The silent struggle: Barriers, delays, and missed opportunities in the treatment of body-focused repetitive behaviors.

BACKGROUND

Despite the high prevalence of body-focused repetitive behaviors (BFRBs; e.g., skin picking, trichotillomania, nail biting, cavitadaxia/lip-cheek biting), many affected individuals neither seek nor receive adequate treatment. This study investigates treatment-seeking behaviors and experience with self-help strategies as well as professional interventions among individuals with BFRBs.

METHODS

A total of 971 participants with BFRBs were recruited via online platforms and self-help organizations. Participants completed the Generic Body-Focused Repetitive Behavior Scale (GBS-8) and answered questions regarding age of onset, perceived causes of their condition, prior self-help attempts, professional treatment history, and reasons for not seeking help.

RESULTS

Only 13.5% of participants with BFRBs had sought professional help (mainly psychologists) for their BFRB. Barriers included lack of awareness, perceived low symptom severity, shame, and distrust of treatment. Use of self-help was common (72.2%). However, only a minority used structured and evidence-based techniques like habit reversal training or decoupling. The average duration of untreated BFRBs for those who eventually sought help was approximately 11 years, with cavitadaxia showing the longest delay. Among those who underwent professional care, around 40% received no evidence-based advice. Habit reversal training was the most frequently recommended technique, followed by medication and habit replacement.

CONCLUSIONS

Despite the significant burden of BFRBs, treatment-seeking remains low. Shame, misinformation, and limited access to professionals with specific expertise remain key barriers. These findings highlight the urgent need for increased awareness, accessible interventions, and low-threshold professional training opportunities (e.g., www.uke.de/e-bfrb-en) to improve care of individuals with BFRBs.