A Body-Focused Repetitive Behavior Surprise

Here is what Dr. Pretlow wrote in 2013, when no studies had yet confirmed that stress-induced eating could be attributed to displacement behavior:

Displacement behavior eating in humans involves the motor actions of eating — which appear to alleviate stress similar to other BRFBs. As with comfort eating and pleasurable taste, once the brain recognizes that the actions of eating ease stress, the brain will insidiously undergo changes to amplify and perpetuate the behavior. Thus, stress-induced eating may become compulsive overeating and lead to obesity.

The previous Childhood Obesity News post discussed a piece called “Creating a Self-Care Toolbox for BFRBs.” This is a special container that does not have to be made of metal or painted red, and it holds things like fidget toys, inspirational words, anything that might come between a person and the acting out of body-focused repetitive behaviors. The expression “skill set” is useful here, because each learned skill is a tool, and to cope with some of these problems does seem to require a whole set of them.

A BFRB we have not mentioned yet is cheek biting. It seems to be fairly common, and even has a Latin name (morsicatio buccarum) and an entry in the Diagnostic and Statistical Manual of Mental Disorders as one of the Obsessive-Compulsive and Related Disorders.

The website BFRB.org is a trove of information and suggestions. Psychotherapist Matthew Traube writes,

It is likely that biologic predisposition, acting through genetic mechanisms, activates the repetitive behavior. This process may be initiated or influenced by emotional states, and can itself cause an emotional feedback loop that results in the recurring behavior… Cheek biting can also be used as a coping mechanism to relieve emotional pain, physical pain or a blend of the two. Understanding the meaning behind the pain can be useful.

Not surprisingly, Traube uses the word “multifactorial” to describe the origins of these behaviors, but stress and anxiety are usually in the mix. Although not always, because there is such a thing as eustress, as distinguished from distress. He mentions that, in common with other BFRB activities like automatic, compulsive eating, the patient can go into a trance-like state and not even realize that self-destructive activity is taking place.

Every paragraph proves the folly of neglecting mental and emotional health, yet psychotherapy is beyond the reach of most people. Instead, Botox has been tried to prevent cheek biting, as well as lip biting, teeth grinding, and facial tics and twitches associated with Tourette’s Syndrome. Sticking needles in a face is, strictly speaking, as invasive as surgery. It seems like a treatment that should be chosen only as a desperate last resort.

Here is a little something for the toolbox, the surprise referenced in this page’s title. A very effective treatment for BFRBs might be watching pimple-popping videos. This is from Caroline Praderio, by way of BusinessInsider.com:

In comment threads and communities across the social media, a small but vocal group of people with trichotillomania and related behaviors report that pimple-popping videos — the internet’s vast collection of blackhead extractions, whitehead squeezes, and cyst eruptions caught on camera — are more than just documentation of human grossness. They make some lives better, and measurably so.

The writer mentions that BFRBS are “complex and highly individualized” — there is the old multifactorialism again — and that for some patients, these videos could be a trigger that brings on the unwanted compulsion. So use caution. Here is a helpful tip for free — in the bathroom, at the dressing table, or wherever grooming is done, dim the lighting.

Your responses and feedback are welcome!

Source: “About Chronic Cheek Biting,” BFRB.org, undated
Source: “Those pimple-popping videos we’re all obsessed with could have a surprising medical benefit,” BusinessInsider.com, 01/29/18
Image by Joachim Schlosser/Attribution 2.0 Generic(CC BY 2.0)

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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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