decoding nervous habits
Let's face it. When we're worried about something, we turn to our 'nervous habits' to calm us down. What you do is different from person to person, and the triggers also vary. Today, I'd like to shine a light on Body-Focused Repetitive Behaviors (BFRBs).
These are specific types of nervous habits that actually cause harm to oneself. Unlike rubbing your hands together or shaking your legs, BFRBs can appear in the form of compulsive skin picking (Dermatillomania), compulsive (non-cosmetic) hair pulling (Trichotillomania), and compulsive nail-biting. These are more than just bad habits, although people might think it's just a phase.
The cause of BFRBs is not known as of now, but there are some clarifications. BFRBs are not an intentional form of self-harm since the purpose of these is not intended to make oneself feel pain or discomfort. Instead, it can feel pleasurable or comforting. While there is a component of 'compulsiveness' like OCD, it is also quite different from it because unlike OCD (where people hate the fact that they have these obsessions), there is a part of BFRBs that feels enjoyable or soothing. Still, that isn't to say that people who have BFRBs don't experience any guilt or shame because of it.
The DSM-5 (Diagnostics and Statistical Manual of Mental Disorders, Fifth Edition) classifies BFRBs in the "Obsessive-Compulsive and Related Disorders" section. BFRBs can be seen as 'compulsions' that one feels the urge to repeat over and over. As a 'compulsion', the behavior is designed to reduce psychological distress or discomfort but could also be a habitual action.
Mental health professionals try to see what triggers a BFRB. From patient reports and research, there have been five categories that seem to fall under 'triggers for BFRBs':
Sensory triggers: Any of the five senses can give someone the urge to perform a BFRB. One might feel a hangnail or see a blemish on the skin.
Cognitive triggers: Thoughts or beliefs could give someone the compulsion to engage in the BFRB. These can be in the form of "I need to pick on my pimples to make it go away" or "If I chew this hangnail off, it won't hurt me in the future". These are less intense than the obsessions that come with OCD.
Affective triggers: Emotions can also be the trigger -- feelings of anxiety, tension, fear, or boredom can lead to an intense feeling of wanting to relieve that with BFRBs.
Motor triggers: Certain movements or postures could kick-start the BFRB. For example, resting your chin on your palm could make it easier to notice the scab on your face.
Setting triggers: the time of the day, whether you're in the room by yourself, or in front of a mirror could all become triggers that initiate BFRBs.
I wanted to write a post about this because it's something that I've always had. It came in different forms since I was young. For a while, it was lip-biting and nail-biting. I had half the size of nails as everybody else because they would get shorter and shorter the more I bit them. I was lucky to get out of that habit when I once hit my hand really hard when I was biting my nails. After that, it just stopped, like magic. I'm not saying that that was the right way to treat it, but it worked.
For a while, I went without any BFRBs, but when I got acne on my face and body, skin-picking became a bit of an issue. I would subconsciously start picking at my face when I touched it and felt a pimple. I would sometimes bleed or get hyperpigmentation in the spots that I picked. It would hurt, but I also wanted the pimples to disappear.
Skin picking came to a stop naturally when my hormones calmed down, and I wasn't getting many pimples. It also helped that I learned (and internalized) that touching my face with dirty hands is one of the worst things you could do when you have acne. I didn't want any scars to be left on my face as a reminder of the pimples I had -- I think that determination got me through.
When I started the IB, however, I think the stressful environment was the trigger for my skin-biting BFRB. Unfortunately, hitting my hand didn't work at all this time. Instead of my nails, I would bite the skin around them. Seeing and feeling hangnails wasn't the only trigger. Even if the skin around the nail was perfectly fine, I would start chewing on it. It was just a way for me to relieve whatever was going on in my mind. Usually, there wasn't even a thought that it was a direct trigger. Just feeling that uncomfortable and tense situation would make my hand go to my mouth.
COVID somehow did help me refrain from biting my skin since we always had to have a mask on. But even with a 'resting period' of BFRB, it would come back like a bad habit. I still haven't found a way to break through this, but I hope that doing research on this and getting to know the triggers and ways to treat it will help me stop. The most concerning part of this isn't how the damaged fingers look, but the increased susceptibility to infections. I know that biting my hangnails has no benefit, and I'm especially reminded to stop when I get an infection, and it hurts. I could avoid all that pain by not biting!
I've looked into ways that would help me cease this BFRB. Cognitive Behavioral Therapy (CBT) is a big one. It's a type of treatment for many mental/behavior disorders. It helps you become more aware of the feelings and thoughts that you have that trigger a certain behavior and gives you an idea of what to do to control your behavior. I tried to keep track of the times that I resort to nail-biting, and it's usually when I feel like things are out of my control or when I'm stressed out about something I need to do. I also experience an urge to keep my nails 'perfect' by biting the hangnails myself.
There's another treatment called Habit Reversal Training (HRT), where you train your awareness (such as triggers, how much time you spend on it, etc), then create a competing response to replace the behavior. There is also a social component where you can talk about the shame and frustration that you might be going through. I might want to get myself a squishy little toy or a fidget cube to replace my BFRB.
It can be a hard habit to break free from, but I won't give up until I've succeeded. Best of luck to anyone else going through this!
This post was written with the help of information provided by the following sites: