Picking Brains: Body Focused Repetitive Behaviours and Emotion Regulation
Upon reading the title, many of you are probably wondering, “What are body focused repetitive behaviours?” However, you encounter them on a daily basis. If you or someone you know performs activities such as nail biting, pulling or fidgeting with hair, or skin picking, then you are already familiar with body focused repetitive behaviours (BFRBs). The formal definition of BFRBs is a group of “recurrent, problematic, destructive behaviours directed towards the body” (Roberts, O’Connor, & Bélanger, 2013). It may be hard for individuals who do not engage in this behaviour to understand why anyone would do it- in fact, it’s even difficult for researchers to understand BFRBs. However, the emotion regulation model provides a promising explanation, which is discussed later in this article.
The three most common BFRB’s are hair pulling (also called trichotillomania), skin picking, and nail biting (Roberts et al., 2013). These behaviours may begin as grooming routines where one removes perceived blemishes such as split ends, skin irregularities, or hangnails (Roberts et al., 2013). Eventually, people may come to rely upon them for alleviation of negative emotions. People engage in these behaviours particularly when they are bored, frustrated, anxious, or depressed (Roberts et al., 2013). In some cases, it may reach a point where individuals spend up to eight hours a day engaging in BFRBs (Roberts et al., 2013). People can experience bald spots, sores, and even infections (Roberts et al., 2013). There is a great deal of shame associated with BFRBs, especially with regard to physical appearance, which may prevent sufferers from seeking treatment (Roberts et al., 2013).
The emotion regulation model proposes that people with BFRBs have difficulty controlling certain emotions such as frustration and anxiety and engage in this behaviour to relieve them. The inability to control these emotions may stem from the fact that people who experience BFRBs experience high levels of comorbid psychiatric disorders and tend to impose unrealistic expectations on themselves (Roberts et al., 2013). The failure to meet these standards can create negative emotions that are relieved through hair pulling, skin picking, or nail biting. The comfort that comes from the BFRB reinforces the behaviour itself (Roberts et al., 2013). Eventually, people may come to engage in automatic BFRBs where they do not even realize that they are doing it, creating further negative emotions such as shame about the behaviour and its physical consequences. This quickly becomes a self-perpetuating cycle (Roberts et al., 2013).
As of now, there are limited treatment options for BFRBs, with mixed results coming from the use of psychotropic medications and therapy. However, they are becoming increasingly recognized as legitimate mental health issues. With further research and public awareness, relief may come for those who have experienced shame, confusion, or distress stemming from body focused repetitive behaviours.
References
Roberts, S., O’Connor, K., & Bélanger, C. (2013). Emotion regulation and other psychological models for body-focused repetitive behaviors. Clinical Psychology Review. 33(6), 745–762. https://doi.org/10.1016/j.cpr.2013.05.004
