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Body-Focused Repetitive Behavior Disorders: From Competing Paradigms Toward Iterative Integration
Dan J Stein1, Christine Lochner2
1SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
Annual Review of Clinical Psychology
|May 7, 2026
Summary
Body-focused repetitive behaviors (BFRBs), like hair-pulling and skin-picking, have been viewed through many lenses. Scientific pluralism, embracing diverse perspectives, offers a path for advancing BFRB knowledge and treatment.
Area of Science:
- Psychiatry and Behavioral Science
- Neuroscience
- Mental Health Research
Background:
- Body-focused repetitive behaviors (BFRBs), including hair-pulling and skin-picking, have a long history of medical description.
- Historical and contemporary understanding of BFRBs has been shaped by various theoretical frameworks, not always theory-neutral.
Purpose of the Study:
- To review the diverse conceptual frameworks used to understand BFRBs.
- To evaluate the strengths and limitations of each framework.
- To propose a path forward for BFRB research and clinical practice.
Main Methods:
- Literature review and synthesis of historical and current conceptual frameworks applied to BFRBs.
- Analysis of theoretical approaches including psychoanalysis, cognitive behaviorism, psychopharmacology, nosology, neuroscience, consumer advocacy, and global mental health.
- Critical evaluation of the contributions and limitations of each framework.
Main Results:
- BFRB understanding has evolved through multiple paradigms, such as psychoanalysis, cognitive behaviorism, and neuroscience.
- Each theoretical approach offers unique insights but also possesses inherent limitations.
- No single framework has fully captured the complexity of BFRBs.
Conclusions:
- Advocating for a new paradigm is less productive than embracing scientific pluralism for BFRBs.
- A pluralistic approach, integrating insights from diverse frameworks, is beneficial for clinicians and researchers.
- Scientific pluralism facilitates iterative and integrative progress in understanding and treating BFRBs.
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