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Body-Focused Repetitive Disorders

Created on August 5, 2017. Last updated on March 6th, 2024 at 04:53 pm

Take me to the effective therapies for body-focused repetitive disorders

What are Body-focused Repetitive Behaviors?

Self-Injurious Thoughts and Behaviors logoBody-focused repetitive disorders (BFRD) are when a child causes harm to himself or herself through a habit. This can happen when the behavior occurs often or produces physical and/or mental health problems.

Examples of these disorders include:

  • Constant hair pulling
  • Skin picking
  • Nail biting
  • Cheek biting
  • Thumb sucking

That said, most cases of repetitive actions are common, harmless habits and are considered only body-focused repetitive behaviors.

Effective Therapies for Body-focused Repetitive Disorders

Treatment may be needed for children who experience severe cases of BFRD. Research supports the use of individual behavior therapy – often referred to as habit reversal therapy (HRT) – for chronic hair pulling and thumb sucking. There is some evidence that shows HRT may also be effective for skin picking, cheek biting, and nail biting. Cognitive behavior therapy (CBT) may be an option for chronic hair pulling and nail biting.

The chart below includes more information on the different evidence-based therapies for BFRD. These therapies have been ranked by the evidence that shows how effective they have been in the treatment of BFRDs.

Unfortunately, because there have not been many studies involving children and adolescents and because of differences between the available studies, health care providers and researchers have not been able to identify a therapy that works well.

That said, experts generally agree that HRT is the most effective treatment for BFRDs. Aside from HRT there are no other credible psychotherapeutic treatments. Habit reversal therapy is often included in cognitive behavior therapy.

Tested Therapies for Children and Adolescents
Levels Trichotillomania Excoriation Nail Biting Cheek Biting Thumb Sucking
Level One:
None None None None None
Level Two:
None None None None Behavior Therapy (HRT)
Level Three:
Might Work
Behavior Therapy (HRT) None None None None
Level Four:
Individual CBT Behavior Therapy (HRT) Behavior Therapy (HRT)

Multicomponent CBT

Behavior Therapy (HRT) None
Level Five:
Tested and Does Not Work
Individual massed
negative practice
 None  None  None  None

To find out more about how these treatment levels are defined, click here.

Therapies and Terms Defined:

  • CBT: cognitive behavioral therapy
  • HRT: habit reversal therapy

Source(s): Woods, D. W., & Houghton, D. C. (2016). Evidence-based psychosocial treatments for pediatric body-focused repetitive behavior disorders. Journal of Clinical Child and Adolescent Psychology, 45(3), 227-240.

Partner Sites:

Evidence-based Services Committee of Hawaii