Starboy the Wolf-Biter

Starboy's Personal BFRB Blog (he/him) ☆ Onychophagia ☆ Dermatophagia ☆ Dermatillomania ☆ With special guests: Anxiety ☆ Bipolar II ☆ ADHD

[wolfbitingstarboy]

BFRB Resources for Struggles Like Ours

These resources vary from reliable sites and blogs to published journal articles, professional papers, books, and more. If you have any recommendations for me, feel free to Submit something.

A separate post for tips, tricks, and non-affiliate product recommendations will be linked here as soon as I've posted it.

Now then, some of you may be wondering...

What is a BFRB?

Body-focused repetitive behaviors are among the most poorly understood, underdiagnosed, and untreated group of mental health disorders.

According to the TLC Foundation for BFRBs:

"Body-focused repetitive behaviors (BFRBs) include any repetitive self-grooming behavior that involves biting, pulling, picking, or scraping one’s own hair, skin, lips, cheeks, or nails that can lead to physical damage to the body and have been met with multiple attempts to stop or decrease the behavior."

(From the TLC Foundation's webpage, "What is a BFRB?")

The PickingMe Foundation says:

"BFRB's are self-grooming behaviors in which individuals pull, pick, scrape, or bite their own hair, skin, or nails, resulting in damage to the body. Many people are more familiar with its sister disorder, Trichotillomania - Hair Pulling Disorder."

(From the PickingMe Foundation's webpage, "What is Dermatillomania?")

The Recovery Village describes BFRBs as:

"Body-focused repetitive behaviors (BFRBs) are a group of mental health conditions that cause people to bite, pick, pull or scrape their skin, hair or nails compulsively. While some people with BFRBs have awareness and insight into their behaviors, others do them automatically. BFRBs are often linked with disorders like anxiety or substance abuse. Treatment is essential for people with BFRBs, but many often hide evidence of these harmful actions and have trouble asking for help."

(From The Recovery Village's webpage, "Body-Focused Repetitive Behaviors")

According to Angela Hartlin's skin-picking support website:

Body- Focused Repetitive Behaviours (BFRB’s) “is an umbrella term for any chronic behavior that causes a person to consistently cause physical damage to oneself unintentionally through a compulsive act in order to relieve anxiety.” The key difference between BFRB and other compulsive behaviours that cause harm to the body is that BFRBs are characterised by direct body-to-body contact. The website goes on to list other BFRBs such as: hair-pulling disorder (trichotillomania), hair eating disorder (trichophagia), skin biting disorder (dermatophagia), nail biting disorder (onychophagia), and nose picking disorder (rhinotillexomania).

Getting BFRBs officially classified as disorders has been a long, slow process that only hurts those of us who struggle with them daily, as treatments and available resources relating to BFRBs can be very difficult to find. That's the reason why I'm composing this. I'll keep updating this post to the best of my abilities, both for myself and for anyone else it might help.

The good news is that while progress may be slow, there is still progress. Dermatillomania was finally added to the DSM-V-TR under the same OCD-Related Disorders umbrella as Trichotillomania, which has been a big step in the right direction. The more awareness brought to BFRBs, the sooner more can be recognized for what they are so the people suffering from them can receive proper medical and psychiatric help where necessary.

Are BFRBs a type of self-harm?

No.

While the two are not mutually exclusive, the general consensus seems to be that where self-harm is voluntary, BFRBs are grooming behaviors that have gone awry to the point that they are categorized as "OCD-Related Behaviors" in the DSM-V-TR due to their compulsory nature. These behaviors may or may not be driven or worsened by anxiety.

In the case of BFRBs, even though these behaviors cause varying degrees of bodily harm, they're ultimately driven by impulses and urges that cannot easily be controlled. Quite often the triggering event is discovering a physical imperfection in any way for any reason and attempting to "fix" it, despite the behavior being counterintuitive to the goal. The resulting behavior can occur actively or passively, with severe active episodes usually likened to being held hostage in your own body.

There is no desire to harm and very little ability to stop, and then all of it is followed by distressing feelings such as shame, guilt, or embarrassment. We try so hard to "break the habit" that we ultimately beat ourselves up mentally for "failing" yet again. Even though many of us might know we can't control it, it's too easy to blame ourselves for something we feel is somehow our fault.

[Please be advised the purple paragraphs below are personal examples with a few details that may be triggering for some.]

For example, the only way I can come out of bad episodes is when my bodily literally cannot continue. This may look like my back giving out from leaning on the counter in the bathroom, or my legs going completely numb from sitting for too long, or (much more commonly) my fingers or nailbeds hurt too much for me to keep using them, regardless of how much I may or may not have bled.

This is always followed up by what I call the "walk of shame" phase as I clean up every injury, apply Neosporin or other balms/salves, and bandage what I can. I've burst into tears before when I had to use Neosporin like it was lotion in order to cover everything, because I had too many wounds on my arms to be able to safely apply bandages/plasters.

No part of that process, from the trigger response to the cleanup, is something I want to do. If I had a say in it, I'd never pick or bite ever again, and my skin would finally be able to heal.

Self-harm, on the other hand, is a term reserved for bodily harm that is deliberately inflicted on oneself, usually as a way of dealing with difficult emotions, memories, situations, or experiences. Instead of acting on an uncontrollable compulsion, this type of harm stems from a different set of triggers, many of which relate to trauma or other disorders. This makes the behavior more of an unhealthy coping mechanism for people in pain who are desperate for release from those feelings.

Note: If you are unsure if your behaviors are a result of a BFRB or self-harm, Crisis Text Line is a good resource:

"Self-harm is serious. And, while the intention behind self-harm usually is not death, it can still be dangerous—both physically and emotionally. Talking to someone who can help you find alternatives is incredibly important. Of course, you can start by texting us. Also, consider telling someone you know who can help you connect with a professional."

General BFRB Resources:

Sites:

The TLC Foundation - "The TLC Foundation for Body-Focused Repetitive Behaviors helps end isolation and shame for people experiencing hair pulling, skin picking, nail biting, cheek biting, and associated behaviors." They feature a robust website full of information on all BFRBs, including "Medications for BFRBs" and "Evidence-based Therapeutic Treatment for BFRBs."

The Recovery Village - "The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals." (BFRB-specific information can be found here.)

SkinPick.Com - While this site is centered around skin picking/excoriation disorder/dermatillomania, they have excellent resources for other BFRBs as well, including their Glossary page, "Complete List of BFRBs," and the blog section for "Related Disorders." I have also listed their site in the Dermatillomania section below.

Articles:

Online Journal: International Journal of Environmental Research and Public Health, Special Issue: "Body-Focused Repetitive Behaviours (BFRBs). Risk Factors, Prevention, Treatment"

The Recovery Village’s article, "7 Myths About Body-Focused Repetitive Behaviors"

The Recovery Village’s article, "8 Little Known Facts About Body-Focused Repetitive Behaviors"

Outreach:

"Health Education & Community Programs" (the TLC Foundation)

Communities & Support:

PickingMe Foundation's Online Support Group.

TLC Foundation's Support Group Directory for peer-led support groups.

SkinPick's online Forum.

Self-Help:

Nathan Peterson's ComB Model for BFRB Treatment, Part 1 and Part 2 on YouTube. Peterson is a licensed OCD specialist who helps people with OCD, anxiety, and BFRBs in person, through his OCD & Anxiety YouTube channel, and through his site, OCD-Anxiety.Com. (His BFRB specific course can be found on his site here.)

SkinPick's free self-guided program to stop skin-picking.

PickingMe Foundation's Derma Resource Packets "...are our campaign to spread Dermatillomania awareness to skin care providers (Dermatologists, Estheticians, Nail Salons, Clinicians), mental health professionals, and anyone who wants more info! We provide them with tools and the opportunity to point Skin Picking Disorder sufferers in the right direction."

PickingMe Foundation's Management Tips page, a "growing list of tips and management strategies!"

Mobile Apps:

SkinPick App – "A free tool to monitor your skin picking behaviors."

Specific BFRB Resources:

Onychophagia:

Not every instance of nail-biting is considered onychophagia. Most nail-biting behavior dissipates over time. It’s when it doesn’t that the behavior requires a closer look. Chronic nail-biting is categorized as an obsessive-compulsive related disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).

SkinPick's blog post, "Onychophagia: More Than a Nervous Habit"

"Art of Prevention: The importance of tackling the nail biting habit," authored by Mohsen Baghchechi BS, Janice L. Pelletier MD, FAAP, Sharon E. Jacob MD, FAAD, FAAP. Published in the International Journal of Women's Dermatology, Volume 7, Issue 3, June 2021, Pages 309-313.

"Update on Diagnosis and Management of Onychophagia and Onychotillomania," authored by Debra K. Lee and Shari R. Lipner. Published in the International Journal of Environmental Research and Public Health, 2022, 19, no. 6: 3392.

Dermatophagia:

Formerly referred to as "wolf-biting," dermatophagia has yet to be recognized as a diagnosable disorder.

SkinPick's blog post, "Do you eat your own skin after picking? There's a name for that."

SkinPick's blog post, "Dermatophagia - What is it?"

Dermatillomania:

Dermatillomania means “Skin Pulling Madness,” and has only been diagnosable since 2013. It is currently classified as an “Obsessive-Compulsive and related disorder” in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), where it is listed as Excoriation Disorder. However, it is known by many names, such as: Skin Picking Disorder, Compulsive Skin Picking, Acne Excoriée, Pathological Excoriation, Neurotic Excoriation, Pathological Skin Picking, and Psychogenic Excoriation. The many names for this disorder cause interference with its understanding and awareness.

Dermatillomania is often confused with other conditions. Common misdiagnoses result because the picking behavior is a result of a medical condition, confused with OCD, Body Dysmorphic Disorder (BDD) and in some cases, Non-suicidal Self-Injury (NSSI).

PickingMe Foundation - "Picking Me Foundation NFP is the only donor-supported non-profit dedicated to advocating for Dermatillomania (Skin Picking Disorder) sufferers, supporters, and educational communities alike, encouraging individuals to choose themselves over the mental illness that chose them by #PickingMe over Skin-Picking."

Angela Hartlin's Skin Picking Support website. Hartlin is the author of, "FOREVER MARKED: A Dermatillomania Diary" and the creator of the documentary, "Scars of Shame," which you can watch for free here with the password, "Scars1" (Thanks, Angela!)

SkinPick.Com - "SkinPick is the #1 platform to treat excoriation disorder (dermatillomania). Get one-on-one support from a therapist specializing in treating compulsive skin-picking through evidence-based techniques."

SkinPick's "Do I Have Dermatillomania?" Test

SkinPick's blog post. "Skin Picking and Body-Focussed Repetitive Behaviours (BFRB)"

Stuff That Works’ page, “Excoriation (Skin-Picking) Disorder”

Trichotillomania:

Probably the most famous BFRB, Trich has the most resources available thanks to being the first diagnosable BFRB. The resources below are more general as a result:

TrichStop - "TrichStop is the world’s leading platform for Trichotillomania treatment. Get one-on-one support from a therapist specializing in treating compulsive hair pulling through evidence-based techniques." From the same support team behind SkinPick.Com.

TrichStop's "Do I Have Trichotillomania?" Test

TrichStop's blog post, "Trich and Comorbid Disorders: What We Are Learning"

The TLC Foundation's Trichotillomania page.

"Trichotillomania," authored by Aubree D. Pereyra; Abdolreza Saadabadi. Published in StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. (Ongoing)

More to come.

There are more BFRBs than this out there, but I don't have the resources gathered for them yet. Hopefully the General resources help! I'll update this as I have time. In the meantime, I wish you all luck on your BFRB journeys.

-> Anxious? Try This:

[wolfbitingstarboy]

BFRB Resources for Struggles Like Ours

These resources vary from reliable sites and blogs to published journal articles, professional papers, books, and more. If you have any recommendations for me, feel free to Submit something.

A separate post for tips, tricks, and non-affiliate product recommendations will be linked here as soon as I've posted it.

Now then, some of you may be wondering...

What is a BFRB?

Body-focused repetitive behaviors are among the most poorly understood, underdiagnosed, and untreated group of mental health disorders.

According to the TLC Foundation for BFRBs:

"Body-focused repetitive behaviors (BFRBs) include any repetitive self-grooming behavior that involves biting, pulling, picking, or scraping one’s own hair, skin, lips, cheeks, or nails that can lead to physical damage to the body and have been met with multiple attempts to stop or decrease the behavior."

(From the TLC Foundation's webpage, "What is a BFRB?")

The PickingMe Foundation says:

"BFRB's are self-grooming behaviors in which individuals pull, pick, scrape, or bite their own hair, skin, or nails, resulting in damage to the body. Many people are more familiar with its sister disorder, Trichotillomania - Hair Pulling Disorder."

(From the PickingMe Foundation's webpage, "What is Dermatillomania?")

The Recovery Village describes BFRBs as:

"Body-focused repetitive behaviors (BFRBs) are a group of mental health conditions that cause people to bite, pick, pull or scrape their skin, hair or nails compulsively. While some people with BFRBs have awareness and insight into their behaviors, others do them automatically. BFRBs are often linked with disorders like anxiety or substance abuse. Treatment is essential for people with BFRBs, but many often hide evidence of these harmful actions and have trouble asking for help."

(From The Recovery Village's webpage, "Body-Focused Repetitive Behaviors")

According to Angela Hartlin's skin-picking support website:

Body- Focused Repetitive Behaviours (BFRB’s) “is an umbrella term for any chronic behavior that causes a person to consistently cause physical damage to oneself unintentionally through a compulsive act in order to relieve anxiety.” The key difference between BFRB and other compulsive behaviours that cause harm to the body is that BFRBs are characterised by direct body-to-body contact. The website goes on to list other BFRBs such as: hair-pulling disorder (trichotillomania), hair eating disorder (trichophagia), skin biting disorder (dermatophagia), nail biting disorder (onychophagia), and nose picking disorder (rhinotillexomania).

Getting BFRBs officially classified as disorders has been a long, slow process that only hurts those of us who struggle with them daily, as treatments and available resources relating to BFRBs can be very difficult to find. That's the reason why I'm composing this. I'll keep updating this post to the best of my abilities, both for myself and for anyone else it might help.

The good news is that while progress may be slow, there is still progress. Dermatillomania was finally added to the DSM-V-TR under the same OCD-Related Disorders umbrella as Trichotillomania, which has been a big step in the right direction. The more awareness brought to BFRBs, the sooner more can be recognized for what they are so the people suffering from them can receive proper medical and psychiatric help where necessary.

Are BFRBs a type of self-harm?

No.

While the two are not mutually exclusive, the general consensus seems to be that where self-harm is voluntary, BFRBs are grooming behaviors that have gone awry to the point that they are categorized as "OCD-Related Behaviors" in the DSM-V-TR due to their compulsory nature. These behaviors may or may not be driven or worsened by anxiety.

In the case of BFRBs, even though these behaviors cause varying degrees of bodily harm, they're ultimately driven by impulses and urges that cannot easily be controlled. Quite often the triggering event is discovering a physical imperfection in any way for any reason and attempting to "fix" it, despite the behavior being counterintuitive to the goal. The resulting behavior can occur actively or passively, with severe active episodes usually likened to being held hostage in your own body.

There is no desire to harm and very little ability to stop, and then all of it is followed by distressing feelings such as shame, guilt, or embarrassment. We try so hard to "break the habit" that we ultimately beat ourselves up mentally for "failing" yet again. Even though many of us might know we can't control it, it's too easy to blame ourselves for something we feel is somehow our fault.

[Please be advised the purple paragraphs below are personal examples with a few details that may be triggering for some.]

For example, the only way I can come out of bad episodes is when my bodily literally cannot continue. This may look like my back giving out from leaning on the counter in the bathroom, or my legs going completely numb from sitting for too long, or (much more commonly) my fingers or nailbeds hurt too much for me to keep using them, regardless of how much I may or may not have bled.

This is always followed up by what I call the "walk of shame" phase as I clean up every injury, apply Neosporin or other balms/salves, and bandage what I can. I've burst into tears before when I had to use Neosporin like it was lotion in order to cover everything, because I had too many wounds on my arms to be able to safely apply bandages/plasters.

No part of that process, from the trigger response to the cleanup, is something I want to do. If I had a say in it, I'd never pick or bite ever again, and my skin would finally be able to heal.

Self-harm, on the other hand, is a term reserved for bodily harm that is deliberately inflicted on oneself, usually as a way of dealing with difficult emotions, memories, situations, or experiences. Instead of acting on an uncontrollable compulsion, this type of harm stems from a different set of triggers, many of which relate to trauma or other disorders. This makes the behavior more of an unhealthy coping mechanism for people in pain who are desperate for release from those feelings.

Note: If you are unsure if your behaviors are a result of a BFRB or self-harm, Crisis Text Line is a good resource:

"Self-harm is serious. And, while the intention behind self-harm usually is not death, it can still be dangerous—both physically and emotionally. Talking to someone who can help you find alternatives is incredibly important. Of course, you can start by texting us. Also, consider telling someone you know who can help you connect with a professional."

General BFRB Resources:

Sites:

The TLC Foundation - "The TLC Foundation for Body-Focused Repetitive Behaviors helps end isolation and shame for people experiencing hair pulling, skin picking, nail biting, cheek biting, and associated behaviors." They feature a robust website full of information on all BFRBs, including "Medications for BFRBs" and "Evidence-based Therapeutic Treatment for BFRBs."

The Recovery Village - "The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals." (BFRB-specific information can be found here.)

SkinPick.Com - While this site is centered around skin picking/excoriation disorder/dermatillomania, they have excellent resources for other BFRBs as well, including their Glossary page, "Complete List of BFRBs," and the blog section for "Related Disorders." I have also listed their site in the Dermatillomania section below.

Articles:

Online Journal: International Journal of Environmental Research and Public Health, Special Issue: "Body-Focused Repetitive Behaviours (BFRBs). Risk Factors, Prevention, Treatment"

The Recovery Village’s article, "7 Myths About Body-Focused Repetitive Behaviors"

The Recovery Village’s article, "8 Little Known Facts About Body-Focused Repetitive Behaviors"

Outreach:

"Health Education & Community Programs" (the TLC Foundation)

Communities & Support:

PickingMe Foundation's Online Support Group.

TLC Foundation's Support Group Directory for peer-led support groups.

SkinPick's online Forum.

Self-Help:

Nathan Peterson's ComB Model for BFRB Treatment, Part 1 and Part 2 on YouTube. Peterson is a licensed OCD specialist who helps people with OCD, anxiety, and BFRBs in person, through his OCD & Anxiety YouTube channel, and through his site, OCD-Anxiety.Com. (His BFRB specific course can be found on his site here.)

SkinPick's free self-guided program to stop skin-picking.

PickingMe Foundation's Derma Resource Packets "...are our campaign to spread Dermatillomania awareness to skin care providers (Dermatologists, Estheticians, Nail Salons, Clinicians), mental health professionals, and anyone who wants more info! We provide them with tools and the opportunity to point Skin Picking Disorder sufferers in the right direction."

PickingMe Foundation's Management Tips page, a "growing list of tips and management strategies!"

Mobile Apps:

SkinPick App – "A free tool to monitor your skin picking behaviors."

Specific BFRB Resources:

Onychophagia:

Not every instance of nail-biting is considered onychophagia. Most nail-biting behavior dissipates over time. It’s when it doesn’t that the behavior requires a closer look. Chronic nail-biting is categorized as an obsessive-compulsive related disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).

SkinPick's blog post, "Onychophagia: More Than a Nervous Habit"

"Art of Prevention: The importance of tackling the nail biting habit," authored by Mohsen Baghchechi BS, Janice L. Pelletier MD, FAAP, Sharon E. Jacob MD, FAAD, FAAP. Published in the International Journal of Women's Dermatology, Volume 7, Issue 3, June 2021, Pages 309-313.

"Update on Diagnosis and Management of Onychophagia and Onychotillomania," authored by Debra K. Lee and Shari R. Lipner. Published in the International Journal of Environmental Research and Public Health, 2022, 19, no. 6: 3392.

Dermatophagia:

Formerly referred to as "wolf-biting," dermatophagia has yet to be recognized as a diagnosable disorder.

SkinPick's blog post, "Do you eat your own skin after picking? There's a name for that."

SkinPick's blog post, "Dermatophagia - What is it?"

Dermatillomania:

Dermatillomania means “Skin Pulling Madness,” and has only been diagnosable since 2013. It is currently classified as an “Obsessive-Compulsive and related disorder” in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), where it is listed as Excoriation Disorder. However, it is known by many names, such as: Skin Picking Disorder, Compulsive Skin Picking, Acne Excoriée, Pathological Excoriation, Neurotic Excoriation, Pathological Skin Picking, and Psychogenic Excoriation. The many names for this disorder cause interference with its understanding and awareness.

Dermatillomania is often confused with other conditions. Common misdiagnoses result because the picking behavior is a result of a medical condition, confused with OCD, Body Dysmorphic Disorder (BDD) and in some cases, Non-suicidal Self-Injury (NSSI).

PickingMe Foundation - "Picking Me Foundation NFP is the only donor-supported non-profit dedicated to advocating for Dermatillomania (Skin Picking Disorder) sufferers, supporters, and educational communities alike, encouraging individuals to choose themselves over the mental illness that chose them by #PickingMe over Skin-Picking."

Angela Hartlin's Skin Picking Support website. Hartlin is the author of, "FOREVER MARKED: A Dermatillomania Diary" and the creator of the documentary, "Scars of Shame," which you can watch for free here with the password, "Scars1" (Thanks, Angela!)

SkinPick.Com - "SkinPick is the #1 platform to treat excoriation disorder (dermatillomania). Get one-on-one support from a therapist specializing in treating compulsive skin-picking through evidence-based techniques."

SkinPick's "Do I Have Dermatillomania?" Test

SkinPick's blog post. "Skin Picking and Body-Focussed Repetitive Behaviours (BFRB)"

Stuff That Works’ page, “Excoriation (Skin-Picking) Disorder”

Trichotillomania:

Probably the most famous BFRB, Trich has the most resources available thanks to being the first diagnosable BFRB. The resources below are more general as a result:

TrichStop - "TrichStop is the world’s leading platform for Trichotillomania treatment. Get one-on-one support from a therapist specializing in treating compulsive hair pulling through evidence-based techniques." From the same support team behind SkinPick.Com.

TrichStop's "Do I Have Trichotillomania?" Test

TrichStop's blog post, "Trich and Comorbid Disorders: What We Are Learning"

The TLC Foundation's Trichotillomania page.

"Trichotillomania," authored by Aubree D. Pereyra; Abdolreza Saadabadi. Published in StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. (Ongoing)

More to come.

There are more BFRBs than this out there, but I don't have the resources gathered for them yet. Hopefully the General resources help! I'll update this as I have time. In the meantime, I wish you all luck on your BFRB journeys.

-> Anxious? Try This:

[fi-bro-no]

This is why I love tumblr. I feel seen in a way that my family never seen me before.

[wolfbitingstarboy]

I see you, friend! 🫂💖

[fi-bro-no]

🫂🖤💜🖤 Fang-k you 😸 (went for the pun. #sorryNotSorry #DadHumour)

[wolfbitingstarboy]

Ha! Perfection. 😂👌

[wolfbitingstarboy]

BFRB Resources for Struggles Like Ours

These resources vary from reliable sites and blogs to published journal articles, professional papers, books, and more. If you have any recommendations for me, feel free to Submit something.

A separate post for tips, tricks, and non-affiliate product recommendations will be linked here as soon as I've posted it.

Now then, some of you may be wondering...

What is a BFRB?

Body-focused repetitive behaviors are among the most poorly understood, underdiagnosed, and untreated group of mental health disorders.

According to the TLC Foundation for BFRBs:

"Body-focused repetitive behaviors (BFRBs) include any repetitive self-grooming behavior that involves biting, pulling, picking, or scraping one’s own hair, skin, lips, cheeks, or nails that can lead to physical damage to the body and have been met with multiple attempts to stop or decrease the behavior."

(From the TLC Foundation's webpage, "What is a BFRB?")

The PickingMe Foundation says:

"BFRB's are self-grooming behaviors in which individuals pull, pick, scrape, or bite their own hair, skin, or nails, resulting in damage to the body. Many people are more familiar with its sister disorder, Trichotillomania - Hair Pulling Disorder."

(From the PickingMe Foundation's webpage, "What is Dermatillomania?")

The Recovery Village describes BFRBs as:

"Body-focused repetitive behaviors (BFRBs) are a group of mental health conditions that cause people to bite, pick, pull or scrape their skin, hair or nails compulsively. While some people with BFRBs have awareness and insight into their behaviors, others do them automatically. BFRBs are often linked with disorders like anxiety or substance abuse. Treatment is essential for people with BFRBs, but many often hide evidence of these harmful actions and have trouble asking for help."

(From The Recovery Village's webpage, "Body-Focused Repetitive Behaviors")

According to Angela Hartlin's skin-picking support website:

Body- Focused Repetitive Behaviours (BFRB’s) “is an umbrella term for any chronic behavior that causes a person to consistently cause physical damage to oneself unintentionally through a compulsive act in order to relieve anxiety.” The key difference between BFRB and other compulsive behaviours that cause harm to the body is that BFRBs are characterised by direct body-to-body contact. The website goes on to list other BFRBs such as: hair-pulling disorder (trichotillomania), hair eating disorder (trichophagia), skin biting disorder (dermatophagia), nail biting disorder (onychophagia), and nose picking disorder (rhinotillexomania).

Getting BFRBs officially classified as disorders has been a long, slow process that only hurts those of us who struggle with them daily, as treatments and available resources relating to BFRBs can be very difficult to find. That's the reason why I'm composing this. I'll keep updating this post to the best of my abilities, both for myself and for anyone else it might help.

The good news is that while progress may be slow, there is still progress. Dermatillomania was finally added to the DSM-V-TR under the same OCD-Related Disorders umbrella as Trichotillomania, which has been a big step in the right direction. The more awareness brought to BFRBs, the sooner more can be recognized for what they are so the people suffering from them can receive proper medical and psychiatric help where necessary.

Are BFRBs a type of self-harm?

No.

While the two are not mutually exclusive, the general consensus seems to be that where self-harm is voluntary, BFRBs are grooming behaviors that have gone awry to the point that they are categorized as "OCD-Related Behaviors" in the DSM-V-TR due to their compulsory nature. These behaviors may or may not be driven or worsened by anxiety.

In the case of BFRBs, even though these behaviors cause varying degrees of bodily harm, they're ultimately driven by impulses and urges that cannot easily be controlled. Quite often the triggering event is discovering a physical imperfection in any way for any reason and attempting to "fix" it, despite the behavior being counterintuitive to the goal. The resulting behavior can occur actively or passively, with severe active episodes usually likened to being held hostage in your own body.

There is no desire to harm and very little ability to stop, and then all of it is followed by distressing feelings such as shame, guilt, or embarrassment. We try so hard to "break the habit" that we ultimately beat ourselves up mentally for "failing" yet again. Even though many of us might know we can't control it, it's too easy to blame ourselves for something we feel is somehow our fault.

[Please be advised the purple paragraphs below are personal examples with a few details that may be triggering for some.]

For example, the only way I can come out of bad episodes is when my bodily literally cannot continue. This may look like my back giving out from leaning on the counter in the bathroom, or my legs going completely numb from sitting for too long, or (much more commonly) my fingers or nailbeds hurt too much for me to keep using them, regardless of how much I may or may not have bled.

This is always followed up by what I call the "walk of shame" phase as I clean up every injury, apply Neosporin or other balms/salves, and bandage what I can. I've burst into tears before when I had to use Neosporin like it was lotion in order to cover everything, because I had too many wounds on my arms to be able to safely apply bandages/plasters.

No part of that process, from the trigger response to the cleanup, is something I want to do. If I had a say in it, I'd never pick or bite ever again, and my skin would finally be able to heal.

Self-harm, on the other hand, is a term reserved for bodily harm that is deliberately inflicted on oneself, usually as a way of dealing with difficult emotions, memories, situations, or experiences. Instead of acting on an uncontrollable compulsion, this type of harm stems from a different set of triggers, many of which relate to trauma or other disorders. This makes the behavior more of an unhealthy coping mechanism for people in pain who are desperate for release from those feelings.

Note: If you are unsure if your behaviors are a result of a BFRB or self-harm, Crisis Text Line is a good resource:

"Self-harm is serious. And, while the intention behind self-harm usually is not death, it can still be dangerous—both physically and emotionally. Talking to someone who can help you find alternatives is incredibly important. Of course, you can start by texting us. Also, consider telling someone you know who can help you connect with a professional."

General BFRB Resources:

Sites:

The TLC Foundation - "The TLC Foundation for Body-Focused Repetitive Behaviors helps end isolation and shame for people experiencing hair pulling, skin picking, nail biting, cheek biting, and associated behaviors." They feature a robust website full of information on all BFRBs, including "Medications for BFRBs" and "Evidence-based Therapeutic Treatment for BFRBs."

The Recovery Village - "The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals." (BFRB-specific information can be found here.)

SkinPick.Com - While this site is centered around skin picking/excoriation disorder/dermatillomania, they have excellent resources for other BFRBs as well, including their Glossary page, "Complete List of BFRBs," and the blog section for "Related Disorders." I have also listed their site in the Dermatillomania section below.

Articles:

Online Journal: International Journal of Environmental Research and Public Health, Special Issue: "Body-Focused Repetitive Behaviours (BFRBs). Risk Factors, Prevention, Treatment"

The Recovery Village’s article, "7 Myths About Body-Focused Repetitive Behaviors"

The Recovery Village’s article, "8 Little Known Facts About Body-Focused Repetitive Behaviors"

Outreach:

"Health Education & Community Programs" (the TLC Foundation)

Communities & Support:

PickingMe Foundation's Online Support Group.

TLC Foundation's Support Group Directory for peer-led support groups.

SkinPick's online Forum.

Self-Help:

Nathan Peterson's ComB Model for BFRB Treatment, Part 1 and Part 2 on YouTube. Peterson is a licensed OCD specialist who helps people with OCD, anxiety, and BFRBs in person, through his OCD & Anxiety YouTube channel, and through his site, OCD-Anxiety.Com. (His BFRB specific course can be found on his site here.)

SkinPick's free self-guided program to stop skin-picking.

PickingMe Foundation's Derma Resource Packets "...are our campaign to spread Dermatillomania awareness to skin care providers (Dermatologists, Estheticians, Nail Salons, Clinicians), mental health professionals, and anyone who wants more info! We provide them with tools and the opportunity to point Skin Picking Disorder sufferers in the right direction."

PickingMe Foundation's Management Tips page, a "growing list of tips and management strategies!"

Mobile Apps:

SkinPick App – "A free tool to monitor your skin picking behaviors."

Specific BFRB Resources:

Onychophagia:

Not every instance of nail-biting is considered onychophagia. Most nail-biting behavior dissipates over time. It’s when it doesn’t that the behavior requires a closer look. Chronic nail-biting is categorized as an obsessive-compulsive related disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).

SkinPick's blog post, "Onychophagia: More Than a Nervous Habit"

"Art of Prevention: The importance of tackling the nail biting habit," authored by Mohsen Baghchechi BS, Janice L. Pelletier MD, FAAP, Sharon E. Jacob MD, FAAD, FAAP. Published in the International Journal of Women's Dermatology, Volume 7, Issue 3, June 2021, Pages 309-313.

"Update on Diagnosis and Management of Onychophagia and Onychotillomania," authored by Debra K. Lee and Shari R. Lipner. Published in the International Journal of Environmental Research and Public Health, 2022, 19, no. 6: 3392.

Dermatophagia:

Formerly referred to as "wolf-biting," dermatophagia has yet to be recognized as a diagnosable disorder.

SkinPick's blog post, "Do you eat your own skin after picking? There's a name for that."

SkinPick's blog post, "Dermatophagia - What is it?"

Dermatillomania:

Dermatillomania means “Skin Pulling Madness,” and has only been diagnosable since 2013. It is currently classified as an “Obsessive-Compulsive and related disorder” in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), where it is listed as Excoriation Disorder. However, it is known by many names, such as: Skin Picking Disorder, Compulsive Skin Picking, Acne Excoriée, Pathological Excoriation, Neurotic Excoriation, Pathological Skin Picking, and Psychogenic Excoriation. The many names for this disorder cause interference with its understanding and awareness.

Dermatillomania is often confused with other conditions. Common misdiagnoses result because the picking behavior is a result of a medical condition, confused with OCD, Body Dysmorphic Disorder (BDD) and in some cases, Non-suicidal Self-Injury (NSSI).

PickingMe Foundation - "Picking Me Foundation NFP is the only donor-supported non-profit dedicated to advocating for Dermatillomania (Skin Picking Disorder) sufferers, supporters, and educational communities alike, encouraging individuals to choose themselves over the mental illness that chose them by #PickingMe over Skin-Picking."

Angela Hartlin's Skin Picking Support website. Hartlin is the author of, "FOREVER MARKED: A Dermatillomania Diary" and the creator of the documentary, "Scars of Shame," which you can watch for free here with the password, "Scars1" (Thanks, Angela!)

SkinPick.Com - "SkinPick is the #1 platform to treat excoriation disorder (dermatillomania). Get one-on-one support from a therapist specializing in treating compulsive skin-picking through evidence-based techniques."

SkinPick's "Do I Have Dermatillomania?" Test

SkinPick's blog post. "Skin Picking and Body-Focussed Repetitive Behaviours (BFRB)"

Stuff That Works’ page, “Excoriation (Skin-Picking) Disorder”

Trichotillomania:

Probably the most famous BFRB, Trich has the most resources available thanks to being the first diagnosable BFRB. The resources below are more general as a result:

TrichStop - "TrichStop is the world’s leading platform for Trichotillomania treatment. Get one-on-one support from a therapist specializing in treating compulsive hair pulling through evidence-based techniques." From the same support team behind SkinPick.Com.

TrichStop's "Do I Have Trichotillomania?" Test

TrichStop's blog post, "Trich and Comorbid Disorders: What We Are Learning"

The TLC Foundation's Trichotillomania page.

"Trichotillomania," authored by Aubree D. Pereyra; Abdolreza Saadabadi. Published in StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. (Ongoing)

More to come.

There are more BFRBs than this out there, but I don't have the resources gathered for them yet. Hopefully the General resources help! I'll update this as I have time. In the meantime, I wish you all luck on your BFRB journeys.

-> Anxious? Try This:

[fi-bro-no]

This is why I love tumblr. I feel seen in a way that my family never seen me before.

[wolfbitingstarboy]

I see you, friend! 🫂💖

[wolfbitingstarboy]

It's my 1 year anniversary on Tumblr 🥳

I didn't realize it'd been that long. I should be more active... 🤔

[wolfbitingstarboy]

Weekly Check-In #2

This one is more bi-weekly, but that's fine. Progress, even in small amounts, is still progress.

My stress lately has been through the roof, so my fingers look like utter garbage right now. I have a few spots on my arms I've been picking at, but my legs and chest are more or less healed now.

Sometimes I wonder what it would be like to not bite or pick. What would that look like? What would it feel like? Sometimes I wonder what it will take to accomplish that, and other times I remember that BFRBs aren't something you generally recover from, but that you recover with. They won't just stop being there, but they can become manageable.

Anyways, that's enough out of me for now. See you later. :)

[wolfbitingstarboy]

Weekly Check-In #1

I have to start somewhere, right?

My arms are healing, which is excellent, but I did have to put on a hydrocolloid bandage to keep myself away from one particularly difficult spot. I have a spot on my face as well, but I've noticed that using my hydrocolloid patches helps me stay away from that, too.

Otherwise, my skin, while scarred from pickings past, is fairly clear. I've noticed that having a semi-regular skincare routine has helped a lot with keeping it clear.

However, my nails and fingers are trashed right now. I haven't bled much over the last week, thankfully, but my nails are ragged and my cuticles are pretty gnarly, too. The picking seems to be worsened by my anxiety, but I don't know yet what triggers the biting. I just sort of always do it if my hands aren't occupied, I guess. I catch myself biting a lot more lately, so I know stress can't be ruled out.

My mini goal is to make it to my support group meeting tomorrow. Since it's virtual, that shouldn't be an issue.

My longer-term goal is to keep up with these check-ins. Let's see what happens. :)

[wolfbitingstarboy]

Starboy's Story

TW: Blood, Nail-biting/picking, Skin-biting/picking, Body Focused Repetitive Behaviors. Be advised that BFRBs are not a form of self-harm, however they may be very uncomfortable to hear about for people sensitive to stories containing self-harm. Thank you.

So, I've always been known for my love of research, to the point that my sister usually calls me a research monkey whenever I fall down a journal article hole. Even with all of my attempts to stop my "bad habits" and the years of research I've poured into them, I never realized BRFBs existed, purely because there's just so little information out there. So, I think it's safe to say that I never expected to discover them through Etsy, of all places.

This is my story.

I started biting and picking my nails at such a young age that I don't remember a time when I didn't. The earliest memory I have about my nails is when I was told not to pick at them by my mom, so of course I started biting them instead because it wasn't picking and I was born a smart ass.

Another time, my parents took me to a doctor that I recall being about as different from my pediatrician as you could get; where my pediatrician was the same short, round, ferociously protective Filipina doctor that delivered me, this new doctor was tall, slim, and felt detached somehow. He asked me to show him my hands, and I remember instinctively holding them behind my back, already aware that what he wanted to see were my ravaged nails. I'd never before felt the sort of shame about my "habit" as I did when he finally looked them over. He never said a word to me, only took notes. At some point, he turned to my folks, but whatever he said to them back then is lost to time now.

Biting and picking my nails at some point became biting and picking the skin around them and my cuticles, which eventually turned into biting the skin on my hands and lower arms to clear away any other "imperfections" I couldn't attack one-handed. Whether it was a blemish, an ingrown hair, a bit of dead or peeling skin, or even if I just spotted the slightest bump or a hair slightly too dark or thick, things would quickly devolve and whatever it had been would be replaced by a new wound.

Over the next handful of years, I became personally familiar with an unfortunately wide variety of textures and types of scabs and scars my behaviors led me to create. I can look at a scab and tell you if the skin underneath is healed "enough" to pick it off without bleeding and be right probably 95% of the time. The same goes for identifying signs of possible infection before they fully set in; when I saw the signs, I would always re-open, sanitize, and add Neosporin and a band-aid to treat the wound site, and very rarely did those signs return.

Looking back, how I managed to get this far without getting incredibly sick as a result of my BFRBs is shocking. Before the pandemic, I always washed my hands whenever I went to the bathroom or they got dirty, or if I was bleeding, but I wasn't especially diligent about it otherwise and just kind of went with the flow.

Fast-forward to somewhere around September of 2022. I was browsing Etsy for subversive "Hello My Name Is..." badges, and found a shop full of buttons saying things like, "Hello, I am asthmatic, not contagious," and something entirely new to me: "Hello I Have Dermatophagia, Dont' Ask About My Fingers/Nails." (Shop link at the end of the post.)

I knew enough to know "dermatophagia" translates to skin-eating, but that was it. I was fascinated. The shop had another one, "Hello I Have Dermatillomania, Don't Ask About My Hands." I wrote those words down and immediately looked them up. That was when I learned that Body-Focused Repetitive Behaviors are A Thing(TM), and not only that but that they're largely misunderstood, underdiagnosed, and untreated.

I finally worked up the courage to join a support group at the start of the year, and spent at least ten minutes of my first session sobbing because I'd never before heard the words, "This disorder is not a character flaw or any fault of your own. It doesn't define us or control us, it's simply part of us and something we recover with rather than from." I was floored.

It turns out there are a lot of us out there, and most of us have never heard the term "Body-Focused Repetitive Behavior" before. That's why I decided to make this blog. I want to share my story and struggles and hope that maybe someone who needs the resources that I have will find it. If nothing else, it's a great outlet and will help me spread awareness.

So if you read this entire thing, thank you for starting this new journey with me.

TL;DR - I found the words "dermatophagia" and "onychophagia" in a cool little shop on Etsy, discovered what BFRBs are, and learned that me being unable to "break the habit" without professional help didn't mean that I was a failure at life. :)

That shop is Doodlepeople on Etsy. You can find their "Hello I Am/Have" buttons here.

[wolfbitingstarboy]