Understanding Body Focused Repetitive Behaviors and the ComB Model for treatment.
If you’ve ever found yourself picking at your skin, pulling your hair, or biting your nails, lips, or cheeks—often without even realizing it—you’re not alone. These behaviors are more common than most people think, and they have a name: Body-Focused Repetitive Behaviors, or BFRBs.
They’re not just “bad habits” or something you can simply stop with willpower. BFRBs often serve a purpose—whether it’s reducing stress, calming anxiety, helping you focus, or offering a sense of relief or satisfaction. Understanding why these behaviors happen is a powerful first step in learning how to manage them.
What Are BFRBs?
BFRBs are repetitive self-grooming behaviors that result in damage to the body. They are considered part of the obsessive-compulsive spectrum and include:
Hair pulling (trichotillomania)
Skin picking (excoriation disorder or dermatillomania)
Nail biting
Lip or cheek biting
Scab or cuticle picking
While these behaviors can temporarily relieve tension or create a sense of control, they often lead to physical discomfort, shame, and emotional distress over time.
Why Do BFRBs Happen?
There’s no single reason someone develops a BFRB. These behaviors are often linked to emotional regulation—helping a person manage anxiety, boredom, stress, or even perfectionistic tendencies. For some, it becomes a sensory experience that’s hard to resist.
What’s important to understand is that these behaviors are not your fault. And more importantly—they’re treatable.
Introducing the ComB Model
The ComB Model (short for Comprehensive Behavioral Model) was developed by Dr. Charles Mansueto as a way to understand and treat BFRBs. Rather than focusing on stopping the behavior, the ComB model helps us understand the function of the behavior—what it provides—and then tailor treatment to those individual patterns.
The Five Domains of the ComB Model
The ComB model explores five domains that may contribute to or reinforce a BFRB:
Sensory – The physical sensations associated with the behavior, such as the feeling of pulling or the texture of skin.
Cognitive – The thoughts or beliefs that might trigger the behavior, such as “I need to fix this imperfection” or “I can’t focus unless I pick.”
Affective – The emotions that lead up to the behavior, like stress, anxiety, boredom, or frustration.
Motor – The automatic movements or postures that are linked to the behavior (e.g., resting your hand on your face while studying).
Place – The specific environments or settings where the behavior tends to happen (e.g., in bed, in the car, while watching TV).
By identifying which domains are most relevant for each person, treatment becomes highly individualized—and much more effective.
What Does Treatment Look Like?
Using the ComB model, treatment involves tracking behavior patterns, increasing awareness, and developing personalized strategies to meet the underlying needs in healthier ways. This might include sensory substitutions (like fidget tools), environmental changes, coping strategies for difficult emotions, or interrupting automatic motor patterns.
Treatment is not about forcing yourself to “just stop.” It’s about curiosity, self-compassion, and skill-building.
You're Not Alone
BFRBs can feel isolating, especially when you’ve tried to stop on your own and haven’t had success. But help is available. Whether you’re a teen struggling with hair pulling or an adult quietly dealing with skin picking, know that you’re not broken—and you’re not alone.
Working with a therapist who understands BFRBs and is trained in tools like the ComB model can make a real difference. Healing is possible, and it starts with understanding yourself—not judging yourself.
Interested in learning more or getting support for BFRBs?
Feel free to reach out or explore more resources. You deserve support that meets you where you are.
