Body-Focused Repetitive Behaviours (BFRBs) are a group of disorders characterised by repetitive, compulsive actions that can cause physical damage and significant distress. These behaviours often emerge as coping mechanisms for stress, anxiety, or other emotional states. 

The BFRB Scale provides a framework for understanding the severity and variety of these behaviours, ranging from mild to severe. Below is a detailed breakdown of the BFRB Scale:

 1. Over Plucking Eyebrows

Description: Excessive plucking of eyebrows.
Severity: Mild
Impact: This behaviour is often noticeable to others but typically does not cause severe physical damage.

2. Scalp Pulling Only, Begins in Adulthood and Only Rarely Occurs

Description: Occasional hair pulling from the scalp, starting in adulthood.
Severity: Mild
Impact: Rare occurrences with minimal physical or psychological impact.

3. Moderate Skin Picking, Never on Face or Hands

Description: Regular skin picking, avoiding the face and hands.
Severity: Moderate
Impact: Can lead to noticeable skin damage on other parts of the body, potentially causing scarring and infections.

4. Hair Pulling from Hidden Areas Only, Skin Picking Including Hands But Not Face and Neck

Description: Hair pulling from areas that are usually covered and skin picking that includes hands but avoids the face and neck.
Severity: Moderate to Severe
Impact: Significant potential for physical harm and psychological distress, as these areas can still be visible to others.

 5. Cheek Chewing, Bruxism, Tongue Chewing, Not Noticed by Others

Description: Habitual chewing of the cheeks, grinding teeth, or chewing the tongue.
Severity: Moderate
Impact: Often unnoticed by others but can cause dental and oral health issues.

6. Childhood Onset and Specific Types

6.1 Baby Tric: Hair pulling beginning before age 5, typically resolving by ages 8 or 9.
Severity: Mild
Impact: Often outgrown, minimal long-term effects.

6.2 Scalp Trichotillomania: Hair pulling from the scalp resulting in up to 25% baldness.
Severity: Moderate
Impact: Can be noticeable and cause significant distress.

6.3 Beard Pulling:
Severity: Moderate
Impact: Noticeable in adult males, can cause patches of baldness.

7. Specific BFRBs

7.1 Skin Picking Without Other BFRBs:
Severity: Moderate to Severe
Impact: Can cause significant physical damage without the presence of other BFRBs.

7.2 Eyelash Pulling:
Severity: Moderate
Impact: Noticeable and can cause distress due to cosmetic concerns.

8. Severe Hair Pulling Leading to Significant Baldness

Description: Hair pulling resulting in more than 26% baldness, often linked to familial mental health issues.
Severity: Severe
Impact: Major physical and psychological effects, including social stigma and self-esteem issues.

9. Combination of Two or More BFRBs/OCDs

Description: Presence of multiple BFRBs or co-occurring with Obsessive-Compulsive Disorder (OCD).
Severity: Severe
Impact: Complex condition with significant impact on daily functioning and mental health.

10. Severe Combination and Additional Impulse Control Issues

10.1 Multiple BFRBs and Twitching, Possible Signs of Borderline Personality Disorder (BPD):
Severity: Severe
Impact: Highly complex, involving both physical and psychological challenges.

10.2 Noticeable Impulse Control Problems in Multiple Areas of Life:
Severity: Severe
Impact: Extensive impact on personal, social, and professional life.

The BFRB Scale serves as a crucial tool for understanding the breadth and depth of body-focused repetitive behaviours. Recognising where an individual’s behaviours fall on this scale can help guide appropriate interventions and support. If you or someone you know is struggling with BFRBs, it is important to seek professional help to address these behaviours and their underlying causes.