BFRBs are behaviors that occur so often that people use their fingers or tools in self-grooming behavior causing damage to their bodies unintentionally, despite the attempts made to curb them. Unlike other obsessive-compulsive related disorders (OCRDs), these behaviors usually give people with BFRBs some kind of pleasure. 

BFRBs such as Trichotillomania (hair-pulling), Excoriation (skin-picking), Onychophagia (nail biting), and Morsicatio Buccarum (cheek biting) are the most familiar embodiments of a Behavioral Feed Risks and BFRBs. Due to frequent manual involvement, the risks can be scarring, skin infections, and loss of hair. 

Most of the time, people do not realize that BFRBs are one of the most elusive, misdiagnosed, and untreated medical conditions. It has been proven that 1 out of 20 people might be affected by BFRBs. Medical scholars have been aware for some time now about these clusters of symptoms, however they have just recently become documented in many textbooks. It is estimated that Trichotillomania alone affects ten million Americans. 

Neuroimaging research has shown that people living with body-focused repetitive behaviors (BFRBs) present variance in brain organization and operation. These behaviors often emerge as strategies for dealing with tension, fear, or unhappiness, leading to maladaptive coping mechanisms that bring about temporary relief or give one a feeling that he or she is in charge. Neurotransmitters imbalances might be significant in emotional regulation and impulse control disruptions among such persons. 

BFRBs are usually used by people as a way of dealing with stressful situations, anxiety, monotony or other negative feelings. Individuals resort to such actions for the sole purpose of enhancing the control over their lives or relieving themselves from mental distress. There are those who believe that BFRBs originate from past events where they were mistreated or experienced trauma. It is proved by scientific research that stressful situations can become the starting point or worsen such behaviors. 

It may be harder for such persons to achieve noticeable change when it comes to their BFRB conditions that have persisted for long periods and are severe. An earlier start as well as proper management and care could lead to more favorable results. In order to enhance general healing process, it is crucial that such co-occurring conditions are taken into account and handled using holistic approaches. A higher rate over time can be observed among children or teenagers suffering from early manifestation phases. Healthier persons may respond better to interventions based on research findings. 

Age: 

Trichotillomania (hair-pulling disorder) and excoriation (skin-picking) disorder are examples of BFRBs that usually appear in children and teenagers. The actions of pulling out hair, picking one’s skin with fingers or an object would typically begin in preschool age even though it is also known to present up to adolsecence. Another very frequent BFRB one can do is biting nails which might begin in young age and may continue even becoming an adult. 

• Observation of behaviours: The individual may show clinician the specific BFRBs they have such as nail-biting or picking the skin, pulling hair. 
• Assessment of functional impairment: A vital element of evaluating involves determining how BFRBs affect an individual’s daily activities, relations with friends, and life quality. 
•  Screening for comorbidities: It is important to screen and diagnose depressive disorder among children as it is with other psychological illnesses. 

Generalized anxiety disorder 

Social anxiety disorder 

Panic disorder 

Major depressive disorder 

Impact of self-esteem, daily functioning and body image

Those with mild acuity may engage in BFRBs every now and then, without any significant interference with daily life. A higher frequency or intensity BFRB characteristics within someone is what constitutes moderate severity but, in most cases, it may lead to noticeable effects on daily functioning than mild ones. A lot of different activities in a person’s life can be seriously affected by severe acuity which involves a high frequency and intensity of BFRB engagement. 

Cognitive-behavioral therapy (CBT) is one of the commonly used psychotherapeutic theories for BFRBs, which is based on the recognition and reformation of the distorted thoughts and beliefs linked to repetitive behaviors. For effective treatment, psychoeducation is a must to have an understanding of BFRBs, their reasons, and the results on mental health. Habit Reversal Training (HRT) is a clear behavioral therapy that is designed specifically for people with BFRBs. It is accustomed to helping individuals identify the triggers, develop more efficient responses and try counter-behaviors that would replace the repetitive behavior. Typically, Exposure and Response Prevention (ERP) is the first choice in the treatment of OCD, which is one of the significant therapeutic interventions targeting the core features of OCD. 

Psychiatry/Mental Health

• Identify triggers:  Interact with the person to rule out the specific factors that are responsible for the onset of BFRBs. The triggering factors may be situational, emotional, or environmental factors. 
• Create a calming environment: The living room or working environment should be designed in such a way that it promotes relaxation and reduces stress. Elements such as colours, decorations, and lighting should be considered as they also contribute to a calming atmosphere. 
• Remove triggers from the environment: Identify and remove or minimize components in the environment that might trigger BFRB. 

Psychiatry/Mental Health

Serotonin: It is a neurotransmitter that plays a role in mood regulation. SSRIs are believed to alleviate symptoms by improving the activity of serotonin. 

Sertraline and other SSRIs are indicated to treat various mental health conditions because of their ability to increase the concentration of serotonin in the brain.  

Psychiatry/Mental Health

N-acetylcysteine: It is an OTC medication which showed promising results in some studies to alleviate the symptoms of trichotillomania and other repetitive behaviours. 

Psychiatry/Mental Health

• CBT (Cognitive-behavioural therapy): In the world of Body Focused Repetitive Behaviors (BFRBs), Cognitive Behaviour Therapy (CBT) has proven to be one of the most researched and effective therapeutic approaches. CBT can identify and challenge distorted thoughts as well as beliefs associated with these behaviors. 
•  HRT (Habit reversal training): HRT is designed specifically for body-focused repetitive behaviours. It consists of awareness training which teaches people about their triggers or situations related with these behaviours. 
• DBT (Dialectical behaviour therapy): 
• DBT includes elements of CBT like mindfulness techniques and focuses on improving emotional regulation, distress tolerance and interpersonal effectiveness skills. 

Psychiatry/Mental Health

• Assessment phase: This phase involves the identification of symptoms of BFRB and a complete evaluation by a mental health professional. 
• Intervention phase: Disseminating information on BFRBs, their triggers and potential impact on mental health promotes insight and empowerment. 
• Behavioural interventions: The process of Habit Reversal Training (HRT) emphasizes on building recognition for these actions, sensing out causes as well as generating new counter-actions that can disrupt a cycle of custom. 
• Maintenance phase: Strategies to prevent relapse and maintain progress are monitored during the maintenance phase. For example, having psychotherapy sessions or continuation of using coping strategies in general and checking for signs of recurrence. 
• Regular follow-up: Regular visits to mental health practitioners help in tracking the treatment process, revising the plan when needful, and handling any new hurdles.