Biting, scratching, and hair-pulling... but not in a sexy way.
Updated: Oct 19, 2021
I remember being a senior in high school when a new show premiered on TLC: My Strange Addiction. At the time, I found it entertaining. I had no idea that there were people in the world that were "addicted" to plastic surgery, sucking their thumbs, or pulling their hair. I actually remember thinking, "why on EARTH would anyone choose to pull their hair out?"
Now that time has passed and I've educated myself on mental health, I now know that this show was nothing but a mockery of people with serious mental illnesses. (The show has since been cancelled.) Maybe the point of the show was to educate, but I personally feel that this point was a far miss if that's what producers were aiming for. I specifically remember classmates talking about the show at school and laughing at the people on the show - I'm ashamed to admit that I was among them.
They're not Addictions; they're Body-Focused Repetitive Behaviors
Fast forward eleven years after high school, and I'm now 28-years-old with an impressive* amount of mental health experience under my belt (*see: "not really impressive"; "actually kind of concerning"). Just before my 25th birthday, I was diagnosed with ADHD-C (Combined Type), Depression, and Generalized Anxiety Disorder (GAD). Being the Researcher-at-Heart that I am, I took to the internet to learn everything I could about my diagnoses: scientific articles, podcasts, blogs, YouTube videos... That's when I stumbled upon Tracy Otsuka's podcast: ADHD for Smart Ass Women. One episode in particular really stuck out to me: Body-Focused Repetitive Behaviors (BFRBs; Episode 34). In the episode, she talked about habits such as skin-picking, nail-biting, and hair-pulling. I was immediately reminded of the TLC show I watched in high school.
"Ah-ha!" I thought. "So there is a name for it!" I was intrigued to hear that nail-biting and skin-picking were in the same category as hair-pulling. It seemed a bit more extreme than the other two, which I was/am guilty of both - skin-picking more than nail-biting. (I'm very much a "germophobe" and I can't stand the thought of biting my nails with GodKnowsWHAT under there!) But I do spend an excessive amount of time picking at my skin: pimples, ingrown hairs, blackheads, etc.
What are Body-Focused Repetitive behaviors?
It's important to understand that BFRBs are not addictions, habits, or tics, per se. Instead they are compulsive behaviors that cause physical damage to oneself (1). Some of the most common BFRB's include:
1. Trichotillomania (compulsive hairpulling disorder; 2)
This can include pulling hair from one's scalp, eyelashes, eyebrows, or anywhere else on the body (arms, legs, abdomen, pubic region, chest, beard, etc.)
2. Dermatillomania/Excoriation Disorder (skin-picking; 2)
This can include picking at "imperfections" on one's face/body, such as pimples, scabs, cysts, blackheads, ingrown hairs, moles, cuticles, etc.
3. Onychophagia (nail-biting; 2)
This is defined as biting your own toe/fingernails to the point of bleeding and/or causing ingrown nails.
4. Dermatophagia (compulsive skin-biting; 2)
Most people's first thought when they hear of this BFRB is that affected individuals are going around biting the skin on their arms and hands. While this may be the case for a very small population of people that struggle with this BFRB, it most commonly refers to those that compulsively bite their cheeks, tongue, and lips.
5. Rhinotillexomania (compulsive nose-picking; 2)
This can refer to picking the actual boogie-oogs inside one's nose, or it could refer to the picking of the skin inside the nose. For example, someone may compulsively pick at a scab inside their nose in the dry season, never letting it fully heal.
6. Trichophagia (compulsive urge to eat one's own hair; 2)
As with Trichotillomania, this can refer to any hair's on a person's body. However, Trichophagia most commonly refers to those that have the urge to eat hairs plucked from their own scalp.
How common are BFRBs?
It's believed that at least 5% of people, globally, have struggled with at least one BFRB in their lifetime (2). However, I personally believe that this is majorly underestimated. Because BFRBs typically cause physical damage, many people that struggle with them are embarrassed about their BFRB(s) and try to hide the damage that has been done.
Why don't they just... stop doing it?
The problem with BFRBs is that they're compulsive. This means that the person has an uncontrollable urge to do the behavior, even though they know that it's damaging. Sometimes, people don't even realize they're doing the behavior. BFRB's can be brought on by a specific trigger, whether that's a stressful or anxiety-inducing event, a traumatic or stressful memory, etc. In this sense, anyone can be affected by BFRBs if the trigger is intense enough. It's just part of The Vicious Cycle:
But, I'm sure you noticed by now that you're on an ADHD website, so there must be a link between ADHD and BFRBs... right?
ADHD and Body-Focused Repetitive Behaviors
To put things simply, people with ADHD have wonky brain chemistry. The science isn't completely in yet, but scientists believe that people with ADHD lack dopamine, and/or dopamine receptors, and/or dopamine transporters. Dopamine is a neurotransmitter in the brain that's heavily associated with the Pleasure and Reward center. This means that when we do something that feels good, rewarding, or fulfilling, our brains are flooded with dopamine. People with ADHD have a hard time reaching the point of The Dopamine Flood, so our brains are constantly looking for ways to find that dopamine and hang on to it.
Enter Stage Left: Body-Focused Repetitive Behaviors
BFRBs tend to be dopamine-inducing, which means that our brains get a hit of dopamine when we pluck a hair from our scalps or pick that 6-month scab from our knees yet again. People that don't have ADHD (ie Neurotypicals; ie Blessed with Dopamine), are less prone to developing BFRBs because they don't necessarily need the dopamine that BFRBs provide. (Please note, though, that I'm not saying neurotypicals can't develop them. They can most certainly fall victim to BFRBs if they have anxiety, trauma, or are under a lot of stress.)
But, ADHD brains, on the other hand... they can't get enough dopamine. So, when our brains realize that dopamine is within reach, and all it has to do is command us to pick at the ingrown hairs on our legs or pluck our eyebrows into oblivion... all bets are off the table. The dopamine that floods the ADHD brain when a hair is pulled or a nail is gnawed on? Unbeatable.
If you struggle with Body-Focused Repetitive Behaviors, please know that you are not alone. It may feel that way, but that's only because many people aren't comfortable talking about it yet. If you're trying to quit, I'd recommend bring up this topic with your doctor to see if they have any useful suggestions.
Many people have found that Fidgeting products help them kick the habit of nail-biting, hair-pulling, etc. (You can find a list of different products here.) Others have found that therapy is a useful tool for coping with their BFRB(s). Everyone is different, and that applies to coping mechanisms as well.
Wherever your BFRB journey takes you, remember three things:
Your BFRB habits do not define you.
You are not alone.