CBT for Body-Focused Repetitive Behavioral Disorders

What are body-focused repetitive behaviors (BFRBs)?

 

Body-Focused Repetitive Behaviors (BFRBs) are disorders of the brain and behavior that involve recurrent pulling, picking, biting, or touching of the body.

Common BFRBs include:

  • Hair pulling (trichotillomania)

  • Skin picking (excoriation disorder)

  • Chronic nail biting

BFRBs are related to obsessive-compulsive spectrum conditions, but they are distinct from OCD. If you are unsure whether your symptoms fall closer to obsessive-compulsive disorder, you can learn more on our CBT for OCD page.

People with BFRBs experience powerful urges to engage in these behaviors. The behavior often produces immediate relief, pleasure, or sensory satisfaction. That immediate reinforcement makes the cycle especially strong.

Over time, individuals may feel embarrassment, frustration, or shame. Some experience noticeable hair loss, skin damage, or physical consequences. Many attempt repeatedly to stop — only to find the urges return.

BFRBs are not simply “bad habits.” They are reinforced behavioral patterns that require structured intervention to change

BFRBs tend to follow a predictable cycle.

An urge, sensation, emotional state, or environmental trigger arises. The behavior provides temporary relief or gratification. That relief reinforces the behavior, increasing the likelihood it will occur again.

Common triggers include:

  • Stress or anxiety

  • Boredom or inactivity

  • Fatigue

  • Specific settings (e.g., driving, watching television, studying)

  • Physical sensations such as tension or itchiness

Because the behavior is rewarding in the short term, willpower alone is rarely effective.

From an Acceptance and Commitment Therapy (ACT) perspective, urges are internal experiences that can be learned to be observed and tolerated without immediate action. We integrate ACT across anxiety, OCD-spectrum conditions, and related concerns.

Evidence-based treatment: CBT for BFRBs

Cognitive Behavioral Therapy (CBT) is the gold-standard, evidence-based treatment for trichotillomania, excoriation disorder, and other BFRBs.

CBT for BFRBs is structured, active, and individualized. Treatment focuses on identifying the specific triggers, sensations, thoughts, and emotional patterns that maintain your unique cycle.

CBT may include:

  • Increasing awareness of early urges and automatic movements

  • Identifying high-risk situations

  • Developing competing responses and replacement behaviors

  • Modifying environmental triggers

  • Building tolerance for urges without acting on them

  • Strengthening emotional regulation skills

If BFRBs occur alongside broader anxiety and or OCD symptoms, we may integrate elements of evidence-based anxiety treatment to ensure comprehensive care.

This is a highly personalized process. Together, we design strategies tailored to your pattern.

What are realistic goals for therapy?

The goal of treatment is not perfection or eliminating every urge. The goal is to reduce frequency and intensity, increase awareness and choice, and help you respond differently to urges when they arise. With structured intervention and consistent practice, many individuals regain a sense of control and experience meaningful improvement.

Our licensed clinical psychologists and therapists provide BFRB treatment in Atlanta and Richmond and via telehealth throughout 42+ states.