OCD and BFRBs: How Are They Related?

Upon leaving our houses, some of us have the occasional anxious questions of “Did I lock the door?”, but we usually try our best to quell them with reassuring thoughts. However, if your doubting has been too persistent and the thoughts have been worrisome enough to interrupt your routines, you might be a victim of obsessive thinking.

You might have given in to your obsession and indulged in compulsive behaviours, which may be excessive and unrealistic, and ultimately not within your control, or at least not without some concerted effort. For example, if you fear contamination with germs, you might end up washing your hands repeatedly just to neutralize the thought. However, the problem is that the thoughts don’t stop even after you clean up well.

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What is OCD (Obsessive-Compulsive Disorder)?

Obsessive-Compulsive Disorder (OCD) is a mental health disorder characterized by persistent, unwanted thoughts, ideas, impulses or doubts (obsessions) that lead to repetitive behaviours or mental acts (compulsions). These compulsions are performed in an effort to reduce the anxiety caused by the obsessions.

Obsessive compulsive disorder (OCD) impacts approximately 1 to 2 individuals out of 100. OCD usually involves obsessive thoughts, ideas, images, impulses, and doubts, followed by compulsive actions and thoughts targeted at neutralizing the said obsessions. It’s a cycle of unhealthy behaviour and thoughts, and it can prove to be highly inconvenient (and sometimes debilitating) in our day-to-day functioning.

OCD has 3 primary elements:

• Obsessions: unwanted, intrusive and distressing images, thoughts, urges or doubts repeatedly entering your mind
• Emotions: the obsessions causing a feeling of intense distress, anxiety, guilt or shame
• Compulsions: repetitive behaviours or mental acts you feel driven to perform as a way of neutralizing the anxiety and distress triggered by the obsession

If you suffer from obsessional thinking and have diagnosed with Obsessive-Compulsive Behaviour, you probably realize that your compulsive behaviours are largely irrational and don’t make much logical sense, but you still can’t stop acting on them because you feel the need to neutralize the obsessions and prevent something bad happening or to get rid of feeling “not just right”.  

Meanwhile, there are behavioural issues that look quite like OCD but aren’t exactly the same. It’s important to carefully assess the problem before dipping our toes into treatment methods. You can have a diagnosis of OCD alongside other OCD-related disorders such as Body Dysmorphic Disorder (BDD), Hoarding Disorder, or Body Focused Repetitive Behaviours (BFRBs), which will be discussed below.

If you suspect that you have some symptoms, you may use our confidential (and free) OCD screening tool to identify if you have symptoms of OCD.

What are BFRBs (Body-Focused Repetitive Behaviours)?

Body-focused repetitive behaviours (BFRBs) are a group of disorders characterized by repetitive behaviours that usually involve the hair, skin, and nails. Examples of BFRBs include trichotillomania (hair pulling), dermatillomania or excoriation (skin picking), and onychophagia (nail biting).

How are OCD and BFRB related?

OCD and BFRBs are related in that they both involve repetitive behaviours they feel driven to perform that are unwanted and cause distress. However, BFRBs are considered a separate disorder from OCD, and people with BFRBs may or may not also have OCD.

What are the 5 main symptoms of OCD?

The 5 main symptoms of OCD are:

• Persistent, unwanted thoughts, ideas, impulses or doubts (obsessions) that cause anxiety or distress.
• Repetitive behaviours or mental acts (compulsions) that are performed in an effort to reduce the anxiety caused by the obsessions.
• The compulsions are typically not realistically connected to the problem they are intended to solve.
• Obsessions or compulsions are excessive or unreasonable.
• Obsessions or compulsions cause significant distress or impairment in social, occupational, or other areas of functioning.

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What are some of the main symptoms of BFRBs?

Symptoms of BFRBs include:

• Recurrent and persistent behaviours of pulling out hair, picking skin, or biting nails.
• Inability or difficulty with resist in the urge to perform the behaviour.
• Behaviours can have an element of feeling pleasurable and soothing.
• Significant distress or impairment in social, occupational, or other areas of functioning because of the behaviour.
• Behaviours are not a form of self-harm or self-mutilation.

The main difference between OCD and BFRBs is that OCD involves anxiety and compulsions that won't be resolved unless they give in to those obsessions. Meanwhile, BFRBs don’t involve having obsessions like “If I don’t pick my skin, something bad will happen”. Hair pulling and skin picking are done serves to lessen aversive cognitions or emotions, and could even feel as though it’s self-regulating.  

Additionally, those with BFRBs find behaviours like hair pulling and skin picking pleasurable while people with OCD don’t like doing their rituals but feel as though they have to do them.

How can OCD be treated?

Many people desire complete freedom from obsessive compulsive disorder, but it can only be managed or treated with the right type of therapy and a good support system. Treatment for OCD includes both cognitive-behaviour therapy (CBT) and medication. These approaches are considered evidence-based treatments for OCD by themselves, or when administered together.  

CBT is all about identifying and changing the thoughts and behaviours that maintain OCD, while medication, such as selective serotonin reuptake inhibitors (SSRIs), help ore on the reduction the symptoms of OCD.  

How Can BFRBs Be Treated?

BFRBs are also manageable and treatable, like obsessive compulsive disorder. The treatment for BFRBs generally involves a form of cognitive-behaviour therapy (CBT) like comprehensive behavioural treatment (ComB), habit reversal training (HRT), or acceptance and commitment therapy.  

These approaches are all about identifying and changing the thoughts and behaviours that maintain the BFRB like hair pulling and skin picking. Some medications can be helpful to reduce the symptoms of BFRBs, especially those that reduce anxiety, such as SSRIs.

When it comes to outpatient therapeutic techniques, clients with OCD and BFRBs can also try out some strategies like mindfulness, relaxation techniques, and stress management. Additionally, it’s also important to have a support system in place, whether it’s friends, family, or a support group for those with OCD or BFRBs for a more relatable discussion.

How Can Archways Help with OCD and BFRBs?

Archways Centre for CBT is an Institutional Member of the International OCD Foundation (IOCDF), and our team includes psychologists and therapists with specialized training in OCD treatment and the proper care for other conditions related to OCD. We work with children as young as 7 years old, adolescents, and adults up to 70 years of age.  

There aren’t many clinicians trained in the up-to-date evidence-based therapies for BFRBs and OCD, so if you want our services virtually across Ontario, Archways can definitely help. You can achieve freedom from obsessive compulsive disorder and from BFRBs through the right management and treatment strategies and techniques. Don’t hesitate to reach out to us today!