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wolfbitingstarboy · 9 months

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BFRB Resources for Struggles Like Ours

These resources vary from reliable sites and blogs to published journal articles, professional papers, books, and more. If you have any recommendations for me, feel free to Submit something.

A separate post for tips, tricks, and non-affiliate product recommendations will be linked here as soon as I've posted it.

Now then, some of you may be wondering...

What is a BFRB?

Body-focused repetitive behaviors are among the most poorly understood, underdiagnosed, and untreated group of mental health disorders.

According to the TLC Foundation for BFRBs:

"Body-focused repetitive behaviors (BFRBs) include any repetitive self-grooming behavior that involves biting, pulling, picking, or scraping one’s own hair, skin, lips, cheeks, or nails that can lead to physical damage to the body and have been met with multiple attempts to stop or decrease the behavior."

(From the TLC Foundation's webpage, "What is a BFRB?")

The PickingMe Foundation says:

"BFRB's are self-grooming behaviors in which individuals pull, pick, scrape, or bite their own hair, skin, or nails, resulting in damage to the body. Many people are more familiar with its sister disorder, Trichotillomania - Hair Pulling Disorder."

(From the PickingMe Foundation's webpage, "What is Dermatillomania?")

The Recovery Village describes BFRBs as:

"Body-focused repetitive behaviors (BFRBs) are a group of mental health conditions that cause people to bite, pick, pull or scrape their skin, hair or nails compulsively. While some people with BFRBs have awareness and insight into their behaviors, others do them automatically. BFRBs are often linked with disorders like anxiety or substance abuse. Treatment is essential for people with BFRBs, but many often hide evidence of these harmful actions and have trouble asking for help."

(From The Recovery Village's webpage, "Body-Focused Repetitive Behaviors")

According to Angela Hartlin's skin-picking support website:

Body- Focused Repetitive Behaviours (BFRB’s) “is an umbrella term for any chronic behavior that causes a person to consistently cause physical damage to oneself unintentionally through a compulsive act in order to relieve anxiety.” The key difference between BFRB and other compulsive behaviours that cause harm to the body is that BFRBs are characterised by direct body-to-body contact. The website goes on to list other BFRBs such as: hair-pulling disorder (trichotillomania), hair eating disorder (trichophagia), skin biting disorder (dermatophagia), nail biting disorder (onychophagia), and nose picking disorder (rhinotillexomania).

Getting BFRBs officially classified as disorders has been a long, slow process that only hurts those of us who struggle with them daily, as treatments and available resources relating to BFRBs can be very difficult to find. That's the reason why I'm composing this. I'll keep updating this post to the best of my abilities, both for myself and for anyone else it might help.

The good news is that while progress may be slow, there is still progress. Dermatillomania was finally added to the DSM-V-TR under the same OCD-Related Disorders umbrella as Trichotillomania, which has been a big step in the right direction. The more awareness brought to BFRBs, the sooner more can be recognized for what they are so the people suffering from them can receive proper medical and psychiatric help where necessary.

Are BFRBs a type of self-harm?

No.

While the two are not mutually exclusive, the general consensus seems to be that where self-harm is voluntary, BFRBs are grooming behaviors that have gone awry to the point that they are categorized as "OCD-Related Behaviors" in the DSM-V-TR due to their compulsory nature. These behaviors may or may not be driven or worsened by anxiety.

In the case of BFRBs, even though these behaviors cause varying degrees of bodily harm, they're ultimately driven by impulses and urges that cannot easily be controlled. Quite often the triggering event is discovering a physical imperfection in any way for any reason and attempting to "fix" it, despite the behavior being counterintuitive to the goal. The resulting behavior can occur actively or passively, with severe active episodes usually likened to being held hostage in your own body.

There is no desire to harm and very little ability to stop, and then all of it is followed by distressing feelings such as shame, guilt, or embarrassment. We try so hard to "break the habit" that we ultimately beat ourselves up mentally for "failing" yet again. Even though many of us might know we can't control it, it's too easy to blame ourselves for something we feel is somehow our fault.

[Please be advised the purple paragraphs below are personal examples with a few details that may be triggering for some.]

For example, the only way I can come out of bad episodes is when my bodily literally cannot continue. This may look like my back giving out from leaning on the counter in the bathroom, or my legs going completely numb from sitting for too long, or (much more commonly) my fingers or nailbeds hurt too much for me to keep using them, regardless of how much I may or may not have bled.

This is always followed up by what I call the "walk of shame" phase as I clean up every injury, apply Neosporin or other balms/salves, and bandage what I can. I've burst into tears before when I had to use Neosporin like it was lotion in order to cover everything, because I had too many wounds on my arms to be able to safely apply bandages/plasters.

No part of that process, from the trigger response to the cleanup, is something I want to do. If I had a say in it, I'd never pick or bite ever again, and my skin would finally be able to heal.

Self-harm, on the other hand, is a term reserved for bodily harm that is deliberately inflicted on oneself, usually as a way of dealing with difficult emotions, memories, situations, or experiences. Instead of acting on an uncontrollable compulsion, this type of harm stems from a different set of triggers, many of which relate to trauma or other disorders. This makes the behavior more of an unhealthy coping mechanism for people in pain who are desperate for release from those feelings.

Note: If you are unsure if your behaviors are a result of a BFRB or self-harm, Crisis Text Line is a good resource:

"Self-harm is serious. And, while the intention behind self-harm usually is not death, it can still be dangerous—both physically and emotionally. Talking to someone who can help you find alternatives is incredibly important. Of course, you can start by texting us. Also, consider telling someone you know who can help you connect with a professional."

General BFRB Resources:

Sites:

The TLC Foundation - "The TLC Foundation for Body-Focused Repetitive Behaviors helps end isolation and shame for people experiencing hair pulling, skin picking, nail biting, cheek biting, and associated behaviors." They feature a robust website full of information on all BFRBs, including "Medications for BFRBs" and "Evidence-based Therapeutic Treatment for BFRBs."

The Recovery Village - "The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals." (BFRB-specific information can be found here.)

SkinPick.Com - While this site is centered around skin picking/excoriation disorder/dermatillomania, they have excellent resources for other BFRBs as well, including their Glossary page, "Complete List of BFRBs," and the blog section for "Related Disorders." I have also listed their site in the Dermatillomania section below.

Articles:

Online Journal: International Journal of Environmental Research and Public Health, Special Issue: "Body-Focused Repetitive Behaviours (BFRBs). Risk Factors, Prevention, Treatment"

The Recovery Village’s article, "7 Myths About Body-Focused Repetitive Behaviors"

The Recovery Village’s article, "8 Little Known Facts About Body-Focused Repetitive Behaviors"

Outreach:

"Health Education & Community Programs" (the TLC Foundation)

Communities & Support:

PickingMe Foundation's Online Support Group.

TLC Foundation's Support Group Directory for peer-led support groups.

SkinPick's online Forum.

Self-Help:

Nathan Peterson's ComB Model for BFRB Treatment, Part 1 and Part 2 on YouTube. Peterson is a licensed OCD specialist who helps people with OCD, anxiety, and BFRBs in person, through his OCD & Anxiety YouTube channel, and through his site, OCD-Anxiety.Com. (His BFRB specific course can be found on his site here.)

SkinPick's free self-guided program to stop skin-picking.

PickingMe Foundation's Derma Resource Packets "...are our campaign to spread Dermatillomania awareness to skin care providers (Dermatologists, Estheticians, Nail Salons, Clinicians), mental health professionals, and anyone who wants more info! We provide them with tools and the opportunity to point Skin Picking Disorder sufferers in the right direction."

PickingMe Foundation's Management Tips page, a "growing list of tips and management strategies!"

Mobile Apps:

SkinPick App – "A free tool to monitor your skin picking behaviors."

Specific BFRB Resources:

Onychophagia:

Not every instance of nail-biting is considered onychophagia. Most nail-biting behavior dissipates over time. It’s when it doesn’t that the behavior requires a closer look. Chronic nail-biting is categorized as an obsessive-compulsive related disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).

SkinPick's blog post, "Onychophagia: More Than a Nervous Habit"

"Art of Prevention: The importance of tackling the nail biting habit," authored by Mohsen Baghchechi BS, Janice L. Pelletier MD, FAAP, Sharon E. Jacob MD, FAAD, FAAP. Published in the International Journal of Women's Dermatology, Volume 7, Issue 3, June 2021, Pages 309-313.

"Update on Diagnosis and Management of Onychophagia and Onychotillomania," authored by Debra K. Lee and Shari R. Lipner. Published in the International Journal of Environmental Research and Public Health, 2022, 19, no. 6: 3392.

Dermatophagia:

Formerly referred to as "wolf-biting," dermatophagia has yet to be recognized as a diagnosable disorder.

SkinPick's blog post, "Do you eat your own skin after picking? There's a name for that."

SkinPick's blog post, "Dermatophagia - What is it?"

Dermatillomania:

Dermatillomania means “Skin Pulling Madness,” and has only been diagnosable since 2013. It is currently classified as an “Obsessive-Compulsive and related disorder” in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), where it is listed as Excoriation Disorder. However, it is known by many names, such as: Skin Picking Disorder, Compulsive Skin Picking, Acne Excoriée, Pathological Excoriation, Neurotic Excoriation, Pathological Skin Picking, and Psychogenic Excoriation. The many names for this disorder cause interference with its understanding and awareness.

Dermatillomania is often confused with other conditions. Common misdiagnoses result because the picking behavior is a result of a medical condition, confused with OCD, Body Dysmorphic Disorder (BDD) and in some cases, Non-suicidal Self-Injury (NSSI).

PickingMe Foundation - "Picking Me Foundation NFP is the only donor-supported non-profit dedicated to advocating for Dermatillomania (Skin Picking Disorder) sufferers, supporters, and educational communities alike, encouraging individuals to choose themselves over the mental illness that chose them by #PickingMe over Skin-Picking."

Angela Hartlin's Skin Picking Support website. Hartlin is the author of, "FOREVER MARKED: A Dermatillomania Diary" and the creator of the documentary, "Scars of Shame," which you can watch for free here with the password, "Scars1" (Thanks, Angela!)

SkinPick.Com - "SkinPick is the #1 platform to treat excoriation disorder (dermatillomania). Get one-on-one support from a therapist specializing in treating compulsive skin-picking through evidence-based techniques."

SkinPick's "Do I Have Dermatillomania?" Test

SkinPick's blog post. "Skin Picking and Body-Focussed Repetitive Behaviours (BFRB)"

Stuff That Works’ page, “Excoriation (Skin-Picking) Disorder”

Trichotillomania:

Probably the most famous BFRB, Trich has the most resources available thanks to being the first diagnosable BFRB. The resources below are more general as a result:

TrichStop - "TrichStop is the world’s leading platform for Trichotillomania treatment. Get one-on-one support from a therapist specializing in treating compulsive hair pulling through evidence-based techniques." From the same support team behind SkinPick.Com.

TrichStop's "Do I Have Trichotillomania?" Test

TrichStop's blog post, "Trich and Comorbid Disorders: What We Are Learning"

The TLC Foundation's Trichotillomania page.

"Trichotillomania," authored by Aubree D. Pereyra; Abdolreza Saadabadi. Published in StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. (Ongoing)

More to come.

There are more BFRBs than this out there, but I don't have the resources gathered for them yet. Hopefully the General resources help! I'll update this as I have time. In the meantime, I wish you all luck on your BFRB journeys.

-> Anxious? Try This:

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