ADHD and Body-Focused Repetitive Behaviors (BFRBs)

Do you ever catch yourself biting your nails, pulling at your hair, picking your skin, or scratching without realizing it? You’re not alone. These actions, known as Body-Focused Repetitive Behaviors (BFRBs), are common—especially among people with ADHD. In fact, research suggests that 15–20% of individuals with ADHD engage in BFRBs like nail biting, skin picking, or hair pulling.

While BFRBs have historically been linked to Obsessive-Compulsive Disorder (OCD), more recent studies show that they often show up alongside ADHD and anxiety as well. These behaviors typically serve a self-soothing or regulating function and aren’t always a sign of distress—but they can become distressing over time, especially if they cause harm or lead to shame or frustration.

Why Do BFRBs Happen in ADHD?

There are several factors that may contribute to the overlap between ADHD and BFRBs:

• Dopamine Dysregulation: People with ADHD often experience lower levels of dopamine, a neurotransmitter linked to motivation and reward. Repetitive behaviors can offer sensory input that feels stimulating or satisfying to the brain.

• Inattention and Understimulation: BFRBs can be a way to self-regulate in moments of boredom, inattention, or mental fatigue. Some people find them grounding or soothing, especially during tasks that require sustained focus.

• Stress and Emotional Regulation: Many individuals with ADHD experience chronic stress related to executive functioning challenges. If a behavior provides relief—even temporarily—the brain can begin to rely on it for self-soothing.

• Impulsivity: ADHD often involves difficulties with impulse control, which can make it harder to interrupt or redirect repetitive behaviors once they begin.

• Time Blindness: It’s common for individuals with ADHD to lose track of time, which can lead to longer periods of engaging in these behaviors than intended.

The visible impact of BFRBs—such as skin irritation, hair loss, or short nails—can sometimes lead to feelings of guilt, shame, or social withdrawal. This can create a cycle of distress that reinforces the behavior.

Tools and Strategies for Managing BFRBs

It’s important to remember that BFRBs are not a moral failing. Like many ADHD-related behaviors, they often develop as coping tools—and with time, insight, and support, it’s possible to build new strategies that feel better aligned with your goals and values.

Here are a few supportive approaches that may help:

• Keep Your Hands Occupied: Fidget tools, stress balls, textured fabrics, or other sensory objects can help provide alternative forms of input.

• Use Deterrent Products: Non-toxic hand creams, cuticle balms, or sensory lotions can act as a gentle reminder when the urge to pick or bite arises.

• Identify Triggers: Notice when and where BFRBs tend to happen—certain situations, emotions, or environments may increase the likelihood. Once you recognize patterns, you can begin to plan around them or use alternative responses.

• Create a Supportive System: A trusted friend, family member, or partner can offer gentle reminders or encouragement when they notice the behavior.

Therapeutic Support for BFRBs: Two evidence-based therapy approaches that have shown promise for managing BFRBs include:

Habit Reversal Training (HRT): A behavioral therapy that helps individuals increase awareness of their behaviors and build new coping strategies. HRT typically includes:

• Awareness Training – Learning to recognize when and where the behavior happens, and identifying internal or external triggers.

• Competing Response Training – Replacing the behavior with a more adaptive action that serves a similar function.

• Motivation and Reinforcement – Building internal motivation and identifying rewards to support positive change.

• Additional elements may include generalization training and relaxation techniques.

Comprehensive Behavioral (ComB) Treatment: A personalized therapy approach designed to explore the thoughts, emotions, and sensations that contribute to BFRBs. ComB typically involves:

• Assessment and Functional Analysis – Understanding what drives and maintains the behavior.

• Targeting Specific Modalities – Exploring the sensory, emotional, or cognitive triggers and identifying personalized strategies.

• Tailored Interventions – May include mindfulness, behavior replacement, or self-monitoring tools.

• Ongoing Evaluation – Assessing what’s working and making adjustments as needed.

Remember: BFRBs are just one of many ways the brain attempts to regulate and manage emotions, attention, or stimulation. Whether you're looking to better understand your behaviors or want support in building new strategies, help is available—and healing is possible.

If you or someone you care about is navigating ADHD and BFRBs, our neurodivergent-affirming therapists are here to support you with curiosity, compassion, and evidence-based tools tailored to your unique needs.