By Laura Hope Hobson, PA-C
Our internal state and external environment are in constant flux, so we all need tools that help us regulate ourselves in this world to maintain overall balance. Enter: BFRBs.
If you've never heard of the term, BFRB is short for body focused repetitive behavior, which includes behaviors/conditions such as hair pulling (trichotillomania), skin picking (dermatillomania/excoriation disorder), nail biting (onychophagia), and more. If you have a BFRB, you are not alone - they’re about as common as having red hair.
Many people who struggle with these behaviors do so with a lot of shame and secrecy, and they can become debilitating for some. For those who struggle with BFRBs, their automatic response may be to view it as a terrible, life-destroying condition that should not exist in the first place, but I'm going to present a radically different interpretation here: BFRBs are an incredible brain hack.
Wait, hear me out! You know how uncomfortable it can be to feel super stressed or totally bored, right? These are just signals of dysregulation, such as experiencing really intense emotions or being under- or over-stimulated.
We can get overstimulated by the dog barking or having too much on our to-do list, or we can be understimulated when we feel bored or are expected to sit still for a movie or a lecture. Or we can be both simultaneously - such as after a long day when we're frozen on the couch (physically understimulating) while scrolling through social media (mentally overstimulating). BFRBs serve as a bi-directional regulation tool, meaning they can help decrease stimulation when we're feeling overstimulated and they can increase stimulation when we're feeling understimulated. So regardless of which direction things are out of balance, BFRBs can act as a one-tool-fits all short-term solution for the distress… even if the long-term outcome is really frustrating.
Let's pause for a moment to consider how few bi-directional regulation tools are out there. Breathing exercises can help up-regulate or down-regulate, but you generally have to choose one or the other - slow breathing to down-regulate or short quick breathing to up-regulate. Same with physical activity - gentle stretching will be better at calming or soothing, and cardio will be better at helping you feel energized. Medication tends to work in one direction or another - they increase activity or decrease activity of specific chemicals in the brain. With hair pulling or skin picking, you don't have to decide which direction you need to adjust towards (which is perfect when you're feeling dysregulated).
BFRBs are also a tool that is readily available - your hair, skin, and nails are always with you. They can't be left behind like your keys, medication, or favorite fidget (much to the chagrin of pullers and pickers).
Furthermore, urges to pick or pull can be thought of as a built-in barometer that lets you know when you're feeling out of balance. If you're not paying attention to how you're feeling (and let's be real - many of us don't really take time to check in with how we're doing), these urges or behaviors can signal that you would benefit from some extra love and care.
So there's nothing inherently "bad" about hair pulling, skin picking, or other BFRBs. Our distress comes not from the behavior itself (most people actually describe it as very soothing), but the consequences (such as bald spots, painful sores) and our interpretation of the behavior, or what we think it says about us. We connect hair pulling or skin picking with embarrassment, judgment, ridicule, shame, and isolation, and that's what feels bad.
If you don’t believe me, consider this - if every time you pulled a hair one more immediately grew back in its place, or every time you picked your skin the spot was immediately covered back up with healthy skin, and there were no negative consequences (meaning no piles of hair, bald spots, sores, infections, etc.) would you still be bothered by your BFRB? Most people say no, their BFRB wouldn’t bother them at all and they would probably pick or pull even more if this were the case! That means it’s the consequences of the BFRB, not the BFRB itself, that you dislike so intensely.
To be clear, I'm not saying that these behaviors don't cause some serious damage, frustration, or impairment; they definitely do. I'm suggesting that we set aside the judgment and shame for a moment so that we can see BFRBs for what they really are: just a neutral signal that we're feeling dysregulated and an accessible tool to help steer us back into balance.
I'm also not saying that you should just deal with it or give up on wanting to change it. (Although if you want to just deal with it, that's cool, too.) I'm actually a huge advocate of finding regulation tools that you can feel good about that don’t have negative consequences, such as breathing exercises, yoga, going for a walk, listening to music, ect.
If you want to manage your BFRB, the keys to successful change are awareness, balance, and self-compassion.
First, increasing awareness helps you learn more about the behavior. Once you understand where, when, and why you engage in your BFRB, you’re in a better position to make meaningful changes.
Next, balancing your life involves making changes to decrease the stressors that are contributing to the dysregulation (which then causes BFRB urges) and/or increasing use of other coping strategies to improve regulation, like those above.
Finally (and this part can’t be skipped!!), practice self-compassion. You didn’t choose your BFRB, it chose you. You are not crazy, weird, or broken. You’re just a person with a BFRB who needs soothing when things get stressful, and there’s no shame in that.
These steps may sound simple, but they’re not necessarily easy and they certainly aren’t a quick-fix. It involves asking yourself difficult questions, using trial and error to figure out what alternative strategies are a good fit for you, and shifting your self-talk when you hear that critical voice in your head. And we're creatures of habit, so you'll also need lots and lots of practice getting comfortable with your newly chosen strategies. The good news is that you are more capable than you think, and you only need to take it one small step at a time.
So do your future self a huge favor - be kind to yourself when you notice your hand reaching or scanning for this totally effective regulation tool, and start to consider how you want to be regulating instead.
About the author
Laura Hope is a Behavior Transformation Coach who helps people break free from unwanted habits and reclaim their confidence. At Hope and Healing Coach, she combines her years of clinical experience with deep empathy to guide clients toward lasting change, specializing in body-focused repetitive behaviors (BFRBs) and other frustrating behaviors. When she's not empowering clients to embrace radical self-acceptance, you'll find her advocating for BFRB awareness, tending to her ever-growing plant collection, or spending time with her two sons and husband. Learn more or contact her at hopeandhealingcoach.com.
