BFRBs and Physical Pain

In some cases, BFRBs may affect pain

If you live with a Body-Focused Repetitive Behaviour, you might experience a distressing extra layer that doesn’t get talked about enough: physical pain. Sensitive or sore fingers, tender skin, aching jaws, headaches, tight shoulders, to name just a few. The experience is like adding insult to injury.

BFRBs and OCDs can show up in physical and emotional pain

If you experience pain alongside BFRBs, please know that you needn’t feel alone. Together, we’ll gently explore the relationship between pain and BFRBs. The nervous system is playing a bigger role than most people consider. In our usual caring approach, we’ll look at the BFRB–pain link in a way that softens self-blame and opens the door to kinder, more effective support.

We’re resisting our BFRB urges without resisting LIFE … as a caring and supportive community.

BFRBs are often a result of being zoomed in on physical sensations, including pain

People with BFRBs often feel the urge to pull out hair or pick skin; similar to, but not the same, as OCD. In both BFRBs and OCD, people may experience repetitive thoughts or actions they feel compelled to do. OCD and BFRBs come from the same brain areas that handle habits (Flessner et al, 2012). BFRBs are more about relieving stress or feeling physical urges, while OCD is more about stopping scary thoughts (Grant & Chamberlain, 2016). They’re closely related, but require different treatment (Snorrason et al, 2015).

Research links OCD and chronic pain

Research has consistently shown that OCD and chronic pain are linked and often coexist. People with OCD are more likely to experience long-lasting physical pain, and people living with chronic pain show higher rates of obsessive–compulsive symptoms. If you experience BFRBs and chronic pain, you’re not imagining it and you don’t need to “snap out of it.” Both conditions involve an over-activated nervous system and shared brain circuits linked to looped behaviours, self-regulation, threat detection and discomfort.

When the brain stays on high alert for too long, cortisol can remain elevated and the nervous system becomes over-sensitised. This can amplify pain signals in the body, increase BFRB urges and catastrophic thinking. Recognising that this is not a weakness or a failure but a biologically driven process, can kick-start the healing process.

According to the Arthritis Foundation, anxiety and chronic pain often go hand in hand and feed each other. Anxiety accentuates pain, while ongoing pain stimulates over-thinking. Overthinking fuels OCD and BFRBs, forming a self-reinforcing loop: more pain, more vigilance; more vigilance, more pain. Understanding this loop helps us minimise self-blame so that we can calm the nervous system instead of criticising ourselves.

Self-Harm OCD

Most forms of BFRBs are in some form related to self-harm. It is harmful (although some might say mildly so) to pick at your skin or pull out your own hair. Eyelash pulling or pulling out finger or toenails might be more harmful due to infection risk. We’re here to listen and to help. Self-harm, in any format, is a method of SHORT-TERM self-regulation to deal with and distract from uncomfortable experiences and thoughts that feel unstoppable.

Breaking the BFRB Pain Loop

• 1. Acceptance

  • Acknowledge and validate your thoughts. Don’t worry about whether they are true or false, ask - are they helpful in this situation?
  • Don’t try to stop thinking about or feeling the pain: This is known in ACT as a Dead Man’s Goal. Trying to block compulsive or unhelpful thoughts can increase them - use distraction instead.
  • Accept that setbacks may occur. Almost everyone gives in to a compulsion now and again, this activates an opportunity to build a plan to interrupt the process next time.

• 2. Commitment

  • STAND UP TO YOUR BFRB. Don’t SIT with a BFRB in process. In class or at work you may have to stay seated if you find yourself picking, but if you can stand up and move your body, so much the better. If you cannot stand, make contact with the floor with your feet and take your attention into your toes.
  • FACE IT. It is natural to want to divert your attention from the problem but studies show that acknowledging and allowing sad and anxious feelings works best.

• 3. Therapy

  • Working with one of our coaches will help you achieve this.

Conclusion

Most painful sensations in the body are not signs of an illness or infection, but some are and they may be worth medically investigating. What matters is how we respond to pain when it shows up. For many people with BFRBs, pain is less a warning sign and more a message from a nervous system that has been on high alert for too long. When we understand pain as part of a stress–urge–relief loop, it becomes easier to meet it with curiosity rather than fear.

By calming the nervous system, softening self-criticism and staying connected to supportive others, we reduce both pain and urges over time. This isn’t about pushing through or ignoring your body — it’s about listening more kindly. You don’t have to do this perfectly, and you don’t have to feel isolated with it. Recovery can be a reality for you and can be done in small, compassionate steps, with a community such as coaching.care.