviors completely, especially after years or even decades of doing them. But more and more research is being done to shed light on these disorders and there are many ways to significantly reduce their occurrence.

Keep your hands or mouth busy

One of the most effective ways to help reduce BFRB’s is to stop the cycle before it starts. By occupying your hands and/or mouth you won’t be able to pick or bite. You’ll also become aware of the moments when the urge strikes, and over time you can build up your will to resist.

A variety of fidget toys are available, from Infinity Cubes to Magnetic Balls. You can even get a variety pack and see what works best for you.

I always keep a couple of these on my desk and even set one on my keyboard at the end of the day along with my gloves so that I’m sure to see it first thing in the morning. In order to make sure you always have something with you, try wearing one around your wrist.

Finger gloves and full gloves can be extremely helpful. Try keeping a pair in all the places you tend you pick, such as your desk, car, bed and bathroom. Gloves with touchscreen capability ensure you won’t take them on and off all the time.

Nail biters can try flavored products and polishes to deter them.

Other objects that can keep your hands busy include these gummy erasers and jewelry with moveable parts or sliding beads. Chewing gum or suckers can help with oral fixations. I even find that having a pet on my lap (real or stuffed) to pet and calm my anxiety helps.

Calm Your Mind

Stress and anxiety aren’t the only causes of BFRBs, but calming your mind can significantly decrease them.

If you catch yourself starting to get an urge, try doing a three minute meditation or breathing break. This can be as simple as closing your eyes and focusing on your breathing, repeating a mantra or affirmations to yourself. There are also many apps and resources for meditation, such as the Calm breathing and meditation app and Headspace.

Sometimes having a fun device to play with can make meditation more appealing. The Muse neurofeedback device senses your brainwaves and helps guide you towards a peaceful mental state.

Besides working on your breathing and meditating, getting plenty of sleep does wonders for your mind. Avoid watching tv in bed or looking at your phone, and be sure to create a dark, quiet space for optimal rest. And the age old advice still applies, get regular exercise and spend time in nature!

 

Reduce Inflammation

Eating an anti-inflammatory diet that doesn’t trigger your body to experience highs or lows can help you make huge strides in your progress to stop BFRBs.

Try reducing your caffeine intake over a number of days. My favorite coffee solution that I’ve written about before is Four Sigmatic Mushroom Coffee and other drinks from Four Sigmatic. They taste good and still give you that coffee feeling while keeping you focused and calm.

Other foods which might aggravate BFRBs are alcohol, gluten and dairy. A two week or 30 day elimination can help you figure out how various foods affect you, and herbs or supplements such as turmeric can help keep your body from inflammation. Try eating anti-inflammatory and see how you feel!

 

 

Set Yourself Up for Success

Do you have a particular mirror which triggers your BFRBs, or a certain time of day when the urges are strongest? Start by keeping a daily log of all the times you do the behavior, how long it lasts, how strong the urge is, what you were doing right before and what you were thinking about and feeling throughout that time. After a week or so you’ll have a good idea of your patterns, and then you can set up your home and schedule to help reduce the behavior.

Cover up mirrors or take them down, keep gloves and fidget toys where you need them. Set alarms on your phone to pull you out of the cycle or that remind you to call someone or stop and meditate.

Write post it notes with reminders and motivations and stick them in places you’ll see them when you have an urge.

 

Get Help

Unfortunately, friends and family often assume that these behaviors are merely bad habits which should be able to be stopped with pure willpower. Calling attention to them or scolding young people who engage in BFRB’s only makes them feel more ashamed and can aggravate the problem. The truth is, nobody wants to have unsightly scars all over their body, bleeding fingernails or bald spots, and they certainly don’t want to spend hours of each week lost in repetitive cycles of self harm. The physical embarrassment resulting from BFRB’s can cause people to stay home from work or social engagements, to spend excess time styling their hair or makeup and to avoid showing skin, even around spouses.

If you search for your particular BFRB, you’ll find online and local therapists, support groups and books to help you.

For skin picking, The Freedom Companion and Skin Picking: The Freedom to Finally Stop are essential books to help you change your behavior.

An in depth book for an overview of BFRBs is Trichotillomania, Skin Picking, and Other Body-Focused Repetitive Behaviors

The treatment for BFRBs may include a combination of psychotropic medications and cognitive behavioral therapy (CBT). CBT often involves Habit Reversal Training and Exposure and Response Prevention (aka Exposure and Ritual Prevention).

Stay Grateful

Never underestimate the power of gratitude. Being grateful for the progress you’ve made, your loved ones and experiences helps you stay optimistic towards your goals, makes you more likely to try new things, improves self esteem and increases mental strength.

Once or twice a day, write down what you’re grateful for. Taking a few minutes to stop and take note of the good things in your life can work wonders.

 

 

 

 

 

 

 

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