What Is Body-Focused Repetitive Behavior (BFRB)? Symptoms, Causes, and Treatment Options
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What is body-focused repetitive behavior (BFRB)?
Body-focused repetitive behaviors (BFRBs) are conditions that cause repeated self-grooming actions, such as picking or pulling hair, nails or skin, or biting the lips or cheeks, that damage the body. They often involve anxiety beforehand and relief afterward. Treatment includes CBT with habit-reversal training, antidepressants and NAC. [1] See a provider if they cause distress or signs of infection.
Key takeaways
Body-focused repetitive behavior (BFRB) disorders are conditions that cause you to perform self-grooming actions that unintentionally harm your body, including skin picking, hair pulling, and nail biting. They are driven by an intense, uncontrollable urge and are difficult to stop on your own, even when you want to. [1]
The two most common types — excoriation (skin picking) and trichotillomania (hair pulling) — are formally recognized in the DSM-5-TR, while other types such as nail biting, lip and cheek biting, teeth grinding, and knuckle cracking are also treated as BFRB disorders. [1]
Research suggests brain structure, genetics, and emotional regulation contribute to these behaviors. They are not caused by vanity or appearance concerns. [1]
Treatment usually combines therapy and medication: cognitive behavioral therapy (CBT) with habit-reversal training teaches you to recognize triggers and respond differently, while SSRIs, antidepressants, or the supplement NAC may help manage symptoms. Improving takes time and practice — behaviors do not stop overnight. [1]
What the research says
Habit reversal and N-acetylcysteine have the strongest trial support for hair pulling. A review and meta-analysis of 29 randomized trials (30 in the network analysis) found strong support for habit-reversal behavioral therapy, Acceptance and Commitment Therapy–enhanced habit reversal, and N-acetylcysteine for trichotillomania, and treatments built on habit reversal generally did better than those without it. These trials studied hair pulling specifically, not every BFRB (Fisak et al., J Psychiatr Res, 2026). [7]
Mild BFRBs are very common, and about one in four people has a more severe form. In a demographically diverse online sample of 1,481 adults, 97.1% reported at least one BFRB in their lifetime and 24% met criteria for a body-focused repetitive disorder; nail biting (11.4%), skin biting (8.7%), skin picking (8.2%), and lip-cheek biting (7.9%) were the most frequent. Rates were higher in women than in men and low after age 40. Because this was a self-reported online survey, its rates are higher than the clinical-diagnosis figures cited below (Moritz et al., Psychol Med, 2024). [8]
Only 13.5% of people with BFRBs in one large survey had sought professional help. Among 971 participants, those who eventually did seek help had gone untreated for about 11 years on average, and around 40% of those who received professional care were given no evidence-based advice (Moritz et al., Compr Psychiatry, 2026). [9]
What Is Body-Focused Repetitive Behavior (BFRB)?
Body-focused repetitive behavior disorders, also known as BFRBs, are a group of conditions that cause you to perform self-grooming actions that unintentionally harm your body. [1]
Many people recognize BFRBs as nervous habits, like picking the skin around your nails or cracking your knuckles when you're bored. But these behaviors are more than just something to do to pass the time. Research suggests your genetics, brain structure, and emotions play a role in why these behaviors happen. [1]
You may try to reduce how often you perform these behaviors but find it difficult to stop them. BFRBs come on with an intense, uncontrollable urge and may bring feelings of pleasure or satisfaction when you do them. Treatment options are available to help you if you need it. [1]
Types of BFRB Disorders
There are different types of body-focused repetitive behavior disorders based on the actions you perform. [1]
The two most common types of body-focused repetitive behavior disorders include excoriation or dermatillomania (skin picking) and trichotillomania (hair pulling). The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) identifies these two types in its current edition. [1]
There are other types of BFRBs as well, including bruxism (teeth grinding), crepitus (finger joint cracking), dermatophagia (skin biting), finger sucking, lip bite keratosis (lip biting), morsicatio buccarum (cheek biting), onychophagia (nail biting), onychotillomania (nail picking), rhinotillexomania (nose picking), and trichophagia (hair eating). [1]
While these other types aren't specified in the DSM-5-TR, a healthcare provider can still diagnose them as a related BFRB disorder. [1]
BFRB type | Common name | What you do |
Excoriation / dermatillomania | Skin picking | Picking at the skin on fingers, face, or other areas |
Trichotillomania | Hair pulling | Pulling out hair from the scalp, eyebrows, or elsewhere [3] |
Onychophagia | Nail biting | Biting or chewing fingernails |
Onychotillomania | Nail picking | Picking at the nails or cuticles |
Dermatophagia | Skin biting | Biting or chewing the skin |
Lip bite keratosis | Lip biting | Repeatedly biting the lips |
Morsicatio buccarum | Cheek biting | Biting or chewing the inside of the cheeks |
Bruxism | Teeth grinding | Grinding or clenching the teeth |
Crepitus | Knuckle cracking | Repeatedly cracking finger joints |
Trichophagia | Hair eating | Eating pulled hair |
How Common Are BFRB Disorders?
Several studies found that between 0.5% and 4.4% of people have a clinical BFRB diagnosis. However, the rate of occurrence is actually much higher because many people don't reach out to a healthcare provider for help with these conditions. [1]
What Does BFRB Feel Like? Symptoms and Signs
Common body-focused repetitive behaviors include picking or pulling your hair, nails, or skin; biting or chewing your nails, lips, or cheeks; cracking your finger joints or knuckles; and grinding your teeth. [1]
Beyond the physical actions themselves, you may notice a consistent emotional pattern around the behavior:
The unpredictable nature of BFRBs is one of the reasons they feel so frustrating. It's difficult to know when the urge to perform a behavior will happen, because sometimes you aren't aware that you're doing it unless someone points it out. [1]
What Causes Body-Focused Repetitive Behaviors?
Healthcare providers aren't sure why BFRB disorders happen. Research suggests the following may contribute: [1]
Brain structure and genetics. The structure of parts of your brain involved in reward processing and emotion may cause BFRBs. Your genetic makeup determines how these parts of your brain develop and function. Genetics may also affect the chemical regulation within your brain of serotonin and dopamine (mood and impulse control). [1]
Emotional regulation. These behaviors may be your body's way of handling or avoiding negative emotions like discomfort, embarrassment, boredom, and unhappiness. [1]
Distraction. BFRBs may be a distraction technique used when you feel understimulated or overstimulated. These behaviors may help you through a stressful or uncomfortable situation by taking your mind off what's going on around you. [1]
While there are some mental health conditions where factors like vanity or a desire to change your appearance drive your behavior, these don't cause BFRBs. [1]
Risk Factors
You may be more at risk of BFRBs if you:
Complications of BFRB Disorders
Repeatedly biting, picking, or pulling at different parts of your body can lead to bacterial infections, bleeding from open wounds, hair loss, and scarring. [1]
Complication | How it develops |
Bacterial infections | Open skin or wounds from picking and biting allow bacteria in |
Bleeding | Repeated damage creates open wounds |
Hair loss | Pulling hair out over time thins or removes hair |
Scarring | Healing damaged skin and tissue leaves scars |
You may also experience a range of emotions that affect your mood, self-esteem, and confidence due to how these self-modifying behaviors unintentionally change your appearance. A mental health professional can help you manage these. [1]
How Are BFRB Disorders Diagnosed?
A primary care physician, dermatologist, or dentist may be the first to recognize the signs of BFRBs. A provider may ask you about your symptoms and how you feel. They may then refer you to see a mental health provider, such as a psychologist or psychiatrist. [1]
A mental health provider will offer an evaluation to see if your symptoms match the following criteria to make a BFRB diagnosis:
Diagnostic criterion | What it means |
1. Damaging repetitive behavior | You perform a repetitive behavior on your body that causes damage [1] |
2. Difficulty stopping | You try to stop (or lessen) this behavior but can't [1] |
3. Distress or impairment | This behavior causes you stress or affects how you're able to function [1] |
How Is BFRB Treated?
BFRB treatment may include one or a combination of the following:
Therapy. A mental health professional will teach you habit-reversal training techniques during cognitive behavioral therapy (CBT). You'll gain more awareness about what could trigger these behaviors and find alternative ways to respond to them. [1]
Medications. There isn't a medication approved by the U.S. Food and Drug Administration (FDA) for BFRB disorders. [4] However, medications are available to help you manage symptoms. A provider may recommend taking selective serotonin reuptake inhibitors (SSRIs) or antidepressants. The supplement NAC (N-acetylcysteine) may be helpful as well. [1]
Treatment approach | What it involves | Goal |
Cognitive behavioral therapy (CBT) | Work with a mental health professional to understand thoughts and patterns | Build lasting coping skills |
Habit-reversal training | Learn to recognize triggers and replace the behavior with a safer alternative | Reduce frequency and intensity of the behavior |
SSRIs and antidepressants | Prescription medications to help manage symptoms [1] | Support mood and impulse control |
NAC (N-acetylcysteine) | An over-the-counter supplement that may be helpful | Support symptom management alongside other treatments |
It's important to stick to your treatment plan even if you're feeling better. You should continue to take the medications prescribed to you as directed unless your provider approves any changes made to your routine. [1]
Outlook: What Can You Expect?
BFRBs look and feel different for each person. You may feel anxious, comforted, or distressed. [1] Over time, these behaviors may damage your body or lead to complications like scars or infections.
Treatment options, usually a combination of therapy and medications, help manage BFRB symptoms. It takes time and practice to get there — you won't stop these behaviors overnight. [1] If you have any questions about what you can expect from your treatment plan, talk to your provider.
When to See a Healthcare Provider
Visit a healthcare provider if you have body-focused repetitive behaviors that you want to stop but have trouble managing on your own. This may include skin picking, teeth grinding, or hair pulling, among others. [1]
Let a healthcare provider know if you have symptoms of an infection like pain, swelling, or pus leaking from a wound. [1]
Questions you can ask your healthcare provider include: How do I stop BFRBs? Should I talk to a mental health professional? Do you recommend I take medications? Are there side effects to taking medications?
No one wants to feel out of control of their own actions. It doesn't matter how much you want to stop — nothing seems to work. This is the reality of having a body-focused repetitive behavior (BFRB) disorder. Fortunately, you don't have to continue these behaviors. A healthcare provider can help you find a solution, and many people find success in managing these symptoms with the right combination of treatment.
Conclusion
Body-focused repetitive behavior disorders — from skin picking and hair pulling to nail biting and teeth grinding — are far more than nervous habits. They are conditions driven by intense urges that are difficult to control, shaped by brain structure, genetics, and emotions. The good news is that treatment works: cognitive behavioral therapy with habit-reversal training, medications like SSRIs, and supplements such as NAC can all help you regain control. If these behaviors are causing you stress, damaging your body, or affecting your confidence, a healthcare provider can help you find a solution.
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Frequently Asked Questions
What is a body-focused repetitive behavior disorder?
A body-focused repetitive behavior (BFRB) disorder is a condition that causes you to perform self-grooming actions — such as skin picking, hair pulling, or nail biting — that unintentionally harm your body. The behaviors come on with an intense, uncontrollable urge and are difficult to stop. [1]
Is BFRB the same as a nervous habit?
No. While BFRBs are often recognized as nervous habits like picking the skin around your nails, research suggests genetics, brain structure, and emotions play a role in why these behaviors happen. They are more than something to do to pass the time. [1]
What are the two most common BFRB disorders?
The two most common types are excoriation (dermatillomania, or skin picking) and trichotillomania (hair pulling). Both are formally identified in the DSM-5-TR. [1]
Is nail biting a BFRB?
Yes. Onychophagia (nail biting) is a recognized type of BFRB, along with nail picking, skin biting, lip biting, and cheek biting. These types aren't specified in the DSM-5-TR but can still be diagnosed as related BFRB disorders. [1]
How common are BFRB disorders?
Studies found that between 0.5% and 4.4% of people have a clinical BFRB diagnosis. The actual rate is likely much higher because many people don't seek help. [1]
Why can't I stop picking my skin even when I want to?
BFRBs come on with an intense, uncontrollable urge and may bring feelings of pleasure or satisfaction. You may try to reduce how often you perform the behavior but find it difficult to stop. Treatment options are available to help. [1]
What causes BFRB disorders?
Providers aren't sure why BFRBs happen, but research suggests brain structure, genetics, and emotional regulation contribute. Your brain's reward and emotion-processing regions, serotonin and dopamine regulation, and negative emotions like boredom or unhappiness may all play a role. [1]
Are BFRBs caused by vanity or caring too much about appearance?
No. While some mental health conditions involve vanity or a desire to change your appearance, these factors don't cause BFRBs. [1]
Who is at higher risk of BFRBs?
You may be more at risk if you are female, have experienced abuse or trauma, have a biological family history of BFRBs, have low self-esteem, or have obsessive-compulsive disorder or a substance use disorder. [1]
Can BFRBs cause physical harm?
Yes. Repeatedly biting, picking, or pulling can lead to bacterial infections, bleeding from open wounds, hair loss, and scarring. These behaviors can also affect your mood, self-esteem, and confidence. [1]
How is BFRB diagnosed?
A primary care physician, dermatologist, or dentist may first recognize the signs and refer you to a mental health provider. Diagnosis is based on three criteria: a repetitive behavior that damages your body, an inability to stop it, and distress or impaired functioning caused by it. [1]
Can BFRB be treated?
Yes. Treatment usually combines therapy and medication. Cognitive behavioral therapy (CBT) with habit-reversal training teaches you to recognize triggers and find alternative responses. Medications such as SSRIs or antidepressants may help manage symptoms, and the supplement NAC may be helpful too. [1]
Is there an FDA-approved medication for BFRB?
No. There isn't a medication approved by the FDA for BFRB disorders, but medications are available to help manage symptoms. [1]
What is NAC and how does it help BFRB?
NAC (N-acetylcysteine) is a supplement that may be helpful in managing BFRB symptoms such as hair pulling, skin picking, and nail biting. Talk with your provider before starting any supplement.
Will my BFRB go away overnight with treatment?
No. Treatment usually takes time and practice — you won't stop these behaviors overnight. Consistency with your treatment plan, even after feeling better, is important. [1]
When should I see a doctor about BFRB?
See a healthcare provider if you have body-focused repetitive behaviors you want to stop but can't manage on your own, or if you have signs of infection such as pain, swelling, or pus leaking from a wound. [1]
Related Reading
Habit Reversal Training: Steps, Uses and How It Works explains habit reversal training.
Trichotillomania: Why People Can't Stop Pulling Their Hair, and What Treatment Can — and Can't — Do
Obsessive-Compulsive Disorder (OCD): Symptoms, Causes & Treatment Guide
Impulse Control Disorders: Understanding the Struggle with Self-Regulation
Anxiety Disorders: Symptoms, Types, Causes, Treatment & Complete Guide
What Is a Bacterial Infection? Symptoms, Causes, and Treatment
References
Cleveland Clinic. Body-Focused Repetitive Behavior (BFRB) Disorders. Cleveland Clinic. Last updated September 23, 2024. https://my.clevelandclinic.org/health/diseases/body-focused-repetitive-behavior-bfrb
Anxiety & Depression Association of America. Body-Focused Repetitive Behaviors (BFRBs). ADAA. Updated October 16, 2026. https://adaa.org/understanding-anxiety/co-occurring-disorders/body-focused-repetitive-behaviors
Grant JE, Stein DJ. Body-focused repetitive behavior disorders in ICD-11. Braz J Psychiatry. 2014;36(Suppl 1):59-64. PMID 25388613. https://doi.org/10.1590/1516-4446-2013-1228
Greenberg EL, Geller DA. Cautious Optimism for a New Treatment Option for Body-Focused Repetitive Behavior Disorders. Am J Psychiatry. 2023;180(5):325-327. PMID 37122275. https://doi.org/10.1176/appi.ajp.20230226
Okumuş HG, Akdemir D. Body Focused Repetitive Behavior Disorders: Behavioral Models and Neurobiological Mechanisms. Turk Psikiyatri Derg. 2023;34(1):50-59. PMID 36970962. https://doi.org/10.5080/u26213
The TLC Foundation for BFRBs. N-acetylcysteine for Hair Pulling, Skin Picking, and Nail Biting. The TLC Foundation. Published March 7, 2024; updated June 12, 2025. https://www.bfrb.org/post/n-acetylcysteine-for-hair-pulling-skin-picking-and-nail-biting
Fisak B, Shorb C, Patel D, et al. The efficacy of psychotherapeutic and pharmacological interventions for trichotillomania: a review and meta-analysis. J Psychiatr Res. 2026;197:264-274. PMID 41812482. https://doi.org/10.1016/j.jpsychires.2026.02.029
Moritz S, Scheunemann J, Jelinek L, et al. Prevalence of body-focused repetitive behaviors in a diverse population sample — rates across age, gender, race and education. Psychol Med. 2024;54(8):1552-1558. PMID 38087951. https://doi.org/10.1017/S0033291723003392
Moritz S, Borgmann L, Rojahn KM, et al. The silent struggle: barriers, delays, and missed opportunities in the treatment of body-focused repetitive behaviors. Compr Psychiatry. 2026;149:152733. PMID 42447654. https://doi.org/10.1016/j.comppsych.2026.152733
Medical disclaimer
This article is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.
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