Have you ever noticed your child engaging in repetitive behaviors like nail biting, hair pulling, or skin picking? If so, you might be witnessing what’s known as Body-Focused Repetitive Behaviors (BFRBs). Don’t worry, you – and your child – are not alone! These behaviors are more common than you might think, affecting children and adults. While BFRBs may not be as widely discussed as other mental health conditions, they are more prevalent than most people realize, with an estimated 2-5% of the population being affected.
How do I know? Because I grew up with a BFRB. I started hair pulling in my tweens. As a child, I thought it was weird and wrong – and that I was weird, ugly, and wrong for doing it. It fueled a lot of negative self-talk, which in turn created anxiety. Out of fear and shame of the physical damage I was doing to myself, I hid my hair pulling. I covered the bald spots on my eyelashes and eyebrows with a black eye pencil. I avoided pool parties and other social gatherings, fearing the makeup would wash off or others would notice and question my missing hair. Others in the community use hats, wigs, makeup, or band-aids to cover up the physical consequences of bald spots, skin infections, or bitten nails.
It wasn’t until I was in my 20s that I found out my involuntary behavior of pulling out my hair was a mental health condition: Trichotillomania. Still ashamed and afraid, I continued to hide my hair pulling because of the lack of education around BFRBs and the stigma around mental illness in the early 2000s. The emotional consequences were not so simple to solve.
In my 30s, my husband caught me without eyebrows one morning after a very bad late-night pull session. I was stressed from work and exhausted from my first pregnancy. I finally shared my trichotillomania secret with him. Together, we dove into the research and found out that hair pulling is part of a broader group of Body Focused Repetitive Behaviors that also includes skin picking (dermatillomania) and nail biting (onychophagia).
As Minneapolis-based Clinical Psychologist Dr. Kavita Desai Dakoji of Peace Out Pain shares, “While BFRBs are not well understood, they are 100% real, physiological conditions that are ‘in our head’ – meaning, brain-based. While science works to better understand BRFBs, they are known to be subconscious self-soothing mechanisms for physical and emotional dysregulation. The relief experienced is temporary and the BFRB causes other problems.”
For many in the BFRB community, those other problems included other mental health conditions, like anxiety and depression, as well as negative beliefs around self-worth. The physical and visible effect of the BFRB often leads to invisible shame and withdrawal from social connection.
Once my husband knew, he started noticing my pulling before I did. As he gently took my hand one day, I had an aha moment, “What if I had something that notified me?”
It didn’t exist, so we built a motion-sensing solution to help us understand the subconscious nature of these behaviors and started HabitAware to help the BFRB community use the power of awareness and peer support to create healthy and lasting behavior change. By using HabitAware’s methods and tools, our goal is to help folks shatter the shame and gain control over their BFRB.
In this post-COVID World, there is greater appreciation for mental healthiness in our culture, and thanks to the internet, more information about BFRBs is available today. However, the misunderstanding that it’s just a “bad habit” that can be “stopped” and the fear of judgment still motivate people to suffer in silence.
Understanding BFRBs and dispelling myths around them can help us support our children better. Pediatricians can be a “first line of defense” in the treatment of BFRBs as they regularly see your young patients. Pediatrician and parenting expert Dr. Kate Harrington shares a few tips for parents and children at the start of their BFRB recovery journey:
1- “Remember that these behaviors are not something that your children have great control over. Your child may not even realize that they are doing them.
2- Talk to your child in a non-confrontational way. When you tell them you’ve noticed them doing these unwanted behaviors, ask them if they have also seen and help redirect them to healthier, wanted behaviors.
3- Check to ensure there isn’t an underlying physical medical issue, like eczema, that may be contributing to the issue.
4- Meeting with a psychologist for Cognitive-Behavioral Therapy (CBT) can be helpful if a child has associated stress or other mental health concerns.”
“Fortunately, BFRBs can be treated effectively,” shares Dr. Kavita, as there are various treatment options, like CBT and Habit Reversal Training (HRT), and resources like support groups for kids to alleviate symptoms and help children cope better. (Note that there are no medications specifically for BFRBs.)
Both Dr. Harrington and Dr. Kavita advocate that the first step to managing a BFRB is making the child aware that the behavior is happening. As Dr. Kavita says, “If you don’t know when a behavior is happening, you can’t make a change!” This is where HabitAware’s smart bracelet and change methodology come into play.
After awareness, both recommend replacing the behavior in a healthier way. One way is to keep the hands busy with fidgets or by using barriers like gloves to prevent the behavior. Dr. Kavita shares, “Practicing alternate self-soothing rituals can help balance the nervous system, bringing actual, lasting calm to our body. Strategies that can be used wherever you are and don’t need tools are beneficial.”
To that end, “Progressive Muscle Relaxation (PMR) is a perfect example,” according to Dr. Kavita, as one strategy for your child’s BFRB tool kit because they won’t need anything else except their body – and the awareness to choose one of these activities in the moment:
- “Hand Squeeze—As you inhale, squeeze your hands, making the muscles in your hands, arms, and shoulders really tight. Hold that tension and breathe for a moment, then let go of the tension. Exhale out to let go of the last bit of tension. Repeat three times.
- Stomach Squeeze – Tighten your stomach like a soccer ball is gonna hit you. Hold it, then breathe out, nice and slow. Let the breath loosen your stomach, letting your body relax and sink into the chair.
- Leg Stomp – Push your legs down into the ground, like pushing your feet into a mud puddle. Tighten up your legs, push down, heels, then toes. Hold the tension, then let it go. Let the tension release, and then you will feel like you are floating!”
Remember, with patience, understanding, and the right support, our children can learn to manage their BFRBs and thrive. I am proud to say I am 100% shame-free and 90% pull free, and through my work at HabitAware, we’ve touched the lives of hundreds of thousands of people. I still live with the condition, but it is smaller in my life, and I can take back control within a few pulls. That is a more graceful and attainable goal than the demand of “just stopping” a chronic condition. By turning my childhood pain into purpose, I strive to ensure that children today with BFRBs get the healing support they deserve much faster than I did.
Thank you, Drs. Desai-Dakoji and Harrington for their expert input, and to Minnesota Parent for allowing me to share my story and raise BFRB Awareness this Mental Health Awareness Month.
Wishing you all love, strength and awareness,
Aneela Idnani
Mental Health Tech Founder, Peer Support Specialist, BFRB Awareness Advocate and a Minnesota Parent!
aneela@habitaware.com
HabitAware cofounder in trichotillomania recovery
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