Nail biting, scratching or pulling bits of skin or cuticles is something that most people do from time to time. This behaviour can simply be a bad habit caused by stress or anxiety. However, you might be noticing that your child’s nails are constantly chewed down with skin infections as a result or bald spots on their scalp because they are pulling their hair out? These can be signs that your child has a Body Focused Repetitive Behaviour (BFRB).

What are Body Focused Repetitive Behaviours?

Body Focused Repetitive Behaviours are a set of interrelated behaviours characterized by “self-grooming” routines. They often result in damage to the body such as baldness, scarring, skin infections to mention a few. The two most common BFRB are trichotillomania (hair pulling) and excoriation (skin picking), yet, the list of these behaviours is long.

As many as 1 in 20 people are suffering from the condition and the behaviours can be found in both children and adults. The disorder can cause both physical and psychological damage if it is left untreated.

Types of Body Focused Repetitive Behaviours

There is a big spectrum of behaviours that individuals with BFRB are engaging in, some of the most common are:

Hair pulling (Trichotillomania)

Trichotillomania, or known in layman terms as hair pulling, is one of the top two most common behaviours within BFRB. It is characterized by repetitively pulling out one’s hair such as the hair on the scalp, eyebrows, eyelashes or anywhere else on the body. Trichotillomania damages the hair follicles, causes inflammation in the skin and trigger scar tissue to develop. This can in the worst cases lead to baldness and hair loss.

Nail-biting (Onychophagia)

Nail biting is a common BFRB where the individual often is unaware of when they are doing it. Nail biting does not only damage the nails, the skin, and cuticles, but can also damage the teeth.

Skin picking (Dermatillomania)

Skin picking behaviour is characterized by a constant picking on the skin (scabs, acne, pimples or even healthy skin) causing tissue damage.

Thumb sucking

Thumb sucking is a common and an accepted behaviour amongst toddlers. However, when your child enters school age and continues to suck its thumb, it can be detrimental. Excessive thumb sucking can alter to the growth of the jaw and cause misalignment of the front adult teeth as they erupt into the mouth.

A Bad Habit or BFRB?

It can be difficult to know what is merely a bad habit and what is BFRB. Everyone can have a bad habit they engage in but the difference between BFRB and just a bad habit is that BFRB causes a significant amount of stress to the individual suffering from it. Sometimes this is affecting school, work or social life or other daily activities. For a child that is affected by BFRB, this might mean they avoid activities they previously loved, maybe they are picking their skin so much they are constantly late for school or they avoid social interactions. The stigma surrounding the condition is very high and it can be detrimental both physically and psychologically for both children and adults suffering from it. They often experience low self-esteem, frustration, anxiety, embarrassment, or even depression. All of this can make it difficult to seek out help.

Parents and family members of a child with BFRB

Being the parent or family member of a child BFRB can be frightening and confusing. It might be hard to understand why your child just can’t stop the behaviours. However, it is important to understand that these are not behaviours that someone simply snaps out of. Children affected by it find the behaviours difficult to control and although not the same, BFRB do share some symptoms with obsessive-compulsive disorders (OCD). Feeling of helplessness and grief among parents are common. Sometimes, a parent might even feel guilty about their child’s condition. You might feel that you have let them down. What you need to remember is, that most of the time, the child feels that they have let YOU down. Try not to feel guilty, both for you and your child’s sake.

Behaviour Modification Therapy

There are only a few large-scale studies done seeking out the optimal treatment for BFRB. Although, one treatment that shows positive results is Behaviour Modification Therapy, a therapy closely related to Cognitive Behavioural Therapy (CBT). However, Behaviour Modification Therapy focuses on sequences of behaviour instead of negative thinking patterns or ideas.

One part of Behaviour Modification Therapy is awareness. Many of the behaviours are done automatically, the individual is many times not even aware that they are engaging in the behaviour. The behaviour is subconscious and becoming aware of the behaviour is crucial. One of the ways of helping your child in becoming aware of when they are about to engage in the behaviour, are tools such as the Keen Bracelet. The Keen Bracelet is developed with kids in mind and looks a lot like a Fitbit so can be worn subtly. The Keen Bracelet is the first wearable technology on the market with the aim of helping people suffering from BFRB. Sensory technology in the bracelet makes it possible to record the movement pattern of the unwanted behaviour, the bracelet is then put on the child’s arm. When the child is about to begin the unwanted behaviour, the bracelet will vibrate, making the child aware of what they are about to do.

If you or a family member is suffering from BFRB, day-to-day life can be challenging. Still, BFRB is more wide spread than you might think and you are far from being alone. There are steps you can take to help, helping the individual becoming aware of when they are starting the behaviour being one of them.

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