BFRB Therapy for Children, Teens, and Young Adults in Portland, OR

What Are Body-Focused Repetitive Behaviors?

Body-focused repetitive behaviors (BFRBs) are repetitive self-grooming behaviors that can be difficult to control and may cause physical damage, distress, or impairment. Common BFRBs include hair pulling (trichotillomania), skin picking (excoriation disorder), nail biting, cheek chewing, and other repetitive behaviors directed toward the body.

Although BFRBs may happen more often during times of stress, boredom, anxiety, or concentration, they are not simply "bad habits" or signs of a lack of willpower. Many children, teens, and young adults describe feeling an urge, tension, or automatic pull toward the behavior. BFRBs can affect self-esteem, social confidence, and daily functioning, but effective treatment is available.

Evidence-Based BFRB Treatment

As a child and adolescent psychologist in Portland, OR, I provide evidence-based treatment for children, teens, and young adults struggling with hair pulling, skin picking, and other body-focused repetitive behaviors.

One of the most effective approaches for BFRBs is Comprehensive Behavioral Treatment (ComB). ComB helps identify the unique factors that contribute to repetitive behaviors, including sensory experiences, emotions, thoughts, environments, and physical urges. Together, we develop practical, individualized strategies to address these factors and reduce the behavior over time.

Treatment may also incorporate principles of Habit Reversal Training (HRT), which helps individuals become more aware of urges and learn alternative responses that compete with the repetitive behavior.

I frequently integrate Acceptance and Commitment Therapy (ACT) to help clients respond more effectively to uncomfortable thoughts, feelings, or urges without getting stuck in cycles of shame, self-criticism, or avoidance. ACT helps young people build compassion toward themselves while focusing on the activities, relationships, and goals that matter most.

Parents and caregivers are often included in treatment to better understand BFRBs and learn ways to support progress at home without increasing stress, conflict, or shame.

What to Expect During Therapy

Therapy begins with a comprehensive assessment to understand the nature of the behavior, including when it occurs, what triggers it, and how it affects your child or teen's daily life.

Together, we identify patterns related to emotions, situations, sensory experiences, and habits that may be maintaining the behavior. Treatment focuses on increasing awareness, developing alternative coping strategies, reducing urges and triggers, and building confidence in managing symptoms.

Because BFRBs are often influenced by multiple factors, therapy is highly individualized. The goal is not perfection, but helping children, teens, and young adults experience greater control, less distress, and improved quality of life.