Hello my Zebras and Spoonies! Thanks for coming and hanging out with me today. I’m glad that you are here. Today I am going to be talking about my experiences with Body Focused Repetitive Behaviors or BFRB as another installment in the “My Diagnosis” Series. This post comes with a warning: there are some photos included that show injuries from BFRB. Please, don’t proceed with the post if this kind of photo will trigger you.
There has been a lot debate in the psychology community as to where these disorders should be classified and that debate is still ongoing. That being said, they are currently classified as “obsessive-compulsive and related disorders” in the DSM-5. Because of that, they are generally considered to be related to OCD. That being said, they are common co-morbidities for both ADHD and autism. I personally, lump them in with my OCD because they feel very similar to my OCD symptoms. But this is definitely one of the areas of grey.
BFRB are behaviors that are focused on the body and are repetitive. This is one of the few mental health diagnosis names that actually nails it. For some the cycle starts with a thought; an obsession. The person considers something about their body to be amiss in some way and then they feel the compulsion to fix it. There is a blemish on the face that must be removed and then the compulsion to squeeze and pick at the zit. For others, there is only the compulsion. It can be a thoughtless movement that provides comfort. Pulling out a hair and then another, producing a sense of calm.
The three most common types of BFRB are trichotillomania (compulsive hair pulling), dermatillomania (compulsive skin picking, also called excoriation disorder), and onychophagia (compulsive nail biting). However, there are many others and most are not specifically listed in the DSM-5. Any behavior set that unintentionally causes physical damage to one’s body and affects appearance is classified as BFRB. Research suggests that one in twenty people experience some form of BFRB. Yet most of the time, these behaviors are socially dismissed as just bad habits. There is often a debate as to when a behavior transforms from a bad habit into a BFRB. Clinically, the answer is when it starts causing bodily harm.
Personally, I have struggled with trichotillomania, dermatillomania, and onychophagia for as long as I can recall. The worst of the three for me has been the onychophagia. I would bite my nails until they bled. The nail biting would frequently cause infections. My fingers were in constant pain. But none of that mattered, I still felt compelled to bite them more. Acrylic nails have been my way out of that behavioral cycle. But it’s not just my finger nails. Here is a couple pictures of my toes. This is what BFRB looks like.
I think the most important part to understand about the above photos is that despite them looking this way, they would not be immune from BFRB again. It doesn’t matter how much it hurts or how awful it makes you look afterwards, denying the urge is so very hard.
My hair pulling is fairly mild. I have been blessed with very thick hair and can pull out a lot of it without anyone ever telling. But I pretty much only pull the hair from my legs. So this one doesn’t really cause me any physical pain nor does it really cause much change in my appearance. But it sure can swallow up a lot of my time. It is an oddly satisfying and relaxing activity.
The skin picking is one that people do tend to notice because I almost always have an open sore on my chin that I am forever picking at. It will start as a small zit and then become a scab that I can’t leave alone. I can never leave my scabs alone. There are times that I am simply amazed that I am not constantly covered in small little, never healing wounds. But some how, my body manages to heal them up despite my constantly picking at them.
Mostly, I find that my BFRB cause two symptoms that are of significance. First there is the physical pain that the behaviors cause. Then there is the shame. I always feel like I should be able to just stop doing it because I know that it’s not good for me. My logical brain feels like this behavioral cycle is completely irrational and cannot equate it to an adult’s behavior. Yet, here I am: struggling not to chew on my fingers and toes on a daily basis. While I know that I am far from being alone in this struggle (1 in 20 is a lot of people) it still feels like something I shouldn’t talk about.
There is an immense amount of value placed on our personal appearance in our culture. I can recall many times that I felt shame because someone noticed and negatively commented on my ragged, chewed on finger nails. There were times that adults in my life tried to tempt me out of my bad nail biting habit by promising to by me nail polishes if I could grow out my nails. Instead, all they did was make me more aware of how out of control my behavior was. Yet, no one ever considered it a problem worth getting help for. I never thought about getting help for it until I went to the International Obsessive Compulsive Disorder Foundation Conference. There was a group there that talked about BFRB and the treatment options for them. That’s when I understood that it was something more then a bad habit.
But things can get better. I haven’t been biting my nails for about four months now. And that feels like a huge victory.
This is just one example of how there are many ways to approach and over come a problem. Don’t be afraid to create your own solutions.
Thanks for hanging out with me today. I hope you found something useful here. Until we hang out again, take care of yourself.