Body-focused repetitive behavior treatment in Naperville, IL
Body-focused repetitive behaviors (BFRBs) are a group of conditions involving repetitive, compulsive behaviors directed at the body, including pulling, picking, biting, or scraping, that are difficult to control and often cause distress or physical damage.
BFRBs are more common than most people realize. Trichotillomania alone affects an estimated 1 to 2% of the population. But because of shame, embarrassment, and a lack of awareness, most people suffer in silence for years before seeking help, or never seek it at all.
BFRBs are not:
• A sign of weakness
• Something you can stop "if you really wanted to"
• A form of self-harm in the traditional sense
• Just a nervous habit
BFRBs are driven by complex interactions between sensory triggers, emotions, habit, and automatic behavior. Understanding your specific pattern is the first step to changing it, and that's exactly what treatment at Untangled focuses on.
Most people who come to me for BFRBs have never talked about it with anyone before. The shame is real, but so is the help. You don't have to keep managing this alone.
What are body-focused repetitive behaviors?
Taking the first step is often the hardest part. Reach out. I'd love to hear what's going on.
Conditions treated at Untangled
Untangled was built around conditions that require real specialty training
Excoriation Disorder (Skin Picking)
Excoriation disorder involves repetitive picking at the skin, often targeting perceived imperfections, scabs, or areas of texture, resulting in skin damage, wounds, and scarring. Like trichotillomania, it can be focused or automatic, and often involves significant time spent picking as well as attempts to conceal the results.
Skin picking is frequently accompanied by feelings of shame and is often kept completely secret. Many clients have never spoken about it with anyone before coming to therapy. That changes here.
Approaches used: ComB, HRT, ACT
Trichotillomania (Hair Pulling Disorder)
Trichotillomania involves recurrent, compulsive urges to pull out hair from the scalp, eyebrows, eyelashes, or other areas of the body. It often results in noticeable hair loss, and the shame and concealment that come with it can be as distressing as the pulling itself.
Pulling can be "focused," meaning deliberate and tension-driven, or "automatic," meaning it happens without full awareness, often while watching TV, reading, or falling asleep. Many people experience both.
Trichotillomania typically begins in childhood or adolescence, but adults who have pulled for decades can and do recover with the right treatment. I work with children, teenagers, and adults.
Approaches used: ComB, HRT, ACT
Onychophagia, chronic, compulsive nail biting, goes beyond occasional nervous nail biting. It involves significant, repetitive biting that causes physical damage to the nails, cuticles, or surrounding skin, and that feels difficult or impossible to control.
While nail biting is often minimized as a minor habit, for those who experience it as compulsive and distressing, it is a real BFRB that responds to the same evidence-based treatment approaches
Approaches used: ComB, HRT, ACT
Onychophagia (Nail Biting)
Dermatillomania & Skin-Focused Behaviors
Beyond excoriation, some clients engage in other repetitive skin-focused behaviors including squeezing, scraping, or targeting specific areas of the body in repetitive ways. These behaviors share the same underlying mechanisms as other BFRBs and are treated similarly.
Approaches used: ComB, HRT, ACT
Other Body-Focused Repetitive Behaviors
BFRBs and co-occurring conditions
BFRBs frequently co-occur with OCD, anxiety, ADHD, and depression. They share some features with OCD, particularly the compulsive, repetitive nature, but they are distinct conditions that require their own specialized treatment approach.
At Untangled, if you are dealing with both a BFRB and OCD or anxiety, both can be addressed in treatment. Having one does not mean the other has to wait.
BFRBs also include lip biting, cheek chewing, nose picking, and other repetitive body-focused behaviors that cause distress or interference with daily life. If you engage in a repetitive body-focused behavior that isn't listed here, reach out. If it's bothering you, it's worth addressing.
Approaches used: ComB, HRT, ACT
Taking the first step is often the hardest part. Reach out. I'd love to hear what's going on.
ComB (Comprehensive Behavioral Treatment)
ComB is the gold-standard treatment for BFRBs, developed specifically because BFRBs are not one-size-fits-all. Every person's BFRB has its own unique pattern, including specific triggers, functions, and maintaining factors, and ComB addresses all of them.
Treatment begins with a detailed functional assessment: identifying when, where, how, and why the behavior occurs. Is it sensory-driven, meaning pulled toward a specific texture or sensation? Emotionally driven, triggered by stress, boredom, or anxiety? Cognitive, preceded by particular thoughts or urges? Or largely automatic and habitual?
From there, treatment is built around your individual profile, using specific strategies to address each dimension of the behavior. ComB is collaborative, practical, and highly individualized.
HRT (Habit Reversal Training)
ACT (Acceptance and Commitment Therapy)
HRT is one of the most well-researched behavioral treatments for repetitive behaviors. It involves three core components:
Awareness training. Developing a clear, real-time awareness of when the behavior occurs, including its earliest warning signs and triggers.
Competing response training. Learning a specific, incompatible behavior to perform in place of the BFRB when the urge arises.
Social support. Involving a trusted person in noticing and gently prompting the competing response.
HRT is often used as a component within ComB, or as a standalone treatment depending on the individual's needs.
ACT supports BFRB treatment by helping clients build a different relationship with the urges, sensations, and thoughts that precede the behavior. Rather than fighting or suppressing the urge, which often intensifies it, ACT teaches psychological flexibility: the ability to notice the urge, make room for it, and choose a different response.
How BFRBs are treated at Untangled
Taking the first step is often the hardest part. Reach out. I'd love to hear what's going on.
Q: I've tried to stop on my own and it never works. Will treatment actually help?
A: Yes. Willpower alone is rarely enough for BFRBs, because the behavior is driven by complex sensory, emotional, and habitual factors that willpower doesn't address. ComB and HRT target the actual mechanisms maintaining the behavior, which is why they work when self-directed attempts haven't.
Q: I'm embarrassed about my BFRB. Will I be judged?
A: Absolutely not. BFRBs are incredibly common, and many people who come to Untangled have never spoken about their behavior with anyone before. This is a judgment-free space. The only goal is helping you.
Q: My child pulls their hair or picks their skin. Can you help?
A: It depends on the child's age and presentation. Reach out to discuss. Treating BFRBs in younger children often involves significant parent coaching and a modified approach.
Common questions about BFRB treatment.
Q: Is there medication for BFRBs?
A: There are medications sometimes used for BFRBs, but behavioral treatment, specifically ComB and HRT, has the strongest evidence base. If medication is part of your care, I am happy to collaborate with your prescribing provider.
Q: Do BFRBs ever go away on their own?
A: Sometimes they reduce, but for most people untreated BFRBs persist or worsen over time. Early treatment tends to produce better outcomes, and it's never too late to start.
Q: Do you take insurance?
A: Untangled is an out-of-network, private-pay practice. I provide superbills after each session that you can submit to your insurance for potential out-of-network reimbursement.
Adress:
PHONE: +1 630-394-5878
Serving Naperville, Aurora, Bolingbrook, Wheaton, Warrenville, Lisle, Woodridge & surrounding suburbs · Telehealth in IL & IA · © 2025 Untangled OCD and Anxiety Specialists
Links:
EMAIL: jelena@untangledocd.com
ADDRESS: 640 South Washington St. Suite 212 Naperville, IL, 60540, United States
LICENSED IN: Illinois & Iowa | Indiana coming soon
Accessibility
I offer in-person sessions in the Naperville area and telehealth across Illinois and Iowa. If you need a home visit for school refusal, anxiety support, or family coaching, I can do that. If you need intensive sessions, I can do that too.
