Body-Focused Repetitive Behaviors (BFRBs) Revisited


This is a retrospective look at some of the many interesting aspects of Body-Focused Repetitive Behaviors (BFRBs), with links to posts that expand on the basic points. But first, why does this quirky-sounding problem matter? What does it have to do with childhood obesity? Only everything!

Disorders do not often present with neatly delineated edges, and until more is known, people will unavoidably conflate various conditions that may or may not have any meaningful connection. For now, we know that displacement behaviors fill a certain function for troubled people, and BFRBs can reasonably be said to fall into that category.

To counteract nervous stress, people pick at their skin, bite their nails, pull their hair, or stroke their mustache. It looks like compulsive eating might also be fairly called a displacement behavior.

People do these activities unconsciously or semi-consciously while watching TV, studying, traveling by car, talking on the phone, sitting in class, or browsing the Web. While thinking of something else, they do compulsive actions that not only take a toll on the affected body parts, but alienate onlookers. Noisy and obnoxious snack-munching can be as off-putting as picking scabs.

BFRBs negatively affect a person’s social life. Many obese people feel that opprobrium is constantly aimed at them, but the reason might not be what they think. Maybe a friend is bursting with the need to say, “Look, I don’t mind that you’re fat. I’m tired of hearing you chew and slurp!”

Versatility in BFRB manifestation

Apparently, BFRB satisfaction can manifest as either an upper or a downer. Feelings of discomfort and emotional distress can be calmed by squeezing pimples or plucking out eyelashes; or feelings of listlessness and boredom can be elevated to a more bearable plane.

Either way, to an objective academic eye they look like self-mutilating behaviors, and are classified as OCD Spectrum Disorders, which are closely related to OCD, or Obsessive Compulsive Disorder. A doctor who specializes in the field notes that clients are very frustrated by their inability to stop doing these things.

In the various WeightLoss2Go smartphone app trials, Dr. Pretlow has seen a recurring pattern that almost makes no sense. In the big picture, children and teenagers have less trouble eliminating their special problem foods, and more difficulty with cutting down their amounts of plain old everyday mealtime foods. While there is plenty of evidence that the food industry makes an effort to invent addictive products, this does not explain why overweight kids cling to over-serving themselves with mundane Mom food.

Unless… there is more going here than flavor, or response to chemical additives. There is wider involvement, in the pleasures of chewing and swallowing, in the repetitive motion of the hand from the food source to the mouth.

This is good news because therapists have ways of dealing with other BFRBs, that also work on compulsive grazing and snacking. Childhood Obesity News wrote about a chain of adolescent treatment centers that had found success with nine different therapeutic modalities. Topics range from physical barriers to the realization that these particular disorders are extraordinarily susceptible to the benefits of group therapy.

Your responses and feedback are welcome!

Image: Quotation from podcast “#342 — Christopher Ryan,”, 03/25/13

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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.

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