How to Recognize Signs of BFRBs in Children and Use CBT Techniques to Address Them

Body-Focused Repetitive Behaviors (BFRBs) is often used as an umbrella term to describe repetitive and compulsive behaviors, which is also known as habit disorder. The condition, which is often associated with Tic Disorders (TD), presents in three distinct categories including trichotillomania, excoriation, and onychophagia. In the case of trichotillomania, the person engages in hair pulling, which may include scalp hair, facial hair, and body hair. Alternatively, individuals that engage in excoriation pick at their skin, which may include scratching, digging, rubbing, and touching. Onychophagia refers to habitual nail biting. In addition to these, individuals experiencing BFBRs often engage in knuckle cracking, lip biting, and tooth grinding.

FRBs behaviors are commonly noted among children and adolescents, though it is more commonly noted among teenagers. This is typically attributed to the fact teenagers experience heightened levels of stress compared with younger children. Part of the increase in stress involves hormonal changes and fluctuations, in combination with challenges faced in transitioning toward adulthood, often resulting in mood swings. Though BFRBs can harm the body, they are distinct from self-harm behavior as they are unintentional and a compulsive response to various stressors.

Seeking early treatment from a professional mental health provider is beneficial to obtaining the most effective long-term out- come for youth. However, knowing when to seek help hinges on the ability to identify signs and symptoms of BFRBs in children and adolescents. The signs and symptoms often include hair-pulling, nail-biting, skin-picking, chewing on lips or cheeks, knuckle cracking, and tooth grinding. However, it is important to observe and track the frequency of the behaviors to assess the severity of the behaviors. It is recommended that new and frequent scabs on the child’s body, bald patches, and areas of missing hair be addressed promptly. There are several treatment options that can help.

One primary treatment option includes the employment of Cognitive Behavioral Therapy (CBT). CBT focuses on addressing the behaviors exhibited by exploring the negative thought patterns that result in negative behaviors. Once these thought patterns are identified, they are challenged and shifted to allow the individual to respond to them in a positive manner. In the case of BFRBs, the CBT techniques are often employed and attempt to regulate the excessive levels of muscle tension and sensorimotor activity occurring. Using CBT techniques can allow for long-term treatment and management of BFRB related symptoms and the development of life-long positive coping skills.

Dr. Michael Clatch, Psy. D.

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