BFRB World — Still Strange

Sometimes a troublesome compulsion can be redirected to another channel that relieves anxiety and does not actually harm the individual. The knowledge of this is ancient. Several religions employ some version of the rosary, and many of them are in fact much older. In the secular world, “worry beads” are a recognized aid for self-soothing, which is what a body-focused repetitive behavior is all about.

Dr. Fred Penzel’s suggestions for avoiding hair-plucking and other undesirable BFRBs include some ideas that come under the heading of “lean into it.” If you compulsively fool with your own hair, find a substitute, or something equally absorbing to your sense of touch, and fiddle with that instead. The nervous tension is relieved, and you get to keep your hair.

Dr. Penzel finds that his patients deal with the urge to do damaging BFRBs by handling more benign objects, like a string of toothed lock washers, or a troll doll. They have also test-driven a number of commercial products, which he names:

— Koosh Balls™ or other feathery, rubbery type toys…
— a small hand toy known as Electronic Bubble Wrap…
— a miniature Slinky™…
— Bandai Edamame Soybean Pod Key chains that squeeze the little beans in and out…
— a Hairy Tangle™, which is very textured and can be twisted into many different shapes…
— a textured, spiky, squeezable ball known as a Nubby Ball™.
— Handle Kinetic Sand™ which is specially treated sand that is very tactile.
— Silly Putty™ or better still, try Theraputty™, which comes in several different levels of firmness…

Please note, these are secondhand recommendations from an expert in another specialty. However, it is possible that playing with an object that captivates the sense of touch could mollify a child who would otherwise be using his hands to convey snack food to his mouth.

Of course, there are quite a few handleable objects on the list that are not identified by brand. Elastic bracelet with textured beads. Loofah mitt. Spring-loaded hand exerciser. Textured pot scrubber. Wide-tooth comb. Rubber cement. Pipe cleaners, “especially like the extra-large and fuzzy type.”

Why bring up these suggestions? Because they might be useful to parents whose children eat obsessively. Something to fiddle with could be the key to tranquillity. Try it for travel. A child shouldn’t be eating in a car anyway, especially not if strapped in the back seat with a lone adult driving. Eating can lead to choking, and that kind of emergency can lead to a five-car pileup and multiple fatalities.

What does all this have to do with childhood obesity? Maybe a lot. Dr. Pretlow writes,

Displacement activity (the addiction behavior) is how the brain has learned to handle significant conflict, and displacement activity is innate, instinct-level, automatic behavior and essentially out of the person’s control, thus compulsive.

If displacement activity is the basis of addictions, including eating addiction, how might we treat this? Addiction treatments generally involve trying to stop the displacement activity, e.g. enforced sobriety, cease using the drug, and food restriction. Yet, the source conflict is not being dealt with, so the displacement mechanism will keep firing.

In the health care field, many clinicians and researchers are dedicated to finding ways to help people deal with the manifestations that are recognized as symptomatic. There is a strong desire to work toward the elimination of the symptom, whether it be hair-plucking, skin-picking, or chewing potato chips from dawn to dusk.

Many professionals are also interested in addressing whatever it is that makes people compulsively perform body-focused repetitive behaviors. Can patients improve to the point where the urge just falls away? What if all children could be so healthy they would never even get involved in these harmful displacement activities in the first place?

Your responses and feedback are welcome!

Source: “Source: “58 Stimulation Substitutes and Behavioral Blockers for BFRBs — Or “The Great Big List of Favorite Fiddles,”, undated
Image by Randen Pederson/Attribution 2.0 Generic (CC BY 2.0)

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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.

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