Help for Body-Focused Repetitive Behaviour

You see scabs or skin sores on your child’s body, and you notice they can’t seem to keep their fingers off them. It could be Compulsive Skin-Picking, an uncontrollable urge to pick at one’s skin, resulting in noticeable damage (sores, scabs, infections). Common areas include: face, head, cuticles, back, arms and legs, hands and feet.

Compulsive skin-picking is an example of a Body-Focused Repetitive Behaviour, or BFRB, a group of repetitive self-grooming behaviours where an individual damages their appearance or causes injury through either pulling, picking, biting or scraping of the hair, skin or nails. The two most common include skin-picking (dermatillomania/ excoriation), and hair-pulling (trichotillomania), which I developed at age 12. Compulsive nail-biting, nose-picking and cheek-biting are also considered BFRBs. These are not a form of self-harm since one does not have the intention or thought to hurt themselves intentionally.

As scary as this might sound, do not panic! BFRB is more common than you might think, affecting approximately two million Canadian adults and children. Yet these are poorly understood conditions, with little to no support and awareness in the medical/mental health field. This is why I founded Canada’s only non-profit organization, the Canadian BFRB Support Network (CBSN), which is dedicated to supporting and educating others about BFRBs.

Typically showing up around puberty, many BFRBs continue into adulthood. This doesn’t mean your child won’t ever stop, but early intervention is key to treating these conditions. In childhood both boys and girls are affected equally, but in adulthood more women seem to be affected.

There are no concrete answers at this time as to why people develop these conditions, but research indicates genetics play a role. With treatment, BFRBs can be reduced to a minimum (although even that isn’t guaranteed), but there is no cure-all to stop completely. With that being said, there ARE people who have been able to be pull-/ pick-free for years.

Parents typically want to do everything under the sun to protect their child when health problems arise, but with BFRBs it’s just not as simple as taking a pill. Many parents start to frantically search for ways to make their child stop these self-damaging behaviours – the concept of not being able to fix something (regardless of how hard you may try) can be extremely difficult and frustrating for parents to come to terms with.

Please understand these symptoms are not personality traits or something a person can simply “snap out of”. You might know a few people who bite their nails or pick at their cuticles constantly, but the difference between bad habits and a BFRB, is that a BFRB causes significant distress (both physically and mentally), which can affect work, social and daily activities. For a child this might mean spending hours picking their skin, and as a result they may be constantly late or tired. They may avoid situations or activities they once loved due to damage they may have caused on certain parts of the body – for example, swimming. Self-esteem is often affected because of the negative consequences these conditions can have on someone’s appearance – becoming bald or having marks on their skin. The stigma associated with these conditions embarrasses many people and makes them frustrated and ashamed. This makes it difficult to seek help. Other mental health conditions, such as anxiety or depression, commonly occur alongside the BFRB.

Having a family member who has a BFRB can put a huge amount of stress on the entire family. At first you might not even know what to do, where to turn, or what to think! You might feel this is somehow your fault, or you could have done something to prevent this. Believe me when I say your child is probably thinking they’ve let YOU down. Try not to feel guilty about your child having this condition, and don’t make them feel guilty either.

Tips From A Survivor

How can you help your child? As someone who began pulling out my own hair at age 12, here’s what I’ve learned.

  • Knowledge is power! Learn all you can about BFRBs, specifically the one your child may have. At you will find tons of information and blogs to give you an inside perspective.
  • Get medical advice. Approach your family doctor for help with your child, if he or she wants to deal with their BFRB. But be prepared. Many doctors aren’t familiar with BFRBs when it comes to treatment. While there are a few specialists in Canada, you may not have one in your area. Bring printed information or material if/when you take your child to the doctor for the behaviour(s). A list of Canadian treatment providers and forms to print out are available at
  • Don’t force help on your child. Adults with BFRBs have said they resented their parents for dragging them around to various doctors and therapists when they did not want to go. As much as you want to find a cure or try every treatment available, your child may not be ready to receive that type of help. If your child is open to receiving help, support their choices regarding treatment options.
  • Don’t confuse symptoms with character flaws. As confused and frustrated as you feel, imagine how your child is feeling. Try to be supportive, understanding and patient with them. If your child does want to talk about it, listen. Don’t interrupt, don’t correct and most importantly, don’t ignore their feelings or experiences.
  • Don’t embarrass or punish your child. This may seem like a good deterrent, but BFRBs are real disorders, not just bad behaviours that can be solved through punishment. Keep in mind that your child very likely doesn’t want to pick or pull, and is probably ashamed of the behaviour. They probably want to stop just as badly as you want them to.
  • Join a support group. CBSN has groups across Canada, both in person and online. Facebook has tons of private groups in which which parents can vent about their daily struggles with a child who has a BFRB. You’ll be surprised by how many children, adults and parents are in the same boat as you.

Sarah Robertson’s experiences within the mental health system and her passion to address the stigma prompted her to found the Canadian BFRB Support Network. She is also on the Frederick W. Thompson Anxiety Disorders Centre Advisory Committee at Sunnybrook Health Sciences Centre in Toronto.

Originally published in ParentsCanada magazine, November/December 2015.

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