BFRBs: Not OCD, Not Self Harm. How and Why.

BFRBs: Not OCD, Not Self Harm. How and Why.
While is there overlap of BFRBs with OCD and Cutting, there are key differences that a crucial for effective treatment and to respect the self concept of the person with a BFRB.

Body Focused Repetitive Behaviors, often shortened within this community as BFRBs are frequently misunderstood by well meaning others in attempt to link BFRBs with something they are already familiar. I do appreciate and welcome the efforts of someone new to BFRBs wanting to learn more. Unfortunately, the tendency to lump BFRBs into something known instead of remaining open in a beginners mindset, is quickly counterproductive.

Don’t get me wrong, I get how having a point of reference as a comparative to build an understanding has value. Especially when you have transferable skills from OCD or Self Harm coping skills that can apply quite nicely. What is important is that this is a starting point to continue to learn about BFRBs, to remain curious about the nuances as it applies to each person living with one, and to deepen your understanding with a full respect of this distinct category of disorders classified as BFRBs.

What harm does it do?

I see the harm of assumptions and lumping together when I am sitting with clients. Regularly they process feeling dismissed, unseen, minimized, or not cared for when someone says, “Oh, that’s just like cutting.” or “Yeah, OCD, I know it.” or “I get it, self harm.” That labeling, or mislabeling to be more accurate, feels like a stopping point to the person reduced to what is “close enough” to the person claiming to want to help. And sometimes they are right, it is a stopping point. The person who assumes they “get it” doesn’t look further and just keeps treating them, clinically or as a friend responding to a friend, as if they have a disorder that they don’t.

More so, in the clinical community, one can jump in to apply OCD or Self harm treatments to the person with the BFRB. The person seeking help can be taught by a trusted professional about themselves in a way that is just not true. While they may collect a few general therapeutic tools along the way, the can do real harm to the person seeking help. Some OCD and Self harm approaches make BFRBs worse!

Further more, when it is discussed in the media or online as if BFRBs were OCD or Self harm, both people suffering in silence with a BFRB and uninformed clinicians seeking information will come across this and point them the wrong direction.  Family members may get their false assumptions validated by this inaccurate information and go back to the person with the BFRB yelling about “stop hurting yourself to hurt me” (can happen with cutting, not what BFRBs are about at all) or nagging them about worry and anxiety (OCD trigger, but not always BFRB trigger) that might not be there. We need accurate and updated media support of people with BFRBs and the research, not reinforced old myths or pop culture stereotypes.

How different are they? Enough that while I specialize in supporting clients with BFRBs for a decade now, I consider  both OCD and Self Harm completely out of my scope of competency. They are different enough that I had to research to adequately and concisely answer how they are same and different because I didn’t know enough about OCD or Self Harm. I found myself frustrated and at a loss for words when inevitably asked this directly at every psychology conference I attend. And now here it is summarized.

Body Focused Repetitive Behaviors (BFRB’s) include:

  • Trichotillomania (Hair Pulling Disorder)
  • Excoriation (Skin Picking Disorder), formerly referred to as Dermatillomania or Chronic Skin Picking
  • Nail Biting
  • Cheek Chewing
  • Lip Biting

What BFRBs have in Common with OCD and Self Harm, AND How they are Distinct

vendiagram illustrating what bfrb ocd and self harm have in common and different
There is overlap of BFRBs with OCD and Cutting, but there are key differences that a crucial for effective treatment and to respect the self concept of the person with a BFRB.


  • OCD ( but can co-occur)
  • Self Harm-Cutting
  • Meth Addiction (although can co-occur)
  • Compulsive Masturbation
  • Personality Disorders (Actually BFRBs are LESS likely to have a personality disorder)
  • Body Dysphoria (Absolutely can co-occur)

I hope this helps friends and family members of people with BFRBs better understand their loved ones. I hope it helps clinicians provide better support to their clients with BFRBs. I hope it helps people living with a BFRB better understand themselves and more clearly advocate for themselves when they come out about having a BFRB. I hope. Of course it is difficult to speak absolutely about any label or disorder because there is always diversity, nuance, and a spectrum of variation in every situation.

Priscilla Elliott is a Licensed Professional Counselor and Somatic Experiencing Practitioner in south Austin. She owns and provides psychotherapy at Courage Counseling, PLLC. While specializing in helping clients who are struggling with trauma, trichotillomania, and/or skin picking disorder; she also supports many in life transitions, anxiety, and depression. Call now for help: 512-673-3987