Body-Focused Repetitive Behaviors

Skin picking, hair pulling, nail biting, and similar behaviors are not just habits. They are often complex, patterned responses that serve a purpose, even if that purpose is not always clear. Many people who struggle with BFRBs feel alone, ashamed, or frustrated. You might find yourself zoning out during the behavior or feeling a sense of relief or focus when it happens—only to be overwhelmed by guilt or distress afterward.

These behaviors are not about willpower. They are not about vanity or self-destruction. They are coping strategies that have developed over time, often as a way to regulate nervous system states, manage emotions, or create a sense of control.

This is not just a bad habit. It is a signal. And therapy can help you listen to it with compassion.

A Personalized Approach: The ComB Model

I use the Comprehensive Behavioral (ComB) treatment model, a research-informed and person-centered approach designed specifically for BFRBs. The ComB model helps us understand why the behavior happens, not just what it looks like.

We explore five key domains that can contribute to hair pulling, skin picking, or other repetitive behaviors:

  • the physical sensations involved before, during, and after the behavior

  • thoughts or beliefs that accompany the urge

  • emotional states that might trigger the behavior

  • physical patterns or gestures that become automatic

  • environmental or situational cues that make the behavior more likely

By understanding your unique profile across these areas, we can develop tools and supports that are tailored to you. This might include sensory substitutions, emotional regulation strategies, habit tracking, and environmental shifts that reduce cues or increase your sense of agency.

This approach is collaborative, gentle, and never about shame.

This Is a Space for Understanding, Not Judgment

Living with a BFRB can affect your confidence, your relationships, and your self-image. You may have tried to stop countless times and felt discouraged when it did not stick. But there is nothing wrong with you. You are doing your best to self-soothe, and there are other ways to do that, ones that align with your values, your body, and your goals.

Therapy is a space to build those new pathways with patience and support.

If you are ready to explore what healing can look like, I offer a free consultation to help us begin.