How common are body-focused repetitive behaviours?

A lot of people pick at their skin, pull out hair, or bite their nails or the inside of their cheeks. For most it is a passing habit. For some it becomes hard to stop, leaves visible damage, and brings a quiet sense of shame that keeps it hidden — often even from a GP. These are body-focused repetitive behaviours (BFRBs), and because they are so easy to conceal, it is reasonable to ask how common they actually are.

What the research looked at

This study surveyed 1,378 adults from the general community — not a clinic sample — and asked about skin picking, hair pulling, nail biting, and lip or cheek biting and chewing. It then compared people who reported a probable BFRB with those who did not, across measures of depression, anxiety, obsessive-compulsive symptoms, body-image concerns and quality of life.

What it found

Close to one in four people — 23 per cent — reported a probable BFRB. Skin picking was the most common at around 14 per cent, followed by nail biting and lip or cheek biting at roughly 6 per cent each, and hair pulling at about 2 per cent.

People with a probable BFRB scored higher on every clinical measure the study looked at, and reported reduced quality of life in some areas. There were few differences between the different behaviours themselves, which led the authors to a useful conclusion: all of these behaviours are worth taking seriously, not just the ones with an obvious name. Skin picking stood out as possibly one of the more severe presentations, with higher body-image concern, but the broader message was that any of these behaviours can cause real distress and impairment.

What this means if this is you

The first thing worth knowing is that these behaviours are common, and they are not a character flaw or a lack of willpower. The second is that they respond to specific treatment. Habit reversal training (HRT) — learning to notice the urge and the early movements, then doing a competing action instead — has a good evidence base, and is usually delivered within a broader cognitive behavioural approach.

Because shame keeps these behaviours hidden, they are easy to live with for years without ever raising them. If skin picking, hair pulling or nail biting is causing damage or distress, it is worth an assessment.

Reference Solley, K., & Turner, C. (2018). Prevalence and correlates of clinically significant body-focused repetitive behaviors in a non-clinical sample. Comprehensive Psychiatry, 86, 9–18. https://doi.org/10.1016/j.comppsych.2018.06.014

Co-authored by Dr Cynthia Turner, Clinical Psychologist, The Moore Centre.

This article is general information, not a substitute for individual assessment. If a body-focused behaviour is causing distress or damage, get in touch — we see children, adolescents and adults in person at the Annerley rooms, by telephone, or by Zoom.