What are BFRBs
This article explains the criteria for diagnosis and discusses how BFRBs (Body Focused Repetitive Behaviors) can be better clarified internationally.
What are BFRBs
The World Health Organisation lists Body-Focused Repetitive Behaviors (BFRBs) under “Obsessive-Compulsive and Related Disorders”. Trichotillomania (hair-pulling) and skin-picking are recognised in ICD-11 (International Classification of Diseases).
BFRBs include:
Hair-pulling, eyelash or eyebrow pulling, cheek-chewing, teeth grinding or jaw clenching (bruxism), skin-picking, nail-biting, finger-biting or lip-picking? Perhaps just splitting hair ends? Other BFRBS. We are here to help!
International Classification
The American Psychiatric Association’s DSM 5 Manual describes Trichotillomania and Dermatillomania as mental health disorders characterized by hair pulling and skin picking. They are generally grouped grouped together, with beard hair pulling, biting lips, cheeks and fingers, and nail biting as body focused repetitive behaviour or BFRBs.- To qualify as trichotillomania, hair pulling must be recurrent and repetitive.
- It must cause distress or problems in social or other functional areas of life.
Problems With International Classification
The word “recurring” is used, however there is clearly a compulsive element in most cases. The manual states that it cannot be explained by another condition, but there is very high cross-diagnosis with OCD, social anxiety and generalised anxiety as well as ASD.
Hair pulling is unusual, but it is not madness. It is not a disease but a condition, which at least in some is genetic in origin. Many people pull hair or eyelashes to remedy what they think are flaws and hairs “growing in wrongly”, the “wrong texture” or ingrown hairs, yet the manual states that it is not dysmorphic.
The final criteria for trichotillomania is that it must cause distress or problems in social or other functional areas of life. This is not true in all cases and particularly not in babies, who can also present with trichotillomania.
Most commonly, people pull hair from their eyelashes, eyebrows and/or the scalp, and they can also pull from the pubic region, pets and other people. These conditions are secretive in nature and often attempts will be made to hide signs of hair loss. It can be hard to comprehend what BFRBs are, because it sometimes leads to social withdrawal.