Body-Focused Repetitive Behaviors (BFRBs): What They Are and How to Find Treatment in Richmond, VA
Body-focused repetitive behaviors (BFRBs) are a group of repetitive actions directed toward one’s own body—most commonly hair pulling (trichotillomania) and skin picking (excoriation disorder). These behaviors are not cosmetic, can happen consciously or automatically, and often cause physical and emotional distress. Many people with BFRBs experience:
Skin irritation, infections, or scarring
Bald spots or hair loss
Shame, guilt, or frustration
A sense of being “out of control”
Increased anxiety or depression
If this sounds familiar, you’re not alone—and effective, evidence-based BFRB treatment is available in Richmond, VA.
What Causes Body-Focused Repetitive Behaviors?
BFRBs can develop for many reasons, including:
Biological or genetic factors
Emotional triggers (stress, anxiety, boredom)
Sensory urges or physical sensations
Habit loops that become hard to break
Importantly, BFRBs are not a lack of willpower. These behaviors can serve as temporary relief or sensory regulation, which makes them extremely hard to stop without support.
Evidence-Based BFRB Treatment in Richmond, VA
The first-line therapy for body-focused repetitive behaviors is Habit Reversal Training (HRT), a structured form of Cognitive-Behavioral Therapy (CBT) designed specifically for concerns like BFRBs. HRT helps people significantly reduce picking and pulling and regain control over their daily lives.
Here’s what treatment typically looks like:
1. Awareness Training
The first step is understanding your unique BFRB pattern. Together, you and your therapist explore:
When the behavior happens
What you’re feeling beforehand
Environmental triggers
How long the episodes last
Whether the behavior feels automatic or intentional
You’ll also learn to notice the physical sensations that show up right before picking or pulling.
Building awareness is the foundation for meaningful change.
2. Competing Response Training
Next, your therapist helps you create a competing response—a physical action that makes picking or pulling impossible. Examples may include:
Clenching your fists
Squeezing a stress ball
Sitting on your hands
These responses help interrupt the picking and/or pulling. They are tailored to fit your unique needs, are less intrusive/bothersome than the BFRBs themselves, and are meant to help interrupt the loop your brain is stuck in when it’s engaging in BFRBs.
3. Maintenance, Practice & Coping Skills
HRT also focuses on long-term success, which includes:
Practicing skills inside and outside of session
Monitoring symptoms and tracking progress
Identifying emotional or sensory triggers
Building coping skills to manage anxiety and stress
Troubleshooting challenges as they arise
This stage helps make new habits stick and reduces the likelihood of relapse.
Finding BFRB Treatment in Richmond, VA
If you’re searching for hair pulling therapy in Richmond, VA, skin picking treatment, or habit reversal training, working with a clinician who specializes in these concerns can make a big difference.
As a clinical psychologist in Richmond, VA, I help children, teens, and adults overcome:
Trichotillomania (hair pulling)
Excoriation disorder (skin picking)
Other BFRBs, including nail biting or cheek biting
Co-occurring concerns like anxiety and OCD
My approach is warm, supportive, and deeply grounded in evidence-based care. You deserve a space where you feel safe, understood, and empowered to create lasting change.
Ready to Start BFRB Therapy in Richmond, VA?
I am currently accepting new clients in Richmond and via telehealth across 40+ PSYPACT states.
If you or your child is struggling with a BFRB, you do not have to navigate this alone. Help is available. Please don’t hesitate to reach out with any questions!
📞 804-214-6416
📧 jherbst@richmondfamilypsychology.com
