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Medication for BFRBs
An in-depth investigation into progress in the field of medication for BFRBs, including surveys of real people who have tried treatments for hair pulling, skin picking and other BFRBs, alongside the latest scientific research. Throughout the page, we clearly distinguish between lived experience and scientific research.
While some studies support medication as a treatment for body-focused repetitive behaviours (BFRBs), each person’s biological makeup is different and what works for one person will not necessarily work for another.On this page you will read about some examples of using medication to successfully treat BFRBs. Of particular interest are treatments that target the body’s glutamate system. This system includes receptors and pathways in the brain and spinal cord which use glutamate as a neurotransmitter to send messages to the brain. Glutamate is the main chemical that stimulates nerve activity in the central nervous system, and it is needed for healthy brain function, learning, and memory. Glutamate also creates other neurotransmitters; those facilitating healthy sleep, anxiety regulation, and muscle function. Having too much glutamate can cause conditions such as dementia and fibromyalgia, while issues in producing or using glutamate can lead to mental health disorders such as depression and obsessive-compulsive disorder (OCD) (Cleveland Clinic, 2022).
Can Medication Help BFRBs?
There is currently no medication specifically approved for the treatment of BFRBs. That does not mean medication cannot help. In some cases BFRBs go alongside anxiety, and in these cases anti-anxiety medication can help for some. Some medicines and supplements have shown promising results in research, while others may help indirectly by treating conditions such as anxiety, depression or OCD which exist alongside a BFRB.
And importantly, BFRBs are not all the same.
The evidence for medication in trichotillomania is different from the evidence for skin-picking disorder. Nail biting has its own, much smaller body of research. For cheek chewing, medication research is remarkably sparse.That's why we've separated the evidence rather than assuming that something which helps one BFRB will automatically help another.
Researchers have become interested in whether altering glutamate signalling might help reduce BFRB urges and behaviours.Two treatments you will encounter frequently in current BFRB research — N-acetylcysteine (NAC) and memantine — affect the glutamate system in different ways.
N-Acetylcysteine (NAC) 🧑🔬
N-Acetylcysteine (NAC)
N-acetylcysteine (NAC) is a supplement that replenishes glutathione (the body’s main antioxidant) in the brain and is known for reducing oxidative stress (Tenório et al., 2021). NAC targets the glutamate system by modulating, or controlling, glutamate levels in the brain.
NAC is particularly interesting for a general BFRB page because, unlike many medications, it has been investigated across several different BFRBs.
A review by Lee and Lipner examined NAC research involving trichotillomania, skin-picking disorder, nail biting and nail picking. Results have been encouraging in some studies but inconsistent in others.
This matters.
“NAC has been studied for BFRBs” does not mean “NAC has been proven to stop every BFRB.”
The quality and quantity of evidence varies considerably depending on the behaviour.
Many people find NAC helpful in reducing their BFRBs, but ideally, a full nutritional programme should be tailored to the individual by qualified personnel.
Medication and nail biting
Nail biting — or onychophagia — has received considerably less research attention than hair pulling or skin picking, but there is some direct medication research.
NAC and nail biting 🧑🔬
A randomised placebo-controlled trial studied 42 children and adolescents with nail biting.
Those taking NAC showed significantly greater nail growth than the placebo group after one month. However, by two months there was no significant difference between the groups.
That makes this an interesting finding rather than proof that NAC is an effective long-term treatment for nail biting.
Adverse effects were also reported in two participants receiving NAC, including headache, agitation and social withdrawal in one participant and severe aggression in another.
This is particularly important when discussing supplements: being available without prescription does not mean something is automatically suitable or risk-free for everyone.
Clomipramine and nail biting 🧑🔬
Clomipramine has also been studied specifically for nail biting.
In a small 10-week double-blind crossover study involving 25 people, clomipramine performed better than the antidepressant desipramine on measures of nail-biting severity and impairment.
However, side effects were common and 11 of the 25 participants dropped out.
A 2025 systematic review of nail biting confirms that pharmacological treatments remain part of the research picture, but behavioural approaches continue to be extremely important.
So there is scientific evidence that medication may influence nail biting — but it is a much smaller and less certain evidence base than we have for some other BFRBs.
Medication and cheek chewing
Cheek chewing or chronic cheek biting — sometimes called morsicatio buccarum — is recognised as a body-focused repetitive behaviour.
People may repeatedly bite or chew the inside of the cheek, sometimes trying to remove a rough area or achieve a feeling of smoothness. Unfortunately, the biting itself can create irregular or damaged tissue, which can then produce another trigger to bite.
What does medication research tell us? 🧑🔬
At present, very little.
We have searched specifically for clinical research into medication for chronic cheek chewing and have not found good controlled medication trials specifically for this BFRB.
Clinical information about morsicatio buccarum instead tends to recommend habit-changing and stress-reduction approaches. BFRB specialists similarly emphasise behavioural treatment.
That absence of evidence is worth reporting.
It doesn’t prove that medication can never help somebody who cheek chews. For example, a person might be prescribed medication for a co-existing condition and notice that their BFRB changes too.
But that would be very different from saying:
“This medication has been demonstrated to treat cheek chewing.”
At present, we don’t have the scientific evidence to say that.
Lived experience matters here 🙋♂️
This is precisely where lived-experience information can become particularly valuable.
Where scientific research has barely investigated a BFRB, reports from people who actually experience it can identify questions researchers have not yet answered.
We will therefore distinguish carefully between what people tell us has helped their cheek chewing and what has been demonstrated in clinical research.
Lived experience can point us towards possibilities. It doesn’t magically turn those possibilities into scientific proof.
Both kinds of information are valuable — they simply answer different questions.
What about other BFRBs?
Research becomes increasingly sparse once we move beyond trichotillomania, skin picking and nail biting.
That presents a problem because BFRB is an umbrella term, not one single behaviour.
Research involving people who pull their hair cannot automatically tell us how a medication affects somebody who bites their lips, chews their tongue or picks their nails.
Where research exists, we’ll tell you.
Where we only have lived experience, we’ll tell you that too.
And where we simply don’t know yet, we’ll say we don’t know.
SSRIs and antidepressants
SSRIs are commonly used to treat depression and anxiety and have been explored for BFRBs. However, evidence regarding their effectiveness is mixed.
This distinction is particularly important because somebody can experience a BFRB alongside anxiety, depression or OCD.
A medication may successfully treat one of those conditions without necessarily treating the BFRB itself.
Equally, reducing anxiety or another difficulty could conceivably make someone’s BFRB easier to manage.
That is one reason medication decisions need to be individual rather than based simply on the name of the BFRB.
Medication alongside behavioural treatment
While not a medication, it is important to highlight that behavioural therapies, particularly the Comprehensive Behavioural Model (ComB), have demonstrated effectiveness in managing BFRBs.
Medication and behavioural treatment do not necessarily have to compete.
Medication might reduce urges or help with another condition. Behavioural approaches can help you understand when, where and why your BFRB happens and develop practical alternatives.
For some people one approach may be enough. Others may find a combination more useful.
So rather than simply asking:
“Which medication stops BFRBs?”
a more useful question may be:
“What combination of support helps me manage my BFRB?”
Scientific research 🧑🔬 and lived experience 🙋♂️
We think both matter.
Scientific trials can help establish whether an apparent improvement is actually associated with a treatment rather than coincidence, expectation or other factors.
But trials also deal in averages.
A treatment which helps a significant proportion of people may do absolutely nothing for another person.
Lived experience tells us something different. It tells us what using a treatment is actually like, what people noticed, what they disliked and sometimes what researchers haven’t thought to ask.
Throughout our medication information we therefore identify which type of evidence you’re reading:
🧑🔬 Scientific research — findings from published studies and clinical evidence.
🙋♂️ Lived experience — experiences reported by people who have actually tried the treatment.
One doesn’t need to masquerade as the other for both to be useful.
Before trying medication or supplements
Each person’s biological makeup is different and therefore must be treated uniquely by a medical professional.
Please discuss prescription medication, changes to existing medication and appropriate supplementation with a suitably qualified healthcare professional.
This is particularly important for children and young people, during pregnancy, when taking other medication, or when other physical or mental health conditions are present.
And please remember: “natural”, “supplement” and “available without prescription” do not mean “risk-free”.
References
American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, 5th ed., text revision (DSM-5-TR).
Lee, D.K. & Lipner, S.R. (2022). The potential of N-acetylcysteine for treatment of trichotillomania, excoriation disorder, onychophagia, and onychotillomania: An updated literature review. International Journal of Environmental Research and Public Health, 19(11), 6370.
Tenório, M.C.D.S. et al. (2021). N-acetylcysteine (NAC): Impacts on human health. Antioxidants, 10(6), 967.
Lipner, S.R. & Scher, R.K. (2022). Update on diagnosis and management of onychophagia and onychotillomania. International Journal of Environmental Research and Public Health, 19(6), 3392.
Perez-Stable, C.T. et al. (2025). Onychophagia: A Comprehensive Systematic Review of Prevalence and Treatment Modalities. Journal of Cutaneous Medicine and Surgery.
Additional references for the individual trichotillomania and skin-picking medication studies are provided on their respective medication pages.