Body-focused repetitive behaviours are a group of compulsive, repetitive behaviours that involve self-grooming or self-injurious actions directed towards one's own body. These behaviours are often performed in response to anxiety, stress, or other emotions, and can provide temporary relief or pleasure. However, they can also result in physical damage, emotional distress, and social difficulties. And you guessed it, they are more common in people with ADHD, likely due to a combination of increased impulsivity and being used as a coping strategy for strong negative emotions.
Below are some of the more common body-focused repetitive behaviours associated with ADHD:
Nail-biting - onychophagia. This a common among people with ADHD and involves compulsive nail-biting, often to the point of damaging the nails and surrounding skin. Nail-biting can result in pain, infection, and negative social consequences.
Skin picking - dermatillomania. Also known as excoriation disorder, this behaviour involves compulsive skin picking, scratching, or gouging that can result in skin damage, scarring, or infection. Individuals with this disorder often feel a sense of tension or anxiety before picking their skin and relief or pleasure afterward.
Cheek/lip biting. This involves compulsively biting the insides of the cheeks or lips, which can result in pain, damage to the oral mucosa, and potential infections.
Hair pulling - trichotillomania. This is characterised by recurrent hair pulling, resulting in noticeable hair loss. Individuals with this disorder often experience a growing sense of tension before pulling their hair and relief or pleasure after the act.
Thankfully, there is treatment for body-focused repetitive behaviours, which generally involve a combination of strategies that address both the repetitive behaviours and the underlying ADHD symptoms.
Here are some evidence-based treatments:
Stimulant medications commonly used to treat ADHD, such as methylphenidate or dexamphetamine, can help to reduce the impulsivity and inattention that can contribute to body-focused repetitive behaviours. By improving ADHD symptoms, these medications may indirectly reduce the frequency and intensity of these behaviours.
Cognitive Behavioural Therapy (CBT) is a widely used psychological treatment that helps individuals understand and change their thoughts and behaviours. In the context of body-focused repetitive behaviours and ADHD, CBT can help individuals develop healthier coping strategies and reduce the frequency of these behaviours.
Habit Reversal Training is a specific form of behavioural therapy that can be couched within CBT and focuses on increasing awareness of the triggers and urges associated with body-focused repetitive behaviours, and then teaching alternative, healthier behaviours to replace the harmful ones.
In some cases, selective serotonin reuptake inhibitors, a class of antidepressant medications, may be prescribed to help manage anxiety or depression that may be contributing to the development or persistence of body-focused repetitive behaviours. These medications may be used alone or in combination with ADHD medications, and will involve a discussion with a person's prescriber.
Mindfulness and relaxation techniques such as deep breathing, progressive muscle relaxation, and meditation, can help individuals with ADHD and body-focused repetitive behaviours manage stress, anxiety, and negative emotions that may contribute to these behaviours.
Below are more resources to further investigate body-focused repetitive behaviours:
Overview of Body-Focused Repetitive Behaviors: Types, Treatments & ADHD Links
ADHD Experts one-hour presentation Nail Biting! Skin Picking! Hair Pulling! Understanding Body-Focused Repetitive Behaviors with ADHD presented by clinical psychologist Dr Roberto Olivardia
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