BFRBs — A Strand of the Childhood Obesity Tangle? (Part 2)

Toro Yama Knot

Yesterday, Childhood Obesity News quoted from the Visions Adolescent Treatment Centers, describing some of the characteristics of Body-Focused Repetitive Behavior (BFRB), a condition which is said to affect millions of people. The purpose is to explore how compulsive eating might relate to this syndrome.

The nervous energy created in the body by feelings of discomfort and emotional distress can be discharged in a number of ways, and some people do it by pulling out their own hair or eyelashes, or helplessly picking at their skin (trichotillomania and dermatillomania). Nail and cuticle biting, and blemish squeezing, and other miscellaneous self-mutilating habits can also be problematic. Actually, there is an umbrella term that covers a lot of seemingly irrational actions triggered by existential angst.

They are called OCD Spectrum Disorders, because they bear similarities to Obsessive Compulsive Disorder and often show up in the same unfortunate patients. When they are upset, the victims feel that doing these things will calm them down. When they are listless and bored, they feel that doing these things will somehow perk them up. Either way, a deep, almost inaccessible part of the person’s psyche is convinced that if these actions are performed, everything will be all right.

A similar mechanism drives people to compulsively eat. (It rarely works in the expected way, especially the perking-up part, because an excess of food, and the wrong kinds of food, all tend to send consumers off for a nap.) Another similarity between OCD spectrum and compulsive eating is the damage element. People who pull out their hair and dig at their skin and chew up their cuticles create bald spots and scars and bloody repulsive fingers. The definition of this range of activities includes causing injury to oneself, and/or damage to one’s own physical appearance.

The victims hurt themselves, and so do compulsive eaters. Compulsive eating negatively affects the appearance, not immediately, but within days, as the body adds a padding of fat. Compulsive eating certainly causes a vast amount of physical damage, though it may not show up for years, and then in the form of diabetes, hypertension, or one of the other well-known consequences. Dr. Robert W. McLellarn, who treats OCD Spectrum Disorders, says:

Our clients are universally extremely frustrated by their inability to stop these behaviors that appear so self-destructive.

And compulsive eaters are also extremely frustrated by their inability to say no to their habits which, while the results do not show up so soon, are equally self-destructive.

Other similarities

Fred Penzel, Ph.D., describes body-focused repetitive behaviors and the ensuing depression, shame, and isolation — and if you didn’t know already the topic of his article you could mistake it for a piece about compulsive eating. This sounds all too familiar:

Hours may be spent in these activities, taking individuals away from family or work activities… Sufferers may go to great lengths to not undress… Children may suddenly refuse to go to school, to avoid being teased or reprimanded by their teachers. Adults may shy away from social situations, work, or job interviews… [F]requent family fights or disputes over the behavior…

And check out this next paragraph. Doesn’t it sound exactly just like what we have heard so often about childhood obesity?

Denial is another approach families take, and has prevented many sufferers […] from being allowed to get the help they badly need. When it is impossible to ignore symptoms […] they may be minimized or explained away as being nervous habits, laziness, childish behavior, attempts to get attention, or get even. In the case of children, pediatricians or family physicians can unwittingly aid in this, telling families to ‘wait and see’ or ‘they will grow out of it.’

(To be continued…)

Your responses and feedback are welcome!

Source: “Body Focused Repetitive Behaviors,”, 10/03/11
Source: “Body-Focused Repetitive Disorder,”
Image by Chris Gladis.

Leave a Reply

Your email address will not be published. Required fields are marked *

FAQs and Media Requests: Click here…

Profiles: Kids Struggling with Weight

Profiles: Kids Struggling with Obesity top bottom

The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources