This BFRB Self-help Book Is a Must-read

When I discovered that skin picking, nail-biting, and cheek biting fall under the same umbrella called Body-Focused Repetitive Behaviors, I was surprised but also kinda relieved.

Suddenly I had the feeling that I only had to fight one battle instead of three different ones.

After more than 20 years, I was finally able to get to the bottom of my behaviors and seek specific help. After some research, I found the book: “Overcoming Body-Focused Repetitive Behaviors: A Comprehensive Behavioral Treatment for Hair Pulling and Skin Picking.”

The BFRB self-help book in a nutshell

This self-help book teaches how to improve BFRBs in three steps:

  1. Building awareness and recognizing patterns: Become aware of when and where your body-focused repetitive behaviors occur. What are the triggers – locations, experiences, feelings, things that cause your behaviors. 
  2. Planning and preparation: Find out what tips and tricks can help you with your BFRBs. Have a strategy when faced with triggers.
  3. Putting the plan in action: Use your custom plan and tricks to prevent the BFRB from happening.

An example of me using the three steps to prevent picking the fingers and nail-biting: 

Trigger: writing copy on my computer in a sitting position. 

Writing copy is super stressful for me. I get nervous, impatient, and distorted thoughts and self-doubt work against me. Plus, I overthink everything. You’re probably wondering why on earth am I writing this blog then. Yes, this BFRB Coping project is a massive challenge for me. But if I gave in to my anxiety, I wouldn’t achieve anything in my life. 

Now back to the implementation of the book’s guideline for nail-biting and picking my fingers:

  1. I’m aware that writing copy is nerve-wracking for me. My fingers keep moving over each other, checking for something to scratch and pick.
  2. plan to use different tricks to prevent picking my fingers and biting my nails. I switch between BFRB tricks, but the most effective so far have been taping my finger, using the finger protector and the DIY fidget ring.
  3. On my desk, I have a box of all kinds of BFRB tools that are always ready to use. I’ll put the plan into action as soon as I sit down at my computer. If I plan to write copy or answer emails, I put on my BFRB gear beforehand – see picture below.

Examples of BFRB trigger situations

BFRBs are the result of stress, anxiety, or even boredom. Other trigger situations can be:

  • Looking in the mirror, especially in the bathroom
  • Watching TV
  • Driving or getting stuck in traffic
  • Thinking of a problem
  • Talking on the phone
  • Reading a book
  • Making decisions
  • Stress at work, at school 
  • Sometimes it’s not even possible to pinpoint a situation… 

What are your trigger situations and locations? Observe yourself and write down when, where and how your BFRBs take place. You might be surprised some of these were not known because your BFRBs are so automated.

The BFRB self-help book “Overcoming Body-Focused Repetitive Behaviors” has much more detailed examples and better explanations. I can’t do the book justice with this post. 

I recommend reading this BFRB self-help book and trying the recommended three steps to a better life with BFRBs: awareness – planning – implementation.

This is my “working gear” 😉


Breathing Exercises to Calm Your BFRBs

We rarely pay attention to how we breathe because it happens automatically without much thought. However, making breathing exercises conscious and integrating them into our everyday lives has many advantages. 

Deep breaths can help resist the BFRB urge until this feeling passes. It’s like a little mental reset to calm down and regain focus.

I pick and bite the most when I’m anxious, overwhelmed, stressed, or worried. When I feel this way, my breath becomes shallow, and I even subconsciously hold my breath or breathe irregularly. Not breathing properly intensifies my negative feelings and thus my BFRBs. 

If I catch myself biting or picking nervously – if possible – I remove myself from the situation and sit with my back straight or even lie down. I set the timer for five minutes and do a breathing exercise. 

After two or three minutes, I feel how my racing mind relaxes. I then have a clear head to see why and what made me so anxious. Then I can focus on the next steps. 

It doesn’t always have to be five minutes. Taking a few deep breaths while feeling tense could go a long way already. It’s a quick check-in with your thoughts and feelings. It helps to understand you and your BFRBs better. 

The next time you’re feeling anxious or stressed, try one of these breathing exercises:

Box breathing: A very simple breathing exercise is box breathing. I like to imagine circling a square while doing this exercise.

  1. Inhale for a count of four
  2. Hold your breath for a count of four
  3. Exhale for a count of four
  4. Hold your breath for four
  5. Continue the pattern

4-7-8 Breathing: The 4-7-8 breathing exercise is also called the relaxing breath because it helps to calm down the nervous system. While doing this exercise I focus on counting and my body instead of my thoughts.

  1. Close your mouth and inhale quietly through your nose to a mental count of four.
  2. Hold your breath for a count of seven.
  3. Exhale completely through your mouth, making a whoosh sound to a count of eight.
  4. Repeat the pattern

Affirmation breathing: This is one of my favorite breathing exercises when my mind is racing with negative self-talk. 

  1. Inhale and say a mental positive thought or focus word
  2. Exhale a mental negative thought or focus word
  3. Repeat the pattern. For example, inhale “I am capable”, exhale self-doubt or inhale “calmness”, exhale “stress”

Sometimes it can be difficult to follow through with breathing exercises on your own. If you need some guidance, try using a breathing or meditation app. Click here to see a list of breathing or meditation apps.

Extra Tip:

Put one hand on your heart and the other one on your belly. Feel your chest and stomach expand when you take a deep breath. That way you can divert the focus from the thoughts to the body. Alternatively, hold your hand in the “Adi Mudra” position to keep your hands still.

Happy calm breathing, Anja

Coping Cards

Lost But Not Losing

This coping card has two meanings for me: I sometimes feel lost, especially after having lost another fight to my BFRBs. But I have to remind myself that I’m not losing the battle

I only recently felt almost arrogant because I thought I had overcome my BFRBs. I felt like I had all of the tricks I need to control my urges. For almost a week, I managed not to pick my skin or chew my cheeks and lips. Even my fingers never looked healthier.

Then, after this long healthy period, I had a major setback. I don’t even know why it happened … I even tell myself that I had no (obvious) reason to relapse. 

And exactly that is the tricky and irrational part of BFRB – you don’t always need a reason to pick, scratch, bite or pull. 

These self-harming and very often self-soothing behaviors have been well practiced for years. It is not that easy to control this subconscious urge. Unfortunately, there is no simple solution to overcoming our BFRBs. We have to go the bumpy road. 

When I started my BFRB healing journey, I knew setbacks would happen. Oh boy, and they happen … But I didn’t think they come with so many tears, self-doubt, and even self-loathing. 

After every setback, I feel like I’m starting from scratch. But that’s not the case because with every setback, I learn something new about myself. And with every new day, there is an opportunity to kick BFRB in the butt with a new trick 😉

Above all, it is crucial to recognize your own progress and celebrate small successes.

So when I reflect on my recent setback, I feel very proud that I left my face alone – this is a huge win! I only picked a few blemishes on my arms and legs. I just nibbled the inside of my mouth instead of biting it until bleeding. Sure, my fingers could look better, but I only bit off two fingernails instead of ten.

Yeah, I’ll lose a few fights, but I’m not going to lose the battle. Let’s get motivated by the small victories and small steps we take. Setting the bar too high will only result in disappointment.

Longstanding behavior patterns will take time and effort to change. Let’s be a little more compassionate and patient with ourselves. We deserve that.


Place Coping Statements at Your BFRB Trigger Locations

Placing BFRB coping statements and reminders at my trigger locations was one of the first steps in my BFRB healing journey.

I need reminders and positive encouragement quotes to control my BFRBs. I worry that if I don’t deal with them regularly, I’ll quickly slip into old patterns of picking and biting without realizing it.

As a hobby and self-therapy, I began drawing BFRB coping reminders and used them to decorate my trigger locations. 

My two main trigger locations are the bathroom and my work desk. So, I placed a hand-lettered quote on my bathroom mirror and another on the computer monitor. 

I know that our dermatillomania, trichotillomania, or onychophagia (nail-biting) are not limited to places. Unfortunately, the triggers and stressors that cause our BFRBs are omnipresent. 

However, adding helpful and visually pleasing reminders to the key trigger locations is already a good start to creating awareness and potentially preventing the urge to pick, scratch, and bite.

After all, scars, scabs, and burning skin are the wrong reminders. We need help before we do the damage.

Check out the Coping Cards section on my website for other coping statements.

Do you know your main trigger locations?

My BFRB Coping reminder on the bathroom mirror.