Body-Focused Repetitive Behaviors and Their Treatment

Body-focused repetitive behaviors (BFRBs) encompass a group of compulsive self-grooming actions, most notably trichotillomania (hair pulling), excoriation disorder (skin picking) and related behaviours such as nail biting. These conditions affect up to 2–3 % of the general population and often emerge in adolescence, persisting into adulthood. They are associated with considerable distress, functional impairment and medical complications, including tissue damage and infections. Neurobiological models implicate dysfunctional cortico-striatal-thalamic circuits, altered dopamine and glutamate transmission, and deficits in habit regulation and emotion control. Psychological factors such as negative affect, perfectionism and impulsivity further moderate symptom severity. Traditional interventions focus on behavioural therapies, notably habit reversal training, sometimes enhanced with emotion regulation components. Pharmacological approaches, including selective serotonin reuptake inhibitors and atypical antipsychotics, are used adjunctively but yield variable outcomes. In recent years, digital and self-help modalities have expanded access to evidence-based strategies, offering promise for scalable, personalised treatment. Despite growing awareness, BFRBs remain under-recognised and under-treated, underscoring the need for interdisciplinary research to refine mechanistic understanding, optimise therapeutic protocols and improve long-term outcomes.

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Body-Focused Repetitive Behaviors and Their Treatment publication trend

The graph below shows the total number of articles in body-focused repetitive behaviors and their treatment across all publications each year (not limited to Nature Index journals).

Technical terms

Trichotillomania: A compulsive hair-pulling disorder leading to noticeable hair loss and distress.

Excoriation (Skin Picking) Disorder: Repetitive picking at skin resulting in tissue damage and psychological impairment.

Habit Reversal Training: A behavioural therapy that increases awareness of urges and teaches competing responses to inhibit unwanted behaviours.

Decoupling: A self-help technique that replaces habitual movements with alternative actions to disrupt the automatic grooming cycle.

Emotion Regulation: The ability to monitor, evaluate and modify emotional reactions to achieve adaptive outcomes.

References

1. The association between trichotillomania symptoms and emotion regulation difficulties: A systematic review and meta-analysis. Journal of Affective Disorders (2023).
2. A Head-to-Head Comparison of Three Self-Help Techniques to Reduce Body-Focused Repetitive Behaviors. Behavior Modification (2021).
3. An Internet-Based Self-Help Intervention for Skin Picking (SaveMySkin): Pilot Randomized Controlled Trial. Journal of Medical Internet Research (2019).