Body-Focused Repetitive Behavior Disorders: From Competing Paradigms Toward Iterative Integration

  • Annu Rev Clin Psychol. 2026 May;22(1):481-503. doi: 10.1146/annurev-clinpsy-081423-015659.
Dan J Stein  1 ,  Christine Lochner  2
Affiliations
  • 1. SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
  • 2. SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa; email: [email protected].
PMID: 42097987 DOI: 10.1146/annurev-clinpsy-081423-015659
Abstract

Body-focused repetitive behaviors (BFRBs), such as hair-pulling and skin-picking, have been described by physicians from Hippocrates onward. The descriptions have not been theory-neutral; clinicians and researchers have applied specific conceptual frameworks to understand such behaviors and to intervene accordingly. These include what might be termed "turns" to psychoanalysis, cognitive behaviorism, psychopharmacology, nosology, neuroscience, consumer advocacy, and global mental health. It is timely to consider lessons learned from this range of conceptual frameworks, each of which has both strengths and limitations. Rather than advocating for yet another paradigm shift to advance knowledge and treatment of BFRBs, we suggest that scientific pluralism is useful for clinicians and researchers and potentially allows iterative and integrative progress in this field.

Keywords
BFRBs; body-focused repetitive behaviors; conceptual frameworks; paradigm shift; scientific pluralism.
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