Body-Focused Repetitive Behaviors

Skin is highly valued in society as a part of your personal brand. My passion lies in making sure everyone wears their brand confidently and ready for life’s everyday events.

About 25% of my patient population suffers from Body-Focused Repetitive Behavior such as compulsive skin picking, hair pulling, and nail biting. In dermatology, we’re trained to identify internal conditions that manifestat on the skin. Many of my patients are unaware of the particular internal and external triggers that may be causing or progressing their conditions. A lot of patients may not even be aware that they are exhibiting repetitive behaviors but are more so concerned with the consequences of those behaviors showing as broken hairs or missing hairs, scars, dark spots, or open sores on the skin. When patients come to the office, they are concerned about the scars or the missing hair or the signs that people see on their skin, but rarely do I have patients come in and understand there may be a conscious factor underlying their skin condition.

Addressing BFRB’s

I try to have extended office visits in general for my patients so that I may understand each one better and therefore tailor a treatment plan to their lifestyle. My treatment plans also involve homework. It’s a team effort to improve one’s skin. Together we come up with a treatment plan, and the patient is responsible for completing their homework. A treatment plan for BFRB can typically involve topical, oral, or injectable treatments, but an integral part is being open and having an empathetic approach to what may be your personal triggers, making the connections as to what the consequences of those triggers may be for the hair, nails, and skin.

Every BFR patient has been a different experience challenging me to pause, pay attention, and listen to learn what may be going on in that person’s life, with their diet, and throughout their daily activities to be triggering their compulsions. BFRBs manifest in different ways in different people. Trying to walk someone back through their trigger then fast forward them to what the consequences of those physical triggers are can be quite difficult and poignant for a short office visit. I most certainly do rely on colleagues in the field who have an expertise in helping individuals connect these processes.

Some individuals may not have emotional trauma but may have the tendency or compulsion to pick or touch. This is very likely in skin conditions where you can easily see the compulsion trigger. Oftentimes, I will have the patient complete their treatment plan in all areas but keep one area completely covered and then compare the differences at the follow up visit. Sometimes there is improvement. Sometimes there is not. It all depends on how well they do their homework.

Raising Awareness

I think awareness is the greatest hurdle in general in trying to access treatments for BFRB. In my field of medicine, patients typically have a very visual connection with their BFRB. Extending this information into educational information would be valuable. Having handouts that show multicultural backgrounds of individuals suffering from BFRB of different types may help explain the condition as well as an appropriate treatment process alongside before & after images of the affected sites. I do believe this helps those experiencing BFRBs to move into the treatment phase with responsibility and awareness. Diversity among the individuals who share their stories publicly can help represent diverse communities. I think people respond best when they see someone else they can identify with in some way struggling with the same condition.

For those in need, the TLC Foundation for Body-Focused Repetitive Behaviors is an organization dedicated to helping those with hair pulling disorder, picking disorder, and other BFRB’s cope with these disorders. They can be contacted at (831) 457-1004, or visit their website at http://www.bfrb.org/find-help-support for assitance finding a support group, local doctor, or therrapist that specialises in helping those experiencing BFRB’s.