Are There Therapists in Canada Who Treat Body-Focused Repetitive Behaviours (BFRBs)?

Many individuals living with body-focused repetitive behaviours (BFRBs) spend years trying to explain their symptoms to healthcare providers, family members, or even therapists who may not fully understand what BFRBs are.

Some people report being told:

• the behaviours are “just a bad habit”
• they simply need to exert more self-control
• or the behaviours are only related to stress or anxiety alone

Others may have seen multiple therapists before finding someone familiar with concerns such as:

• hair pulling (trichotillomania)
• skin picking (excoriation disorder)
• nail biting
• cheek biting
• or other repetitive grooming-related behaviours

As a result, many individuals begin wondering whether there are actually therapists in Canada who understand BFRBs and provide treatment specifically for these concerns.

The short answer is yes. However, finding clinicians familiar with BFRBs can sometimes take more effort than finding a therapist for more commonly discussed mental health concerns.

This blog explains:

• what BFRBs are
• why they are often misunderstood
• what treatment approaches may help
• and what to look for when searching for a therapist in Canada who works with BFRBs.

What are body-focused repetitive behaviours (BFRBs)?

Body-focused repetitive behaviours (BFRBs) involve repetitive behaviours directed toward the body that can become difficult to stop even when individuals want to reduce or prevent them.

Common BFRBs may include:

• hair pulling (trichotillomania)
• skin picking (excoriation disorder)
• nail biting
• cheek biting
• lip biting
• or other repetitive grooming-related behaviours

Many individuals describe experiencing:

• urges or tension before the behaviour
• temporary relief, satisfaction, or regulation afterward
• shame or embarrassment following or due to impacts of the behaviours
• frustration about difficulty stopping
• or cycles of avoidance and concealment over time

BFRBs are not simply habits, attention-seeking behaviours, or signs that someone “is not trying hard enough.”

In clinical practice, many individuals with BFRBs describe feeling highly distressed, emotionally exhausted, or discouraged after repeated unsuccessful attempts to stop the behaviour on their own.

Why do so many people with BFRBs feel misunderstood?

Many individuals with BFRBs report that even healthcare professionals or therapists may have limited familiarity with these concerns.

Because BFRBs are often hidden due to shame or embarrassment, people may go years without discussing the behaviours openly.

Some individuals become highly skilled at:

• concealing hair loss or skin damage
• avoiding situations where the effects of the behaviours may become visible
• hiding repetitive behaviours from others
• or minimizing the emotional impact of the behaviours altogether

In practice, many individuals with BFRBs have spent years believing they are alone in the experience or worrying that others may not understand the behaviours accurately.

BFRBs are also sometimes misunderstood as:

• self-harm
• “bad habits”
• anxiety alone
• or behaviours that should be easy to stop through willpower

This misunderstanding can increase shame and frustration and make it more difficult for individuals to seek support.

Are BFRBs related to OCD or anxiety?

BFRBs can overlap with concerns such as OCD, anxiety, perfectionism, emotional regulation difficulties, ADHD, sensory sensitivities, and stress, although they are generally understood as distinct clinical concerns rather than symptoms of OCD alone.

In clinical practice, some individuals describe pulling or picking behaviours that occur:

• automatically during periods of distraction or boredom
• intentionally in response to urges or sensory experiences
• during stress or emotional overwhelm
• or while attempting to regulate uncomfortable emotions or internal sensations

For some individuals, the behaviours may feel more strongly connected to tension, sensory experiences, emotional regulation, or automatic behavioural patterns than to obsessional fears alone.

Understanding these patterns often becomes an important part of helping individuals respond to urges more effectively, with greater awareness, flexibility, and less shame or self-criticism over time.

Are there therapists in Canada who work specifically with BFRBs?

Yes. Some therapists in Canada do work specifically with BFRBs or have additional experience treating concerns such as hair pulling and skin picking.

At the same time, many individuals report difficulty finding clinicians with experience treating BFRBs compared to more commonly discussed concerns such as generalized anxiety or depression.

When searching for a therapist, it may be helpful to look for clinicians who mention:

• BFRBs directly
• trichotillomania
• skin picking or excoriation disorder
• habit reversal training (HRT)
• Comprehensive Behavioral (ComB) treatment
• cognitive behavioural therapy (CBT)
• acceptance and commitment therapy (ACT)
• or behavioural approaches for repetitive behaviours

In clinical practice, individuals often benefit from working with therapists who understand that BFRBs usually involve emotional, sensory, cognitive, and behavioural processes occurring together rather than simply behaviours that should be easy to stop through willpower alone.

Treatment may involve exploring:

• triggers and urges
• emotional and sensory experiences
• behavioural patterns
• shame and avoidance cycles
• environmental factors
• and strategies for increasing awareness, flexibility, and self-understanding over time

What kinds of therapy are used for BFRBs?

Several therapy approaches may be used when working with BFRBs, depending on the individual’s symptoms, goals, and treatment needs.

Behavioural and cognitive-behavioural approaches are commonly discussed within BFRB treatment literature.

Treatment may involve various evidence-based interventions, such as:

• habit reversal training (HRT)
• awareness training
• identifying triggers or high-risk situations
• stimulus control strategies
• emotional regulation work
• cognitive-behavioural interventions
• acceptance and commitment therapy (ACT) strategies
• or work focused on shame and self-criticism

In clinical practice, treatment is often individualized because BFRBs can serve different functions for different people.

For some individuals, behaviours may be more connected to:

• emotional regulation
• sensory experiences
• self-soothing strategies
• perfectionism
• stress reduction
• boredom
• tension relief
• or automatic behavioural patterns

As a result, treatment often focuses on understanding the behaviour more fully rather than approaching it simply as a behaviour that must immediately stop. 

Exploring these patterns with a therapist is often an important part of understanding and addressing the emotional, sensory, behavioural, and environmental factors contributing to the BFRB over time.

Why can BFRB treatment sometimes feel emotionally difficult?

Many individuals with BFRBs experience significant shame, secrecy, or self-criticism related to the behaviours.

Some people worry:

• they will be judged
• others will not understand
• the behaviours sound “strange”
• or they should already be able to stop on their own

In practice, some individuals have never discussed their hair pulling or skin picking openly with another person before beginning therapy.

Others may have experienced:

• teasing or bullying
• comments from family members
• embarrassment about appearance-related changes
• or frustration after repeated unsuccessful attempts to stop the behaviour independently

Because of this, beginning treatment may feel emotionally vulnerable at first.

A thoughtful therapeutic approach often involves creating enough emotional safety for individuals to discuss urges, behaviours, shame, and setbacks openly without fear of criticism or judgment.

Why do shame and secrecy become so common in BFRBs?

Shame is often one of the most emotionally painful parts of living with a body-focused repetitive behaviour.

Many individuals with BFRBs spend significant amounts of time trying to hide:

• hair loss
• skin damage
• repetitive behaviours
• urges
• or emotional distress connected to the behaviours

As a result of BFRBs, some people may avoid:

• social situations
• dating or intimacy
• hair salons or medical appointments
• swimming or bright lighting
• or situations where others may notice changes in appearance or repetitive behaviours

In clinical practice, many individuals describe feeling caught between wanting support and simultaneously fearing judgment, embarrassment, or misunderstanding from others.

Over time, shame and secrecy can sometimes increase emotional distress and make behaviours feel even more isolating or difficult to discuss openly.

For some individuals, an important early part of therapy involves reducing shame, increasing self-understanding, and developing the ability to talk more openly about urges, behaviours, setbacks, and emotional experiences without harsh self-criticism.

Can BFRB therapy be done online?

Yes. Many aspects of BFRB treatment can occur effectively through online therapy.

Virtual therapy may allow individuals across Canada to access clinicians with experience treating BFRBs, even when local providers are unavailable.

For some individuals, online therapy may also feel:

• more private
• less intimidating
• or emotionally easier when discussing behaviours that have been hidden for years

In clinical practice, many individuals become more comfortable discussing repetitive behaviours once therapy begins and trust develops within the therapeutic relationship.

Virtual therapy may also allow treatment discussions to occur more directly within the environments where behaviours, urges, or routines are actually occurring day to day.

What should I look for in a therapist for BFRBs?

Finding a therapist who feels knowledgeable, collaborative, and emotionally safe is often an important part of BFRB treatment.

When looking for a therapist, some individuals find it helpful to ask whether the clinician has experience working with:

• trichotillomania
• skin picking or excoriation disorder
• nail biting or cheek-biting behaviours
• habit reversal training (HRT)
• behavioural interventions for BFRBs
• OCD or anxiety-related concerns
• or emotional regulation difficulties

It may also be helpful to pay attention to whether the therapist:

• approaches the behaviours without judgment
• explains treatment thoughtfully
• understands shame and avoidance patterns
• and works collaboratively rather than punitively

In clinical practice, many individuals benefit from therapy environments where setbacks, urges, and behavioural slips can be discussed openly without fear of criticism or failure.

What if I have never met anyone else with a BFRB?

Many individuals with BFRBs report feeling isolated or alone for years before realizing these concerns are more common than they initially believed.

Because BFRBs are often hidden, people may assume:

• “nobody else does this”
• “something is wrong with me”
• or “other people would not understand”

In practice, many individuals describe enormous relief simply from learning that:

• BFRBs are recognized clinical concerns
• BFRBs are often connected to emotional, sensory, behavioural, and environmental factors rather than a single cause
• other people experience similar urges and struggles
• meaningful treatment approaches do exist

For some individuals, reducing shame and secrecy becomes an important early part of the therapy process itself.

How do I find a therapist in Canada who works with BFRBs?

Many individuals begin by searching online for terms such as BFRB therapy in Canada, trichotillomania therapy, skin picking treatment, excoriation disorder treatment, or therapists familiar with habit reversal training (HRT) or Comprehensive Behavioral (ComB) treatment.

When exploring therapists or clinics, it can be helpful to look for clinicians who specifically mention BFRBs, discuss hair pulling or skin picking directly, and appear comfortable discussing the emotional impact these behaviours can have over time.

Forward Thinking Psychological Services® provides virtual psychological services across Canada, including support for body-focused repetitive behaviours, OCD, and anxiety-related concerns.

Many individuals find it helpful to schedule an initial consultation to better understand whether the therapist feels like a good fit, how treatment may be approached, and whether the clinician appears comfortable discussing BFRBs openly and knowledgeably.

Conclusion

Many individuals with body-focused repetitive behaviours spend years feeling misunderstood, ashamed, or unsure whether effective treatment even exists.

At the same time, there are therapists in Canada who understand concerns such as hair pulling, skin picking, and related repetitive behaviours and who approach treatment in thoughtful, evidence-informed, and nonjudgmental ways.

For many individuals, treatment involves more than simply trying to “stop” a behaviour. Therapy may also involve understanding urges, emotional patterns, shame, avoidance, sensory experiences, and the contexts in which behaviours occur.

Working with a provider such as Forward Thinking Psychological Services® or another regulated therapist familiar with BFRBs may help individuals better understand available treatment options and whether therapy feels like a helpful next step.