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Hi everyone. I'm Dr. Patrick McGrath, the Chief Clinical Officer for NOCD. And I'm excited to talk to you today about a topic that is related to obsessive compulsive disorder, the body focused repetitive behaviors.

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These are behaviors that are in the Diagnostic and Statistical Manual of Mental Health Conditions and they are in the OCD and related conditions, right? So if you've ever had this urge or found yourself pulling your hair, picking at your skin, biting your nails, chewing your cheeks, and then we're doing some of these things, maybe without even recognizing doing them, but regretting having done it, or feeling shame afterwards, you might be experiencing something that we call a body focused repetitive behavior. Now these are related to OCD and they can often occur together. And in fact one study showed that 21% of people with OCD also had co occurring body focused repetitive behaviors. And people with OCD are more likely to develop these than people without ocd. Like ocd, the body focused repetitive behaviors can be misunderstood and even overlooked. Just like people might say to someone with ocd, well just stop thinking about it, right? Or just don't do that compulsion, something someone might say to someone with a bfrb, well, just stop picking at your skin or just stop biting at your nails. And if it was that easy, I wouldn't have a job, right? I mean that's all I would have to say. It would be a one session cure for someone. But it's so much more than that. So let's talk about what some of the BFRBs are. First, there's something called trichotillomania, which is hair pulling. Then there's excoriation, which is skin picking. There's nail biting, which has a very weird like onychophagia. And no one ever says that, at least in my field, we just say nail biting. I, in fact, I don't think we'll have trichotillomania or excoriation probably listed in future generations of the dsm. I think it will just go to hair pulling and skin picking. And then we might have people who do other things like biting at your cheeks or your lip or picking at your nose, something of those nature. Now how do these interact? Well, it appears that they may share some neurobiological and genetic factors and they may also respond similarly to certain medications. So that's one of the reasons why they were probably lumped together in the dsm. The DSM looks at things from these areas more so than treatment. And that's some of the divide between. The DSM is written by Psychiatrists and people in the medical field who focus more on genetics and response to medications than those of us in the psychological field who focus more on how things reply to treatment. That being said, no matter where it might be located in the Diagnostic and Statistical Manual, I can tell you that there's really good behavioral treatments that are out there and that's what we're going to talk about because OCD and BFRBS both reply well to evidence based treatments right now. Like OCD symptoms, BFRBs can cause a lot of intense, you know, difficulties in people's life and they could be a response to stress in a lot of people's lives as well. BFRBs and OCD compulsions provide what appears to be maybe some short term sense of relief or calmness or soothing that you might get in the BFRB experience. But that doesn't last and it worsens the behavior over time. Someone with hair pulling may, for example, not even notice that they're pulling at their hair. They may be searching their head for that one hair that feels a little bit stiffer or thicker than the other ones. When they find it, there may be a certain thing that they do with it. Eventually they pull it out. Sometimes people roll it between their fingers. They may smash that little bulb that's on it on their nail. They may throw it on the ground. Some people even eat it. This can be dangerous because you can get a hairball in a human that's called the Trichobazar and if it gets too big, it has to be surgically removed because humans can't expel hairballs the way cats do. And you don't want that to happen. So that's why intervention is really key in these types of situations. Now, body focused repetitive behaviors don't appear to be fueled by fear of specific consequences. Like you have an OCD that if you don't do this compulsion, this terrible thing will happen. Instead it seems to be more of like a self regulatory function and done in response to wanting to be regulated or soothed instead of done response to intense, you know, obsessions or negative emotions or something of that nature. We know this though, there can be shame and BFRBS can be very difficult. Right? How do you go to work with a bald spot? What if you've been picking at your face and there's just all sorts of marks and scabs all over your face? There's a lot of societal pressure and beauty standards in skincare culture to look really good. And there's this notion that, well, you just have A really bad habit. And you just need to stop that. Right? And don't do that anymore. Again. If that worked, one session cures, that's all that we would have. Same for ocd. If we could just tell people to stop thinking of something, then I really wouldn't need to be doing this video or have a job. I would just say, hey, stop it, everybody, and you'd be fine and everything will be okay. But it's so much more than that. If you have a body focused, repetitive behavior and you spend all sorts of time trying to do things to hide what's going on, wearing hats, bandanas, combing your hair or brushing it over in a certain way, using hairspray to kind of get the hair that you do have to be over the top of the spots that you don't want anybody to see. Wearing gloves all of the time. So no one could see your nails or your hands or bandages around these things or covering up your arms because you've been picking at skin or wearing a mask over your face so nobody sees you. All of these can be very difficult for people to deal with. Right? And people could feel a lot of guilt or shame about this. We want you to know that there's great treatment that's available for body focused, repetitive behaviors. You've heard us talk about ERP for OCD here, but we haven't talked as much about something called habit reversal training or hrt. And the goal of habit reversal training is really to bring awareness to people so that they'll know that they're doing a behavior. So if you're the kind of person who maybe pulls at their hair but doesn't really notice it, but when you do it, you're often sitting, watching television. We'll have a glove there where you watch tv, and when you go to sit down for tv, you put the glove on. And that way when you go up here to do it, it's going to feel different. You're going to be like, oh, wait, oh. Oh, gosh, look what my hand just did. Right? There's even bracelets that people can wear. Now. You can program so that if it goes in a certain position, it will send a little buzz, not a shock or anything, but a buzz to your wrist just to say, hey, by the way, you're doing this thing again, right? You want awareness to be there. And once people become aware of what they're doing, then they can do something else instead. Right? That can be helpful if maybe play with. Remember those koosh balls or something instead of pulling out your hair, maybe pull it one of those. Allow the hair to grow back. Allow people to get that full head of hair back again. Because sometimes when the hair grows back, it's a little, you know, sticky or it's a little pokey or something, and then you're just going to keep pulling away at that if that's the, the feeling of hair that you don't want to have. And then that could create a permanent bald spot which somebody would not want to have happen.