OCD Family Podcast – S4E151

OCRD Series IV, Part I: BFRBs Explained: Lived Experience Meets Psychological Expertise to Benefit Families
Release Date: November 8, 2025
Host: Nicole Morris, LMFT
Guests: Jason Yu (counseling student, Fidget podcast host) and Dr. Lisa Conway (therapist and BFRB/OCD clinician and trainer)

Episode Overview

This episode launches the podcast's annual OCRD (Obsessive Compulsive and Related Disorders) series with a deep dive into Body-Focused Repetitive Behaviors (BFRBs)—including hair pulling, skin picking, nail biting, and beyond. Nicole is joined by Jason Yu (who shares his lived experience and advocacy work) and Dr. Lisa Conway (an expert clinician and trainer) for an honest, hope-filled discussion aimed at families supporting loved ones with BFRBs.

Topics include:

• What BFRBs really are and how they differ from habits
• Why shame and willpower myths harm those struggling
• How to foster supportive communication in families
• Lived experience perspectives and practical analogies
• Insights on BFRBs across the lifespan and neurodiversity
• Self-compassion, community, and hope for lasting change

Key Discussion Points & Insights

1. What Are BFRBs? [08:49–12:09]

• Definition: Body-Focused Repetitive Behaviors are under the umbrella of obsessive-compulsive and related disorders and go beyond grooming “habits.”

  • Includes trichotillomania (hair pulling), excoriation (skin picking), compulsive nail biting, cheek/lip biting, teeth grinding, etc.
  • Behaviors become a “disorder” when they cause distress, are hard to control, or impair daily functioning.

• Prevalence:

  • “Prevalence rate is pretty similar to OCD’s, like 2 to 5% of the population” — Dr. Lisa Conway [09:42]

• Why They Persist:

  • Positive reinforcement (feels good), negative reinforcement (removes discomfort or stress), fills emotional/sensory needs.

2. Egosyntonic vs. Egodystonic Experience [10:11–13:56]

• BFRBs can “meet underlying needs”—providing comfort, release, or regulation—which makes them feel in alignment with the self (egosyntonic).
• “It’s not even so much the quantity of time, but it’s the quality of the time…even if it’s five minutes, that can be just as, or more, distressing.” — Nicole Morris [12:09]

3. Willpower & Shame: Myths and Harm [23:33–25:38]

• Willpower Myth:

  • Willpower alone is not enough to stop BFRBs. “Wouldn’t it be nice if we could all just, like, stop the thing that we didn’t want to do?” — Dr. Lisa Conway [23:33]

  • People try to shame themselves (or are shamed by family) into stopping, but this only leads to more distress and reinforces the cycle.

  • Anecdote: Jason shares a story about a coworker's intention to “shame” her child out of nail biting for fear of school bullying. He relates: “That line of thinking is the same line of thinking I used for myself…if it was just as simple as putting on gloves, or more willpower, I would have done it, you know?” — Jason Yu [21:35]

4. Family Perspectives & Communication Strategies [15:11–19:19, 92:11–97:35]

• Family Feelings:

  • Parents or partners observing BFRBs may feel fear, embarrassment, shame, or urgency to “fix” their loved one.
  • “All of this is about how do I open up lines of communication or offer that open space to support when and if it’s warranted…” — Dr. Lisa Conway [17:01]

• What NOT to Do:

  • Don’t grab hands, slap, yell, or otherwise try to control the behavior physically or through shame.

• What TO Do ([93:03]–[97:35]):

  • Have proactive, collaborative conversations outside the moment of picking/pulling.

    • “Making space for when we approach someone, it’s like, ‘Hey, I noticed the other night that I saw you picking…next time, can we brainstorm what would be helpful?’ The time to have that conversation is NOT in the middle of the picking episode.” — Jason Yu [93:03]

  • Respect boundaries; sometimes what’s needed is a gentle offer, a hand squeeze, or just leaving them be.

  • Helpful Reframe:

    • Instead of “Why are you giving me a hard time?”, ask, “Are you having a hard time?” — Dr. Lisa Conway [94:49]

  • Don’t try to be a mind reader. Ask what support would be truly helpful, and accept when input isn’t wanted in the moment.

5. Shame, Grief, and Self-Compassion [39:34–61:29]

• The shame spiral is common––setting resolutions to “never do it again,” then feeling like a failure upon relapse.

  • “The experience of having a BFRB is like every day is a New Year’s resolution.” — Jason Yu [40:38]

• Grieving is normal. Self-compassion and curiosity about the function of the behavior are crucial to healing.

  • “We don’t shame ourselves into being better…how do we start to slowly shift that relationship?” — Dr. Lisa Conway [60:38]

6. Lived Experience: Jason’s Story & the Low Fuel Light Analogy [19:19–22:07; 44:50–48:43]

• Jason describes years of shame, hiding, and misunderstanding before discovering his skin picking was a BFRB.

• Low Fuel Light Analogy [44:50–48:43]:

  • BFRB urges are like a “low fuel light”—a signal that a need is unmet (hunger, stress, emotion).
  • “My BFRB was trying to help me…it was giving me information I wasn’t listening to before, and that’s why the urge was so big.” — Jason Yu [48:43]

• Moving from “at war” with the behavior to curiosity and respectful partnership with it (“like a friend or sidekick”).

7. Neurodiversity, Sensory Issues & BFRBs [49:56–51:59]

• BFRBs can be “soothing” for those with sensory processing difficulties, autism, or ADHD, helping “turn the volume down” on an overwhelming world.
  • “What a BFRB sort of helps us do…it turns the volume knob on the world down.” — Jason Yu [51:12]

8. Journey, Community, and Cultural Considerations [54:54–86:45]

• BFRBs are often long-term, lifelong journeys—not problems to “cure” in a week.

  • “It is a journey of a lifetime you go on every single day…that kind of timescale is helpful to reduce the minute-to-minute urgency.” — Jason Yu [77:08–78:12]

• The power of community and peer support: “When I met other people with BFRBs, that was like the place to normalize just how much of a challenge it was, like, with no judgment.” — Jason Yu [66:03]

• Cultural identity and assimilation can shape the experience and function of BFRBs, adding layers of complexity and, sometimes, loneliness.

9. Hope, Flexibility, and Practical Tools [79:26–82:03, 92:11–98:24]

• Progress is not linear; relapse is not failure but a normal part of managing BFRBs.
• Therapeutic goals shift from “control” to “trust, peace, and freedom.”
  • “I don’t use the word control. What I’m looking for is more like trust, peace, and freedom. Like that’s what we’re cultivating.” — Jason Yu [26:17]
• Community support, lived experience podcasts, and evidence-based treatments offer real hope.

Notable Quotes & Memorable Moments

• “Shame is not gonna make us better.” — Dr. Lisa Conway [24:41]
• “Building awareness is a reminder: How can I love myself today?” — Nicole Morris [27:02]
• “This is not a cancer—this is a part of me.” — Nicole Morris [63:12]
• “You don’t have to be a mind reader. Isn’t that great news? You don’t.” — Nicole Morris [97:08]
• “We don’t shame ourselves into being better.” — Dr. Lisa Conway [60:38]
• “A relapse is going to come...that’s not a moral failing. It makes sense.” — Jason Yu [26:17]
• “If we can practice curiosity about something, even if it is deeply painful, we aren’t scared of it.” — Dr. Lisa Conway [43:44]
• “Having that self-compassion of: Realistically, I’m not gonna ever be able to just stop-stop. That was a win for me…and being able to celebrate that win.” — Nicole Morris [78:12]
• “AFGO: Another F***ing Growth Opportunity.” — Dr. Lisa Conway [81:19]

Key Timestamps

• What are BFRBs? [08:49]
• Willpower & Shame Discussion [23:33]
• Family Impact & Communication [15:11; 92:11]
• Jason’s Low Fuel Light Analogy [44:50]
• Sensory Regulation & Neurodiversity [49:56]
• Community & Lifelong Journey [66:03; 77:08]
• Cultural Experiences [86:45]
• Practical Support for Families [92:11]
• Closing Reflections & Hope [98:24]

Tone & Language

• Compassionate, validating, and warm—balancing lived experience with clinical insight
• Honest about pain and complexity, but hopeful and empowering
• Uses analogies (Low Fuel Light, UNO game) and humor to make the material relatable
• Gentle encouragement: “Let’s be curious together” and “You’ve got this!”

Takeaways for Listeners

• BFRBs are common, persistent, and misunderstood. They’re genuinely difficult to manage—not simply “bad habits.”
• Willpower and shame do not help; self-compassion, curiosity, and support do.
• Family members should approach their loved ones with open communication, ask for permission to discuss, and collaborate (not intervene reactively).
• Progress is messy and gradual—peaks and valleys are normal.
• Community, accurate information, and accepting the “forever” nature of BFRBs are powerful sources of hope.

Resource Notes:

• Jason Yu’s Fidget podcast: lived experience storytelling, advocacy, and practical analogies like the Low Fuel Light.
• Dr. Lisa Conway: clinician, trainer, and sensory panel expert (links on episode blog).
• Community resources: Picking Me Foundation, HabitAware, IOCDF, peer support groups.

Closing Encouragement:
“When in doubt, let’s zoom out…Add some curiosity to that and we have a really good recipe for hope.” — Nicole Morris [98:24]