BFRBs? Start Here
A primer on Body Focused Repetitive Behaviors
If you’ve ever felt stuck in a cycle of pulling, picking, biting, or scratching, and at a loss as to why your efforts so far haven’t helped you stop, you’re not alone. These behaviors, called Body-Focused Repetitive Behaviors (BFRBs), include hair pulling (trichotillomania), skin picking (excoriation disorder), nail biting, cheek biting, and others. They often start as a way to cope, focus, or soothe, but at a certain point they can start to cause damage. By then, they can feel automatic and hard to control.
BFRBs are common in the neurodivergent community, tending to co-occur with OCD, ADHD, and autism, so I’ve invested time in training and research to be able to offer support.
The good news is that there is a well-researched treatment called ComB (Comprehensive Behavioral Model) that helps you understand your unique patterns and then make small, targeted changes that work for you.
I find that most people benefit from an acceptance and compassion process at the very beginning, that can help them see and avert the judgment and shame struggle with their BFRBs that compounds symptoms. This process really benefits from a therapist or guide, or process like a mindful self compassion group. However, in the meantime, the ComB model can give anyone a head start to work on their own, especially if they are feeling ready to take action.
Central to the ComB modality is an organizing tool called SCAMP, that helps us learn to notice the different factors that lead up to and keep a BFRB going.
What is SCAMP?
SCAMP is an acronym and simple way to remember the five domains that can influence your BFRBs. In technical terms, SCAMP sets you up for functional analysis. We assume that the behavior serves a function and follows a pattern, and try to understand first, rather than fix or judge.
SCAMP stands for:
Sensation – What physical sensations are you feeling before or during the behavior? This could be tingling, dryness, itchiness, tension in your muscles, or even the texture of your hair or skin. Sometimes the sensation itself is what draws you into the behavior.
Cognition – What thoughts or mental images are happening? This might be self-critical thoughts (“I can’t stand the way this looks”), perfectionistic thoughts (“I need to smooth this out”), or just mind-wandering.
Affect – What emotions are you feeling? Stress, boredom, anxiety, frustration, and even excitement can be triggers. Sometimes, there’s a mix of emotions or even a numbed-out feeling.
Motor – What movements are already in motion? Many BFRBs are partly muscle-memory—your hands may be moving toward your hair or skin before you even realize it. You might have certain “rituals” or ways of positioning your body that make the behavior easier to start.
Place – Where are you? Certain environments, like sitting at your desk, lying in bed, or being in the bathroom, can be high-risk spots for engaging in the behavior. Also think about time of day here, and anything in the environment that sets up or cues the BFRB.
How SCAMP Helps You build awareness needed for change
The goal of engaging in SCAMP and functional analysis is to notice patterns. When you can identify which SCAMP domains are most involved in your BFRB cycle, you can start experimenting with small changes that interrupt it.
For example:
If Sensation is a big trigger, you might use lotion, fidget toys, or change clothing textures.
If Cognition is a key factor, you might practice noticing and defusing from thoughts, getting curious about your thoughts, and introducing other perspectives.
If Affect (emotion) is driving the behavior, you can learn emotional regulation and self-soothing tools, or engage in problem solving that can support the unsolved problems triggering emotions.
If Motor habits take over, you might keep your hands busy with alternative movements or find a way to block the process (ie gloves, removal of tools, hats, hydrocolloid patches).
If Place is the biggest cue, rearranging your environment or setting up barriers and positive cues can make a big difference.
Why Start Here
BFRBs often feel mysterious because they don’t always respond to willpower alone. SCAMP gives you a way to make sense of what’s happening and see that these behaviors follow a pattern and serve a function. That means they can be changed.
By mapping your behaviors through SCAMP, you’re building the foundation for a personalized plan to replace the behavior with something that meets the same need, without harming yourself.
If you live with a BFRB, you don’t have to figure it out alone. Working with a therapist trained in ComB can help you go step-by-step, using SCAMP as your roadmap toward recovery.
Already in Therapy?
It is common for a person to be in therapy working on other goals and not even mention their BFRB. For one thing, they might not realize it has its own diagnosis and treatment model; for another, their BFRB may not be high in the hierarchy of things they’re working on, or may seem impossible to stop. I have noticed that BFRBs are hard to talk about, and the symptoms might not rise to my awareness as a clinician unless I directly ask. I want folks to know that even if your therapist isn’t a specialist in this area, there are providers out there who can do adjunctive work with you, as well as self-help resources that are of great support.
You might be wondering about root causes for BFRBs, or already working on these in therapy. Excess stress, a tendency to dissociate or avoid feelings, perfectionism and self-criticism, and feeling socially isolated, anxiety, grief, or struggling with a loss of autonomy or role change can all be life factors that contribute to BFRB intensity and frequency. Working on these issues in therapy can also be very supportive of managing BFRB symptoms.
I hope that these ideas give you some first helpful steps that you can take. If you haven’t already reached out to see if my services might be a fit, you can do so here.
Appendix
Here is the ComB self-help manual detailing this method: Overcoming Body-Focused Repetitive Behaviors
BFRB.org has a ton of self-help resources, a provider directory, and support groups: https://www.bfrb.org/
