I wear many “hats “ in life, from taxi driver to short order cook, to healer, to coach but if I had to summarize my two main roles it would be psychologist and mother. As a psychologist, I specialize in the treatment of anxiety and related disorders. One group of clients that I particularly enjoy working with is people struggling with Body Focused Repetitive Behaviors (BFRBs). Body Focused Repetitive Behaviors is a fancy term for simple behaviors such as hair pulling, nail biting, and skin picking. I see clients ranging from very young to very old, looking to work on Body Focused Repetitive Behaviors. Actually, to be more accurate, when working with children, it is often the parents that are looking to work on the hair pulling or nail biting or skin picking and the young person is “strongly encouraged” to work on this condition.
In my first session, when working with parents of children engaging in Body Focused Repetitive Behaviors, I try to discern how intrinsically motivated is the young person to work on the pulling, picking, or biting. I assess how much distress this behavior is causing the identified client and how much it is negatively impacting his or her life. If the Body Focused Repetitive Behavior is only causing minimal distress and is not impacting functioning, I may still work with parents to come up with an extrinsic reward system to reduce the behavior but chances are, it will only be minimally effective until the young person is motivated to reduce the behavior.
My next focus is to assist the parents in learning to manage the distress they experience and limit their reactions, when they notice their child engaging in a Body Focused Repetitive Behaviors. I work with many adult clients who continue to struggle with hair pulling or skin picking or nail biting and when they find themselves engaging in the unwanted behavior, they experience a storm of negative self talk along the lines of “why are you doing this?” … “this behavior makes you look nervous and unprepared” … “you look like someone who does not have their life together” … “what is wrong with you”… “STOP”… “This behavior is a sign that something is wrong with you”. Many of these sentiments came directly from well-meaning care givers who encouraged them to stop the Body Focused Repetitive Behavior and warned them of all the negative consequences of the behavior. The problem is these tips, coming from either the inside or the outside, do little to reduce the behavior. If anything, harsh, critical feedback serves to increase the unwanted behavior. The smaller and more powerless one feels, the less likely one will put up a fight to resist a strong urge.
And so, I work with parents to do one of the hardest thing a parent can do – nothing. It is so painful to stand back and watch someone you love, especially your child, enact a behavior that goes against their best interests. Even if your child does not know that others are looking at their missing eye brows or bitten up cuticles, you do. You know the judgements that others may make and how harsh a world it can be. If you could fight this battle for them, you would. Unfortunately, you can’t.
All you can do is:
And so, back to my life of many hats, as a psychologist and as a mother. It is a lot easier to offer the words of wisdom above, when wearing my psychologists hat than it is to implement said words when wearing my mommy hat. For example, yesterday I was out with my 3 little ones, on a stressful, hectic errand, when I noticed my little one nibbling at her cute little nails (which she has a tendency to do when she is bored or tired or just notices any imperfection that she feels compelled to munch off). Did I calmly note her engaging in a Body Focused Repetitive Behavior and try to redirect my energy towards something I could control? No, of course not. Instead I yelled, “Stop biting your nails right now or you are going to get sick. Do you want to vomit again? Was that fun when you had the flu last week?”. So no, not my finest moment. But then there was the moment the other day when I noticed her biting her nails and without commenting about it, I asked her if she wanted to play catch. We then spent the next 15 minutes spending quality time together, using up some of our excess energy, engaging in a competing behavior which was at odds with her biting. And so, in the “real world”, as a parent, we are going to win some and lose some. Sometimes we are going to rock and get parenting just right and sometimes we are going to stumble and flail about. But if our hearts are in the right place and we keep learning and growing, I truly believe it all works out in the end, for our children, and for ourselves.