BFRB Treatment: Does a Child Have to Want to Stop?

Ambivalence about stopping body-focused repetitive behaviors is expected because the behavior serves a function for the child. The function may regulate arousal, soothe difficult feelings, provide reliable sensory input in an overstimulating day, or meet a need that other options have not met. Pressure to stop can make the behavior harder to understand and meet the child’s needs, leading to secrecy, lying, resentment, and shame, while straining the parent-child relationship. Clinical work can begin wherever a child is on a willingness continuum, including children with no interest, partial curiosity, conditional motivation, or quiet readiness. Willingness grows when children feel known, capable, less alone, and less ashamed.

"Ambivalence about stopping isn't resistance; it means the BFRB is serving a function for the child. It's true we can't force another person to be ready to change. But with Body-Focused Repetitive Behaviors (BFRBs), like hair pulling, skin picking, and nail biting, ambivalence about stopping isn't resistance. It's expected because the behavior is serving a function. It may be regulating arousal, soothing a difficult feeling, providing reliable sensory input in an overstimulating day, or meeting a need that nothing else has yet met."

"When we ignore that function and pressure a child to stop, we often make it harder to understand the behavior and meet the child's needs. Pushing a child to change a behavior that is, on some level, working for them tends to produce a paradoxical effect. The behavior moves underground. Children pull or pick in secret. They may lie about it. Resentment builds. Shame builds. And the parent-child relationship, one of the most protective factors a child has, bends under the weight of a behavior nobody discusses honestly."

"Willingness is a continuum, not a switch. Some children arrive with no interest in working on their BFRB. Some are curious but uncommitted. Some are willing to talk about it but not change it. Some will try a strategy if there's a reward attached. And some are quietly ready, and simply need the right clinician and the right invitation. All of those starting points are workable."

"Willingness is built through feeling known, capable, less alone, and less ashamed. The clinical challenge is to honor that parental instinct while meeting the child where they are and joining them with kindness and curiosity. When a child isn't yet willing to address the behavior directly, there can still be substantial, meaningful clinical work that supports readiness and reduces shame."

Read at Psychology Today