Skip to main content

Verified by Psychology Today

Body-Focused Repetitive Behaviors

The Cost of Beauty: More Than Just Skin Deep

The impact of unrealistic beauty standards on body-focused repetitive behaviors

Key points

  • Unrealistic beauty standards significantly impact individuals with BFRBs complicating their path to recovery.
  • For many, emotions are central to the cycle of body-focused repetitive behaviors (BFRBs).
  • Shame is common in individuals with BFRBs, acting as both a trigger and a consequence of the behaviors.
  • Understanding and managing emotions in BFRBs may lead to more effective, sustainable recovery.

Unrealistic beauty standards and perfectionistic expectations of physical appearance are deeply ingrained in our society. These ideals permeate various aspects of life, transcending cultural boundaries and manifesting in our family and community lives, workplaces, leisure activities, and beyond. Social media, through digital tools that modify images and augmented reality beauty filters, along with makeup tutorials on platforms like TikTok and Instagram, constantly bombards individuals with idealized notions of beauty. This relentless promotion of unattainable aesthetics by the $374.18 billion beauty industry, which is projected to grow to $758.05 billion by 2032, significantly impacts how people view themselves and others.

For individuals experiencing body-focused repetitive behaviors (BFRBs) such as hair pulling, skin picking, nail-biting, or other BFRBs, these beauty ideals can be particularly impactful, severely damaging one’s sense of self and complicating treatment and recovery. The emotional pain associated with manifesting unwanted self-inflicted damage to one’s own appearance when these ideals are held out as aspirations by our society is significant for many.

Emotions are central to the cycle of BFRBs. Individuals with BFRBs are often more vulnerable to intense emotional experiences and have difficulties regulating these emotions. Furthermore, shame is a prevalent emotion among individuals with BFRBs. It is both a trigger and a consequence of the behaviors. Shame about one’s appearance or one’s inability to control these behaviors can lead to social withdrawal and isolation, exacerbating the problem.

Research shows that shame is positively correlated with the severity of BFRB symptoms, distress, and body dissatisfaction. The emotion regulation model of BFRBs suggests these behaviors serve as a mechanism for immediate self-regulation, initially providing relief but ultimately leading to negative emotions such as frustration, anger, sadness, and anxiety. By understanding and managing the emotional underpinnings of BFRBs, individuals can achieve more effective and sustainable recovery.

A range of evidence-based psychological treatment strategies may be useful in addressing the emotional factors that contribute to the perpetuation of the BFRB cycle, including, but not limited to, the following:

Psychoeducation: Educating individuals about the role of emotions in BFRBs is a critical first step. Understanding the emotional triggers and the subsequent cycle can empower individuals to take proactive steps in managing their BFRB. Psychoeducation also helps normalize their experiences and reduce feelings of isolation.

Cognitive Behavioral Therapy (CBT): Traditional cognitive therapy strategies can be helpful in addressing unhelpful thought processes in BFRBs. They involve identifying and challenging the distorted thoughts and beliefs that contribute to negative emotions. By restructuring these thoughts, individuals can reduce the emotional triggers that lead to BFRBs.

Mindfulness and Acceptance-Based Strategies: Mindfulness and acceptance-based strategies help individuals become more aware of their internal experiences without judgment. Techniques such as mindfulness practices can increase emotional awareness and acceptance, reducing the urge to engage in BFRBs. Acceptance and commitment therapy (ACT) focuses on accepting difficult emotions and other internal experiences rather than avoiding them, fostering a more flexible, adaptive response to them when they arise.

Emotion Regulation and Distress Tolerance Skills: Teaching emotion regulation skills is often essential in BFRB treatment. Traditional CBT skills, such as diaphragmatic breathing, progressive muscle relaxation, and visualization, can help individuals more effectively manage distressing emotions. Dialectical behavior therapy (DBT) skills drawn from emotion regulation, distress tolerance, and interpersonal effectiveness modules may also be very beneficial.

Self-Compassion: Developing self-compassion skills is often essential for individuals with BFRBs, who often experience high levels of self-criticism. Self-compassion practices involve treating oneself with kindness and understanding during difficult times, reducing the intensity of negative emotions like shame and guilt.

Building Support Systems: Building a strong support system is vital. Involving family and friends in the treatment process can provide emotional support and help reduce misunderstandings about BFRBs. Support groups, both in-person and online, can offer a sense of community and shared experience.

The pervasive influence of unrealistic beauty standards significantly impacts individuals with body-focused repetitive behaviors (BFRBs), intensifying their emotional distress and complicating their path to recovery. These ideals, perpetuated by a burgeoning beauty industry and amplified through social media, exacerbate feelings of shame and body dissatisfaction. Understanding the emotional triggers and responses associated with BFRBs is crucial for effective intervention. A multifaceted approach, incorporating psychoeducation, cognitive behavioral therapy, mindfulness, emotion regulation skills, self-compassion, and robust support systems, can empower individuals to manage their behaviors more effectively. By addressing the underlying emotional challenges and fostering a more compassionate self-view, individuals with BFRBs can work towards sustainable recovery and improved well-being.


Bottesi G, Cerea S, Ouimet AJ, Sica C, Ghisi M. Affective correlates of trichotillomania across the pulling cycle: Findings from an Italian sample of self-identified hair pullers. Psychiatry research. 2016;246:606–611. doi:10.1016/j.psychres.2016.10.080.

Snorrason I, Smári J, Olafsson RP. Emotion regulation in pathological skin picking: findings from a non-treatment seeking sample. J Behav Ther Exp Psychiatry. 2010;41(3):238-245. doi:10.1016/j.jbtep.2010.01.009

Snorrason Í, Smári J, Ólafsson RP. Motor inhibition, reflection impulsivity, and trait impulsivity in pathological skin picking. Behav Ther. 2011;42(3):521-532. doi:10.1016/j.beth.2010.12.002

Houazene S, Leclerc JB, O'Connor K, Aardema F. "Shame on you": The impact of shame in body-focused repetitive behaviors and binge eating. Behav Res Ther. 2021;138:103804. doi:10.1016/j.brat.2021.103804.

Houazene S, Aardema F, Leclerc JB, O’Connor K. The Role of Self-Criticism and Shame in Body-Focused Repetitive Behaviour Symptoms. Behaviour Change. 2021;38(1):10-24. doi:10.1017/bec.2020.16

More from Psychology Today