Habit Disorders

Body-Focused, Repetitive Behavior (BFRB)

BFRB disorders can be considered types of obsessive-compulsive disorder (OCD), because of the compulsive urge to perform repetitive behaviors. BFRB include “self-grooming” behaviors—such as hair pulling or skin picking that can damage the body–and can also be disruptive nervous habits, such as thumb sucking, body rocking, stuttering or tapping fingers.

At some point, BFRBs change from mild, nervous habits to serious problems needing treatment. Some criteria:

- Repetitive, non-cosmetic hair removal from anywhere on the body (trichotillomania) or skin picking (dermatillomania), taking up a lot of time during the day
- Multiple, unsuccessful attempts to decrease or stop the behavior
- Interferes with physical, emotional or social functioning, such as avoiding the beach or gym or spending time covering up sores (skin picking) before work or social events
- Hair pulling or skin picking may cause noticeable scars and marks on the skin and are not caused by other medical conditions, such as psoriasis or eczema

Trichotillomania or hair-pulling disorder (HPD)

This chronic condition affects up to 4% of the population and typically begins during early adolescence. It is categorized by non-cosmetic removal of hair despite repeated attempts to stop, accompanied by distress or impairment.

Individuals often pull their hair in different ways that can change over time. They may do so without conscious awareness or due to uncomfortable emotions or sensations. It commonly co-occurs with other BFRBs (i.e., skin picking), obsessive-compulsive disorder (OCD), depression, substance use or anxiety.

Dermatillomania or skin-picking disorder (excoriation)

This condition—for example, picking a scab or the skin around the nails—can become so frequent and intense that it causes bleeding, sores and scars. Some with this disorder repeatedly scratch to try to remove what they see as imperfection in their skin.

Skin-picking disorder—which happens in both children and adults and can begin at almost any age—often develops in one of two ways:

After some kind of rash, skin infection, or small injury. A person may pick at the skin, which keeps the wound from healing. More itching leads to more picking and more scabbing, and the cycle continues.
During a time of stress, a person may absently pick at a scab or the skin around the nails and find the repetitive action helps relieve stress. It then becomes a habit.

Nervous Habit Disorders

Most children show repetitive patterns of movement, but these “habits” are only considered disorders if they interfere with their physical, emotional or social functioning. Habit patterns can begin as purposeful movement and, through repetition, lose their original significance, becoming instead a means of discharging tension.

Nervous habits are gestures, movements or actions that may be benign and short-lived. They can include:

Head banging, leg shaking, body rocking
Touching hair or ears
Thumb sucking, teeth grinding
Cheek chewing, nail biting, biting parts of own body
Taping fingers, fidgety fingers
Repetitive vocalization, stuttering, air swallowing

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