Body-Focused Repetitive Behaviours (BFRBs) comprise a cluster of chronic neurobehavioral conditions including Trichotillomania (compulsive hair pulling), Excoriation Disorder (compulsive skin picking), and Onychophagia (severe nail biting). Driven by basal ganglia dysregulation and sensorimotor regulation attempts, BFRBs involve repetitive physical manipulation of one’s own body resulting in physical tissue damage (alopecia, scarring, infections) accompanied by repeated unsuccessful attempts to stop. Grounded in Nathan Azrin and R. Gregory Nunn’s Habit Reversal Training (HRT) and the Comprehensive Behavioral (ComB) model by Charles Mansueto, the Body-Focused Repetitive Behaviours Psychoeducation Module offers 20 structured video lessons detailing sensory awareness, motor competing responses, and stimulus control.
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The Functional Mechanics: Automatic vs. Focused Pulling/Picking
BFRBs are not forms of self-harm or suicidal gestures; rather, they serve as maladaptive homeostatic regulators of the nervous system. The behavior occurs across two distinct modalities:
- Automatic (Low Awareness): Engaging in pulling or picking during passive, sedentary activities (watching television, reading, driving) without conscious cognitive awareness.
- Focused (High Awareness): Deliberately seeking out specific asymmetrical hairs, coarse textures, or skin blemishes to achieve a sensory “release” or soothing sensation.
The 3 Pillars of Habit Reversal Training (HRT)
- Awareness Training: Learning to detect early premonitory urges—such as fingers scanning the scalp, sensory tingling, or emotional boredom.
- Competing Response Training: Immediately engaging in a physically incompatible motor behavior (e.g., clenching fists, holding a stress ball, sitting on hands) for 1 to 2 minutes upon feeling the urge.
- Stimulus Control: Altering the physical environment to make picking/pulling difficult (wearing finger bandages, reducing mirror proximity, using sensory fidget toys).
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