Understanding Self-Harm and Body-Focused Repetitive Behaviors

Individuals sometimes face emotional challenges they may struggle to express, leading to behaviors that cause concern. Two such behaviors are self-harm and body-focused repetitive behaviors (BFRBs). These behaviors can seem difficult to understand, but recognizing the differences between them is crucial for providing the appropriate support.

What Is Self-Harm?

Self-harm, or nonsuicidal self-injury (NSSI), refers to actions that intentionally cause physical harm, such as cutting, burning, or hitting oneself. However, the goal of self-harm is not to end one's life; instead, it's often a way to cope with overwhelming emotional pain. Individuals may engage in self-harm when they feel emotionally numb, using the physical sensation to override their emotional suffering.

This behavior typically develops as a way to deal with feelings of distress, frustration, or even self-criticism when emotional coping skills are insufficient. It’s important to note that while self-harm is not a suicide attempt, it’s still a sign of deep emotional pain that requires attention and care.

Why Do Individuals Engage in Self-Harm?

Individuals who self-harm may feel emotionally overwhelmed or disconnected and use physical pain as a way to release or control these feelings. It’s often a response to intense sadness, anger, or anxiety. For some, it provides temporary relief, while for others, it’s a form of self-punishment for feelings of guilt or inadequacy.

What Are Body-Focused Repetitive Behaviors?

BFRBs involve repetitive actions like biting, pulling, or picking at hair, skin, or nails, which can cause damage to the body. While these behaviors may seem similar to self-harm, they are not performed with the intention of causing pain. Instead, although the specific function(s) can vary from person to person, BFRBs tend to serve as a means of self-regulation when uncomfortable internal states arise (thoughts, feelings, bodily sensations).

Common BFRBs in children include these:

• Trichotillomania (hair pulling)
• Excoriation disorder (skin picking)
• Nail biting
• Lip and cheek biting

These behaviors can lead to noticeable damage over time, like bald patches, scabs, or scarred skin.

Why Do Individuals Engage in BFRBs?

Individuals may engage in BFRBs as a way of responding to internal discomfort, such as distressing thoughts, emotions, or bodily sensations. While the behaviors can feel satisfying or soothing in the moment, they often lead to frustration, embarrassment, or social withdrawal due to the visible effects, such as hair loss or skin damage. Despite attempts to stop, people often find these behaviors difficult to control, which can add to their distress and further perpetuate the behavior.

Key Differences Between Self-Harm and BFRBs

Though both self-harm and BFRBs involve harm to the body, the two are fundamentally different in both intent and purpose:

• Intent: Self-harm is a goal-directed intentional act meant to cause physical pain or injury as a way to cope with acute emotional distress. BFRBs, on the other hand, are habitual behaviors, sometimes carried out with little to no awareness, that cause physical damage without the intention to harm.
• Emotional factors: Self-harm is usually driven by intense emotional pain, often serving as a means to achieve emotional release or to feel "something" when emotionally numb. While BFRBs may also be associated with uncomfortable emotions, their purpose is more varied and complex, often serving multiple self-regulatory functions.
• Goals: Self-harm is not typically associated with a desire or attempt(s) to stop or decrease the behavior (outside of adherence with treatment). In contrast, although there may be some ambivalence about behavior change due to the function(s) the behavior is serving, individuals with BFRBs do not want to engage in the behavior, are motivated to stop engaging in the behavior to free themselves of the negative consequences experienced, and have made attempts to do so with varying degrees of success.

What Are Signs of Self-Harm and BFRBs?

Recognizing the signs of both behaviors is crucial in offering the right support:

• Self-harm: Common signs include cuts, burns, or other injuries that don’t seem accidental. Individuals may wear long sleeves or pants to hide these injuries, even in warm weather. They might also struggle to talk about their emotions and may isolate themselves or engage in risky behaviors like substance use. These behaviors may be seen more often in the context of family systemic dysfunction, history of abuse/neglect/trauma, mood disorder, and/or personality disorder.
• BFRBs: Signs of BFRBs include noticeable hair loss, scabs, or skin damage from repeated picking or biting. Individuals might spend excessive time grooming or trying to cover up the physical damage. They may also feel embarrassed or frustrated by their inability to stop these behaviors. Individuals with BFRBs may engage in a wide range of avoidance behaviors and other means of attempting to cope with the negative consequences of their BFRB and may also struggle with anxiety, mood symptoms, or other psychological distress.

How to Support an Individual Engaging in Self-Harm or BFRBs

If you suspect someone important to you is engaging in either self-harm or BFRBs, maintaining a compassionate, nonjudgmental approach is vital. Engage in open dialogue and offer reassurance that their feelings are valid. Professional help from a mental health specialist can provide the tools and support necessary for them to develop healthy behaviors, promote healing, and improve their quality of life.

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What Is Psychodermatology?

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.