Although BFRBs can cause damage to the body, the goal is quite different than that of people who engage in self-harming behaviors. Self-harm (cutting, scratching, burning, etc.) is done with the goal of intentional harm to one’s body in an attempt to reduce the sensation of emotional pain or to manifest physical pain to drown out emotional pain. Alternately, BFRB behaviors are, for many people, self-regulating and serve some internal need. Many people who engage in BFRBs report that they are pleasurable, that they help them in some way, or that they help them to achieve some goal (symmetry or smoothness). When a person engages in their BFRB, physical damage is created as a result of their behavior but is an unintentional result of their repetitive behavior.

BFRBs are not self-harm. BFRBs are not caused by trauma.

Myths and Misperceptions

Myth: Anxiety is the sole cause of BFRBs.

Almost everyone with a BFRB reports pulling/picking at least some of the time when they are feeling anxious or stressed, however a host of other emotions, beliefs, sensations, and habitual triggers are also reported. The goal of therapy is to understand the internal and external triggers that lead a person to engage in their BFRB, as well as the internal and external events that reinforce them (make them more likely to happen again in the future). For some people with a BFRB, anxiety management skills are a key focus of treatment, while for others it is not a part of treatment at all. The key to good treatment is understanding what is driving the behavior for that person, and then offering interventions to address those unique drivers. Treatment for BFRBs is tailor-made to the individual and should be customized to the needs of the presenting person.

Myth: Only women experience BFRBs.

BFRBs are equal opportunity behaviors that affect both men and women. They are highly underreported and undiagnosed disorders, which oftentimes provides the illusion that women are more susceptible to experience hair pulling, skin picking, nail biting, cheek biting, and other associated behaviors. It is possible that men are less likely to report having a BFRB than women; therefore, present less frequently for treatment. Although research shows that more women likely suffer with hair pulling, it may be that men are just as implicated, but do not report their symptoms.

Myth: Bad parenting causes BFRBs.

Similar to other mental health disorders, BFRBs are a combination of neurobiological, environmental, and genetic factors, not the result of “bad parenting.” In fact, most parents of children with BFRBs are quite supportive and would do just about anything to help their child with a BFRB. Conversely, there are many families fraught with trauma and abuse where BFRBs are completely absent. Unfortunately, when parents try to help and the BFRB persists, parents can become frustrated and even frightened for their child. To support parents, TLC offers ongoing health education webinars and connection to support your child in ways that feel empowering and that lead to healing.

Myth: BFRBs are extremely rare.

BFRBs are common behaviors rarely discussed in the general public. It is estimated that 3% of the world’s population experience BFRBs. Due to the shame associated with hair pulling, skin picking, nail biting, cheek biting, and other associated behaviors, they often go unreported, undiagnosed, and misdiagnosed. If prevalence estimations are correct, if you put every person with a BFRB in one place, their population would be larger than the country of Brazil.

Myth: BFRBs are caused by trauma

Some people assume that hair pulling, skin picking, nail biting, cheek biting, and associated behaviors are signs of some unresolved issue or problem that needs to be addressed, including past trauma. There is no evidence supporting the belief that BFRBs are associated with past trauma or are caused by past trauma. BFRBs are also not a form of self-harm.

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