Supporting Loved Ones with Nail-Biting, Hair-Pulling, or Skin- Picking Habits: What Parents and Partners Can Do to Help with Body-Focused Repetitive Behaviors
Do you or someone you love struggle with nail-biting, hair-pulling or ski-picking?
If you don’t know me, hi there! I’m Kristy Leone, LCPC, LCPAT, ATR-BC (she/they), and I am a licensed mental health counselor, art therapist, and artist. Read more about my work as the Outdoor Art Therapist here!
Body-focused repetitive behaviors (BFRBs) are more common than many realize. As a therapist working with clients who have OCD and anxiety, I see firsthand just how frequently BFRBs occur. Despite their prevalence, these behaviors are often overlooked or misunderstood. When mental health conditions and symptoms aren’t openly discussed, shame can build, making it even harder for individuals to seek help!
In this blog post, I’ll explore common types of body-focused repetitive behaviors, myths that people have about BFRBs, and how I help individuals of all ages overcome their BFRBs and form new habits here at Labyrinth Art and Wellness.
Types of Body-Focused Repetitive Behaviors
1. Trichotillomania (Hair-Pulling Disorder) Individuals with trichotillomania feel a strong urge to pull out hair from their scalp, eyebrows, eyelashes, or other body areas. Over time, hair loss and skin damage can occur, leading to distress and social withdrawal.
2. Dermatillomania (Skin-Picking Disorder) Also known as excoriation disorder, this involves compulsively picking at the skin, often focusing on scabs, blemishes, or perceived imperfections.
3. Onychophagia (Nail-Biting) While many people bite their nails occasionally, chronic nail-biting can lead to pain, infection, and permanent nail damage.
4. Lip and Cheek Biting Some individuals habitually bite the inside of their cheeks or lips, often without realizing it. Over time, this can lead to sores, pain, and even thickened patches of skin in the mouth.
Common Myths About Body-Focused Repetitive Behaviors
There are many misconceptions about BFRBs, and these myths often contribute to the stigma surrounding them. Let’s set the record straight!
Myth #1: "BFRBs Are Just Bad Habits."
One of the biggest misconceptions is that BFRBs are simply bad habits that people can stop if they just try harder. In reality, BFRBs are compulsive behaviors that are not controlled by willpower alone. They are often linked to underlying neurological and psychological factors, including anxiety, OCD, and sensory processing issues.
Myth #2: "BFRBs Are a Form of Self-Harm."
While both BFRBs and self-harm involve repetitive behaviors, they have different motivations. People who engage in self-harm usually do so as a way to cope with intense emotional pain. In contrast, BFRBs are not typically driven by a desire to cause harm—many people with BFRBs do these behaviors to relieve stress, self-soothe, or satisfy sensory urges.
Myth #3: "Only Adults Struggle with BFRBs—Kids Will Grow Out of It."
Many assume that BFRBs are just a phase that children go through and that they will naturally outgrow them. While some kids may stop engaging in BFRBs as they get older, for many, these behaviors persist into adolescence and adulthood. Early intervention is key—if a child is showing signs of a BFRB, addressing it early can help prevent it from becoming a long-term struggle. Parents and caregivers should approach the behavior with understanding rather than punishment, as shame and pressure can make the behavior worse. I love working with families on figuring out creative ways to meet their child where their at and help them overcome these symptoms!
Myth #4: "BFRBs Are Just a Symptom of OCD and Anxiety."
While it’s true that BFRBs often coexist with OCD and anxiety, they are not always directly caused by them. Some individuals with BFRBs do not have OCD or an anxiety disorder—instead, their behaviors may be linked to genetics, brain chemistry, or sensory-seeking tendencies. Viewing BFRBs solely as a symptom of other conditions can prevent people from getting the right kind of treatment
Myth #5: "People With BFRBs Can Stop If They Really Want To."
Another common misconception is that BFRBs are entirely under a person's control and that if they just had enough willpower, they could stop. In reality, BFRBs are compulsive behaviors that are not easy to stop simply by wanting to. For many, these behaviors are triggered by stress, boredom, or sensory needs, and they often happen automatically—sometimes without the person even realizing it.
Saying "just stop" can make individuals feel ashamed or frustrated, reinforcing feelings of failure when they struggle to quit. Instead of focusing on willpower, effective treatment strategies like Habit Reversal Training (HRT), Cognitive Behavioral Therapy (CBT), and creative interventions like art therapy can help individuals manage their BFRBs in a supportive, structured way. Overcoming a BFRB isn't about just wanting to stop—it's about understanding the behavior and finding healthier ways to cope!
How Shame Plays a Role
If you’re a parent, partner, or close friend of someone with a Body-Focused Repetitive Behavior (BFRB), knowing how to support them can make a huge difference. Many people who struggle with BFRBs experience shame around their behaviors, which can lead them to hide their struggles instead of seeking help. As a loved one, understanding what to look for and how to offer compassionate support can help reduce that shame and encourage healthier coping mechanisms.
How Art Therapy and Habit Reversal Training (HRT) Can Help
Both Art Therapy and Habit Reversal Training (HRT) are powerful tools that help individuals manage BFRBs by addressing emotional triggers and changing behavioral patterns.
1. Art Therapy: A Creative Approach to Emotional Healing: Art therapy provides a non-verbal way to process emotions that may trigger BFRBs. Many individuals use BFRBs as a way to cope with stress, boredom, or anxiety, and art therapy offers an alternative, hands-on way to express these emotions.
Reduces Stress – Engaging in creative activities like painting or drawing can be calming, reducing the urge to engage in BFRBs.
Increases Awareness – Some people engage in BFRBs without even realizing it. Art therapy can help individuals recognize emotional triggers and underlying feelings in a safe, non-judgmental way.
Provides a Replacement Activity – Using hands for creative work can serve as a healthy alternative to pulling hair, picking skin, or biting nails.
2. Habit Reversal Training (HRT): Rewiring the Brain: HRT is one of the most effective behavioral therapies for BFRBs. It focuses on building awareness and replacing unwanted behaviors with healthier alternatives.
Awareness Training – The first step is recognizing when, where, and why a BFRB happens.
Competing Response Training – Instead of engaging in the BFRB, individuals practice an alternative action (e.g., clenching fists, using a stress ball, or deep breathing).
Support & Motivation – HRT involves self-monitoring and may include guidance from a therapist or support system.
Both Art Therapy and HRT empower individuals to take control of their behaviors, rather than feeling controlled by them. While different approaches work for different people, combining these strategies can make a significant impact on managing BFRBs in a compassionate and effective way.
Recognizing the Signs of Shame in BFRBs
BFRBs are often done in private or in subtle ways that make them less noticeable to others. Many individuals go to great lengths to hide their behaviors due to embarrassment or fear of being judged. As a parent or partner, being aware of these behaviors can help you approach the situation with understanding rather than criticism.
Here are some signs that a loved one may be struggling with shame around their BFRB:
Wearing long sleeves, hats, or makeup to cover bald spots, skin lesions, or nail damage.
Avoiding physical closeness (e.g., pulling away from hugs or touch to hide affected areas).
Getting defensive or changing the subject when the behavior is mentioned.
Engaging in the behavior when alone but stopping when others are around.
Expressing frustration or self-blame (e.g., saying, “I hate that I do this” or “I wish I could stop, but I can’t”).
Becoming withdrawn or avoiding social situations due to embarrassment.
What You Can Do as a Parent or Partner
Create a Safe and Judgment-Free Space: Instead of pointing out the behavior in a way that could cause shame, express care and concern. For example, instead of saying, “You need to stop picking at your skin,” try, “I’ve noticed you seem stressed lately—how are you feeling?” This invites conversation rather than making them feel defensive.
Educate Yourself on BFRBs: Many people (including those with BFRBs) don’t fully understand why these behaviors happen. By learning about BFRBs, you can better support your loved one and help them explore treatment options without reinforcing the idea that something is "wrong" with them.
Avoid Punishment or Ultimatums: Telling someone, “If you don’t stop biting your nails, I’m going to take away your phone” or “If you keep pulling your hair, I won’t go out with you” can increase stress and make the behavior worse. BFRBs are not choices—they are compulsions. Encouragement works far better than punishment.
Encourage (But Don’t Force) Support Options: Some people may benefit from therapy, Habit Reversal Training (HRT), or creative coping strategies like art therapy. If your loved one is open to it, gently suggest exploring these options together, but respect their pace.
Celebrate Progress, Not Perfection: If your loved one is working on managing their BFRB, acknowledge their efforts rather than only focusing on results. Saying something like “I know this is tough for you, and I’m really proud of how you’re handling it” reinforces progress and self-compassion.
Offer Creative, Fun Alternatives: Some people find relief through fidget toys, stress balls, or mindfulness techniques. If they’re open to it, help them explore different strategies to see what works best for them. A lot of my clients will engage in collage journaling, paper ripping, and slime-making as ways to replace behaviors with other safe options.
Be Patient and Supportive: I can’t stress this enough! Change doesn’t happen overnight. Some days will be better than others, and relapses are part of the process. What matters most is that your loved one knows they’re not alone and that their struggles don’t define them. 🌿
Want more resources?
Check out more blog posts here or head on over to my free resources page! I love sharing free resources that I find and creating my own worksheets for clients and supervision students to use in their journey of wellness!
If you’re ready to embark on this transformative journey toward inner healing, I invite you to take the next step and reach out through my website here.
Let’s walk this path together toward a more vibrant and fulfilling life—for you, for your child, and for your inner child!
Kristy Leone, LCPC, LCPAT, ATR-BC is a licensed art therapist and mental health counselor that specializes in therapy for children and therapy for inner child healing in Baltimore County, Maryland at Labyrinth Art and Wellness.
Kristy recognizes that this blog post is meant to spark ideas and creativity, and is not a substitute for therapy itself. If you have questions, comments, or feedback, please don’t hesitate to reach on out.
Interested in beginning therapy for you or for your child? Kristy is currently accepting new client in the office, online, and outdoors for walk and talk therapy!
