Why You Need to Know the Difference Between Self-Harm and Body-Focused Repetitive Behavior in Children

As a young girl, I picked up the terrible habit of picking at my skin. I picked at skin on my hands, arms, and legs. I picked at my skin so much that I created scabs and scars that will never fade. At 33 years old, my habit of picking my skin has never gone away, though I feel it is a constant work in progress. 

I was always led to believe that this habit was a form of self-harm, though I was never convinced. For one thing, I was a very happy child with a wonderful and supportive family. I had friends, loved music and dancing, and was always surrounded by love. But I was an anxious child, so I picked at my skin because, believe it or not, it felt good. It became my way of self-soothing, which was usually triggered by anxiety. But I never did it because I wanted to cause harm or feel pain. To me, at tough times, it was comforting. 

My 3-year-old daughter seems to be showing signs of the same habit. I’ve noticed her picking at her skin, specifically around her nails. While trying my best to stop her, I recognize, like myself, it is a work in progress. It has made me realize just how important it is not only to get these issues under control but also, when noticing these habits in your child, to properly diagnose them. Self-harm and Body-Focused Repetitive Behavior (BFRB)—like my habit of skin picking—may seem similar, but they are very different. Here with expert advice, we will discuss what these conditions are, why children engage in them, how to spot signs that your children may be struggling with these issues, and how to know the difference between self-harm and BFRB. 

 

What is Self-Harm?

Self-harm is a means of hurting oneself intentionally, specifically harming the physical body. 

“Common examples of self-harm include cutting, burning, carving into the skin, punching self, and banging the head into objects,” said Dr. Michele Goldman, psychologist and Hope for Depression Foundation Research Foundation media adviser. 

Meet the expert
Dr. Michele Goldman
Psychologist and Media Adviser for the Hope for Depression Foundation

Children engage in self-harm for a number of different reasons. It could be to try to regulate or balance intense emotions, feel like they “get something out” or have an emotional release, receive attention from others, or decrease feelings of emptiness. Usually, children who engage in NSSI or non-suicidal self-injury typically have higher rates of depression, anxiety, and stress versus children who do not engage in these behaviors,” Dr. Goldman said. 

 

What is Body-Focused Repetitive Behavior?

Body-Focused Repetitive Behaviors (BFRBs) are repetitive self-grooming behaviors that involve biting, pulling, picking, or scraping one’s own hair, skin, or nails that results in damage to the body and have been met with multiple attempts to stop or decrease the behavior. As I mentioned above, I suffer from BFRB by picking at my skin. 

“These behaviors, when rising to the level of clinically significant distress or impairment, include trichotillomania (hair pulling) and excoriation (skin picking) disorder,” said Dr. Marla W. Deibler, PsyD, psychologist and founder of The Center for Emotional Health.

Meet the expert
Dr. Marla W. Deibler, PsyD
Psychologist and founder of The Center for Emotional Health

Other forms of BFRBs may include behaviors such as onychophagia (nail biting), onychotillomania (chronic picking, pulling, and manicuring of the nails), lip and cheek biting, and tongue chewing. “The function of BFRBs is not to cause harm to oneself,” Dr. Deibler said. “Although the specific function(s) can vary from person to person, overall, it is an unwanted means by which individuals self-regulate when uncomfortable internal states arise (thoughts, feelings, emotions, bodily sensations).”  

Dr. Deibler said that although the long-term effects of these behaviors are unwanted (e.g. hair loss, embarrassment), the immediate consequences perpetuate the behavior pattern (e.g. feels satisfying, serves as a distraction).

 

 

What is the Major Difference Between Self-Harm and Body-Focused Repetitive Behavior?

While initially, self-harm and BFRB may seem similar, it is important to note that they are extremely different. “The major difference tends to be around intention; children who self-harm have the intention of hurting themselves in comparison to children with BFRBs, who do not intend harm,” Dr. Goldman said.

A big difference also relates to the purpose behind the behaviors—as Dr. Goldman pointed out, the appeal of self-harming is usually related to the decreased intense negative emotional states whereas engaging in BFRBs might be soothing but is also reflexive. As with my personal case, though it may be hard to understand, picking at my skin has always been comforting. 

 

Signs to Look for and How to Tell the Difference Between Self-Harm and BFRB

As a parent, noticing marks on your child’s body can understandably be cause for alarm, so it is crucial to know what signs to look for and how to know if these are signs of self-harm or BFRB. 

“Look for unexplained damage to the body and check skin, hair, and other parts of the body,” said Angela Karanja, an adolescent psychologist and parenting teenagers expert as well as founder of Raising Remarkable Teenagers. “Look for unusual dressing or behavior. Are they trying to hide or conceal anything? Are they wearing makeup at unusual times or never coming out in public without it?” Karanja said. 

Meet the expert
Angela Karanja
Adolescent Psychologist and founder of Raising Remarkable Teenagers

As soon as you notice something that could be a warning sign, it’s time to talk with your child. Karanja said to speak gently with the child and let them know you’ve noticed, you are curious not furious, and invite a conversation. She said that you’ll pick up on the intentionality in the conversation.If it’s self-harm, they’ll probably tell you they’ve been struggling and that’s a way of relief. Make sure to lean in and listen so you can glean their needs,” Karanja said. 

If it’s repetitive, chances are likely they may not even genuinely be aware, she explained.

Karaja also noted in both cases, it’s important to be sensitive because your child may be gripped by guilt and shame, so make sure not to approach this in a condemnatory way. 

 

 

Signs of Self-Harm

Dr. Goldman specifically broke down some of the warning signs of self-harm, such as:

  • Fresh cuts or burns
  • Scars on legs or forearms 
  • Wearing clothing that does not fit with the weather (i.e. long sleeves and pants on a hot day)
  • Having a difficult time regulating themselves
  • Impulsivity and emotional instability 

 

Signs of BFRB

Specific warning signs of BFRB to look out for, according to Dr. Goldman, are:

  • Noticing scabs on your child’s face
  • Hair missing from their eyebrows or eyelashes
  • Bald patches on their scalp
  • Bleeding around their nail beds
  • Notice if your child is bored/inactive to see if they engage in repetitive behaviors
  • Observe when they’re stressed, as this is a time they may be more likely to engage in BFRB

 


While these issues can sometimes go away on their own, it is up to parents to decide when it may be time to intervene with medical help either through a psychiatrist, psychologist, or therapist, depending on the severity of the situation. 

What it comes down to is wanting to help your child regulate whatever emotions they may be feeling that are leading them to self-harm or BFRB. Make it clear to your child that they do not have to feel embarrassed by these issues and how medical intervention will be for their benefit. 

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