Understanding Body-Focused Repetitive Behaviors (BFRBs) in Children

Understanding Body-Focused Repetitive Behaviors (BFRBs) in Children

By: Ruby Koontz, LMHC-A | PILLARS OF WELLNESS

How BFRBs Can Impact Families

For many families, body-focused repetitive behaviors (BFRBs) seem to appear out of nowhere. A parent may notice a child’s thinning eyelashes, constant nail biting, or small sores from skin picking and wonder what’s really going on. Children often describe feeling an urge they can’t fully explain, and many feel embarrassed or frustrated when they’re told to stop but can’t. What looks like a simple habit on the surface can be evidence of a much bigger, underlying issue.

What Are Body-Focused Repetitive Behaviors (BFRBs)?

Body-focused repetitive behaviors (BFRBs) are repetitive self-grooming behaviors that involve damaging the body, such as skin picking, hair pulling, nail biting, or cheek biting. These behaviors are often linked to anxiety, stress, OCD, sensory processing needs, or difficulty regulating emotions. While they may provide temporary relief or comfort, they can become difficult to control and may interfere with daily life, self-esteem, and relationships.

The Emotional Toll on Families

For parents, watching a child struggle with a BFRB can feel heartbreaking. Many describe feeling helpless when reminders like “just stop” don’t work. Some families find themselves caught in cycles of monitoring, correcting, and worrying, which can unintentionally increase stress for everyone involved. Without their family being able to understand the behaviors, children with BFRBs often become experts at hiding it.

The emotional impact can be significant. Kids may avoid school photos, sports, sleepovers, or social activities because they fear judgment. Parents may spend hours researching treatments, replacing bandages, covering bald spots, or trying to protect their child’s self-esteem. Over time, even well-meaning support can become emotionally exhausting.

BFRBs Are More Than “Bad Habits”

What’s important to remember is that BFRBs are not “bad habits” or signs of poor parenting. These behaviors are complex and deeply connected to emotional regulation and the nervous system. Compassion, education, and appropriate support make a tremendous difference.

Families often find relief when they shift from punishment and shame toward curiosity and understanding. Open conversations, therapy approaches like habit reversal training, sensory support, and reducing stress at home can help children feel safer and more empowered. Just as importantly, parents benefit from support too, because caring for a child with a BFRB can be isolating.

Support and Treatment Can Help

There are practical ways families can support a child with a BFRB at home. Reducing repeated reminders like “stop doing that” can help lower shame and anxiety. Instead, parents can focus on calm observation, curiosity, and open conversations about urges and triggers.

Sensory supports such as fidget tools, textured materials, or worry stones may also help children redirect restless hands while building awareness of their behaviors. Most importantly, responding with empathy rather than criticism can normalize these experiences and help children feel safe discussing their experiences.

Professional support can make a meaningful difference. Treatment often focuses on helping children understand triggers, increase awareness of urges, strengthen emotional regulation, and develop healthier coping strategies.

Evidence-based approaches may include:

Habit Reversal Training (HRT)
Helps children recognize early warning signs and practice alternative responses to interrupt pulling, picking, or biting behaviors.

Cognitive Behavioral Therapy (CBT)
Supports children in identifying thoughts, emotions, and stressors that may contribute to BFRBs while building healthier coping skills.

Parent Support and Family Education
Helps caregivers reduce shame, avoid power struggles, and respond in ways that support progress at home.

How Pillars of Wellness Can Help

At Pillars of Wellness, our therapists work collaboratively with children and families to understand the emotional, behavioral, and sensory factors contributing to BFRBs. Using evidence-based, child-centered approaches, we help children build awareness, strengthen emotional regulation, and replace repetitive behaviors with healthier responses.

We also help parents practice reducing shame, avoid power struggles, and have open conversations with their children to support them through this process. Consistent support and evidence-based treatment help children experience reduced BFRB symptoms, improved self-esteem, and greater confidence in managing stress.

If your child is struggling with a body-focused repetitive behavior, you don’t have to navigate it alone. Schedule an appointment today or call us at (219) 462-0037 to learn more about how we can support your family.