Body-Focused Repetitive Behaviors and Substance Abuse

Repetitive behaviors and substance abuse often occur together. Body-focused repetitive behavior treatment is most effective when done with substance abuse treatment.

Repetitive behaviors and substance abuse often occur together. In clinical settings, these behaviors are called body-focused repetitive behaviors (BFRB). BFRBs include skin picking, hair pulling, nail biting and itching. A person with BFRBs feels a compulsion to perform these behaviors to the extent that they are difficult to stop without help. Individuals may still struggle with BFRBs after completing substance use treatment.

Effects of Drug Use on Body-Focused Repetitive Behaviors and Substance Abuse

A common symptom among people with addiction is itchy skin, according to an article in the Journal of Clinical & Experimental Dermatology Research. This sensation can develop for a few different reasons. Intravenous drug use can lead to infections, which cause skin irritation. Some drugs also stimulate the body in a way that causes a reaction in the skin that can also cause it to feel itchy.

Withdrawal and BFRBs

Itching is a commonly reported side effect of withdrawal from substances. During active periods of substance abuse, the body adapts to the constant presence of the substance. When the person stops using the substance, the body’s reaction has to adjust again. Itching is often the result.

The ways BFRBs manifest themselves during withdrawal vary from drug-to-drug:

• Alcohol Withdrawal Itching: Some people report intense periods of itching during alcohol withdrawal. Itching may be related to the reaction of the nervous system as it adjusts to the absence of alcohol. It’s also one of the tactile hallucinations a person can have during delirium tremens (DT). DT is the most severe symptom of alcohol withdrawal and is considered a medical emergency.
• Gabapentin Withdrawal Itching: Gabapentin is a drug used to treat epilepsy and pain. Some people who stop using gabapentin feel severe itching sensations all over their bodies. This constant itching sensation can cause both physical and mental distress.  
• Heroin Withdrawal Itching: Skin picking is a body-focused repetitive behavior related to the anxiety felt when using heroin. This anxiety can drive a person to pick at their skin constantly. Researchers believe that heroin may stimulate an inflammation response from a person’s immune system that triggers the urge to pick at the skin.
• Meth Withdrawal Itching: Itching is a well-known reaction to using meth. Much like heroin, meth creates a sense of anxiety that can trigger the urge to pick at the skin. People who use meth often report an intense feeling that bugs are crawling in their skin, also known as “meth mites.”

Statistics on BFRBs and Addiction

BFRBs are more common than many people realize. According to a study in Current Behavioral Neuroscience Reports, the chances of someone developing a BFRB in their lifetime ranges from 0.5–4 percent. Because accurate information about BFRBs is scarce, the number of people with BFRBs is most likely underreported.

It’s not clear how commonly BFRBs co-occur with addiction. However, people often develop at least one other disorder along with a BFRB. Shame is strongly attached to BFRBs, leading to low reporting rates. People with a substance use disorder may feel this shame so acutely that they are more likely to receive treatment for their addiction than their BFRBs.

Can Body-Focused Repetitive Behaviors Lead to Drug Abuse?

Research about BFRBs is still in its early stages. While a BFRB can result from drug abuse, there is not a clearly defined risk of a BFRB leading to drug abuse.

However, well-researched links do exist between depression and drug abuse. According to an article in the Annals of Clinical Psychiatry, people with skin picking and trichotillomania disorders were more likely to also have depression.

At this time, it may be the risk of developing other mental health disorders that can lead to drug abuse. Future research may reveal more about the risk of BFRBs leading to drug abuse.

Treating BFRBs and Co-Occurring Substance Use Disorders

Body-focused repetitive behavior treatment is most effective when undergone as part of substance abuse treatment. While harmful behaviors and vulnerable emotions are characteristic of both of these conditions, each disorder also has its own distinct features and patterns that need to be addressed.

If you or someone you care about live with body-focused repetitive behaviors and substance abuse, help is available. With centers across the country, our staff has the specialized training to treat co-occurring disorders. Reach out to a representative from The Recovery Village today to learn more.

Editor – Megan Hull

Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more

Medically Reviewed By – Erika Krull, LMHP

Erika Krull has a master’s degree in mental health counseling and has been a freelance writer since 2006. Read more