You’ve done it again. Sitting at your desk, you glance down and realize your cuticles are raw, or there’s a small bald patch you’ve been worrying with your fingers, or your nails are bitten down to the quick. You didn’t even notice yourself doing it. That’s the strange, quiet grip of a body-focused repetitive behavior, and if you’re reading this on Christmas Day 2025, wondering why you can’t seem to stop, you’re not alone.
Body-focused repetitive behaviors—BFRBs for short—include skin picking (excoriation disorder), hair pulling (trichotillomania), nail biting, cheek biting, and similar actions. They’re not habits in the casual sense. They’re driven by a complex mix of sensory seeking, emotional regulation, and neurological wiring that makes willpower about as effective as trying to think your way out of a sneeze. The Diagnostic and Statistical Manual of Mental Disorders recognizes some BFRBs as clinical conditions, but even when they don’t meet diagnostic thresholds, they can still cause real distress and physical harm.
What separates a BFRB from an ordinary habit is the difficulty stopping, the time it consumes, and the damage it leaves behind. People with BFRBs often describe a trance-like state, a compulsion that feels both soothing and shameful. The behavior might start as a way to manage boredom, anxiety, or even excitement, but it quickly becomes automatic. Your hands move before your brain catches up.
Why willpower doesn’t work
Telling someone with a BFRB to “just stop” is like telling someone with depression to “just cheer up.” These behaviors operate below the level of conscious decision-making. Research suggests they involve the same neural pathways as obsessive-compulsive spectrum disorders, with differences in how the brain processes reward, impulse control, and sensory input. The behavior itself often provides a temporary dopamine hit or a release of tension, which reinforces the loop.
Shame makes it worse. Many people hide their BFRBs, wearing long sleeves to cover scabs, avoiding social situations, or lying about bald spots. The secrecy feeds the cycle, because isolation removes accountability and increases stress, which in turn triggers more picking, pulling, or biting. Understanding that this is a neurobiological issue, not a character flaw, is the first step toward breaking the pattern.
The trigger map exercise
Before you can interrupt a BFRB, you need to know when and why it happens. Grab a piece of paper or open a note on your phone. For the next week, every time you catch yourself in the behavior—or right after—jot down three things: the time of day, where you were, and what you were feeling.
Patterns will emerge. Maybe you pick at your skin every night while watching TV. Maybe you pull your hair during Zoom calls or bite your nails when you’re reading. The emotion might be anxiety, but it could also be boredom, frustration, or even contentment. BFRBs aren’t always stress responses; sometimes they’re sensory self-soothing during neutral or positive states.
Once you have your map, you can start designing interventions. If you always pick in the bathroom mirror, cover the mirror with a towel during high-risk times. If you pull while reading, switch to an audiobook and hold a fidget tool. The goal isn’t to white-knuckle your way through the urge, but to redirect it before it starts.
Swap strategies that actually work
Fidget tools are more than trendy desk toys. For people with BFRBs, they provide the sensory input your hands are craving. Textured putty, spiky rings, smooth stones, or even a piece of Velcro can satisfy the need to touch, pull, or manipulate without causing harm. Keep them everywhere: your car, your nightstand, your coat pocket.
Barrier methods create physical obstacles. Wearing gloves, bandages, or even fake nails can interrupt the automatic hand-to-skin or hand-to-hair pathway long enough for your conscious mind to catch up. Some people use bitter-tasting nail polish for nail biting, or hydrocolloid bandages on common picking sites. These aren’t punishments; they’re speed bumps that give you a chance to choose differently.
The “timed urge” technique borrows from addiction treatment. When the urge hits, set a timer for five minutes. Tell yourself you can do the behavior after the timer goes off, but not before. Often, the urge will pass or diminish. If it doesn’t, and you do engage in the behavior, you’ve still practiced the skill of pausing, which builds over time.
When it crosses a line
Not all BFRBs require professional treatment, but some do. If you’re causing infections, scarring, or noticeable hair loss, that’s a medical concern. If the behavior is taking up more than an hour a day, interfering with work or relationships, or causing significant emotional distress, it’s time to ask for help.
Physical signs to watch for include skin infections (redness, warmth, pus), permanent scarring, bald patches that aren’t growing back, or dental damage from cheek or lip biting. Emotional red flags include avoiding mirrors, canceling plans because of visible damage, or feeling intense shame that affects your mood for hours or days.
You don’t need to hit rock bottom to deserve support. If it bothers you, it’s worth addressing.
Treatment options to ask about
Cognitive Behavioral Therapy, specifically a protocol called Habit Reversal Training (HRT), is the gold standard for BFRBs. HRT teaches you to recognize the early warning signs of the behavior (the “premonitory urge”), then substitute a competing response—something that makes the BFRB physically impossible for a minute or two. For hair pulling, that might be clenching your fists. For skin picking, it might be sitting on your hands.
Acceptance and Commitment Therapy (ACT) is another evidence-based approach. Instead of trying to eliminate the urge, ACT teaches you to notice it without acting on it, reducing the power it has over you. Some therapists combine HRT and ACT for a more flexible approach.
Medication isn’t a first-line treatment for BFRBs, but it can help when anxiety, depression, or OCD are driving the behavior. Selective serotonin reuptake inhibitors (SSRIs) and N-acetylcysteine (NAC), an over-the-counter supplement, have shown promise in some studies. Always discuss these options with a psychiatrist or physician.
For peer support and education, the TLC Foundation for Body-Focused Repetitive Behaviors (www.bfrb.org) offers free resources, including a therapist directory, online support groups, and a annual conference. Their materials are evidence-based and compassionate, written by people who understand the lived experience.
You’re not broken, and you’re not alone. BFRBs are more common than most people realize—estimates suggest that 2-5% of the population has a clinically significant BFRB, with millions more experiencing milder forms. The silence around them makes them feel rare, but they’re not. What you’re experiencing has a name, a community, and a path forward. Start with your trigger map this week. Notice without judgment. The awareness itself is the beginning of change.