Why It’s Easy to Confuse BFRBs with OCD
At first glance, Body-Focused Repetitive Behaviors (BFRBs) and Obsessive-Compulsive Disorder (OCD) might look pretty similar.
Both involve repeated actions that are hard to control. Both can cause distress, and both can make you feel “stuck” in a loop you didn’t sign up for.
It’s no wonder people often ask: Is this BFRB or OCD? Or both?
This confusion is common—even among mental health professionals—because these conditions share the same diagnostic category in the DSM-5: “Obsessive-Compulsive and Related Disorders.”
But dig deeper, and you’ll find some very clear differences in thought patterns, triggers, and treatment strategies.
This guide will walk you through everything you need to know, and by the end, you’ll take a short quiz to help you understand where your behavior might fall.
Understanding the Importance of an Accurate Diagnosis
Knowing the difference between OCD and a BFRB isn’t just about labels—it’s about finding the right treatment and learning to respond to your urges more effectively. Mislabeling can lead to therapy that doesn’t work or missing tools that could really help.
So whether you’re dealing with skin picking, nail biting, hair pulling, constant checking, or ritualized hand washing—this article is for you. Let’s break down both conditions clearly and compassionately.
What Are BFRBs?
Common Types of Body-Focused Repetitive Behaviors
BFRBs are behaviors where a person repeatedly damages or manipulates their own body, often without realizing it. These include:
- Trichotillomania – hair pulling
- Dermatillomania (Excoriation Disorder) – skin picking
- Onychophagia – nail biting
- Morsicatio – cheek or lip biting
These behaviors are more than habits—they’re often automatic, emotionally triggered, and incredibly difficult to stop without structured intervention.
Emotional and Sensory Triggers Behind BFRBs
BFRBs are often responses to:
- Stress or anxiety
- Boredom or zoning out
- Perfectionism (like removing a bump or stray hair)
- Sensory discomfort (something feels “off” and must be fixed)
For example, someone might pick at their skin while watching TV without realizing it. Or pull out hair while reading because it brings a sense of calm. These behaviors are often driven by a need for soothing or sensory relief, not obsessive thoughts.
Most importantly, BFRBs don’t usually involve fear-based thoughts or compulsions to prevent imagined harm—that’s where OCD differs.
What Is OCD?
Core Features of Obsessive-Compulsive Disorder
OCD is a mental health disorder that involves:
- Obsessions: intrusive, unwanted thoughts, fears, or images (e.g., “What if I hit someone with my car and didn’t notice?”)
- Compulsions: repetitive behaviors or mental rituals done to relieve the anxiety caused by those obsessions (e.g., checking the door lock 15 times to “make sure it’s safe”)
These actions are driven by fear, not pleasure. People with OCD often know their fears are irrational, but they can’t stop the compulsions without major anxiety or distress.
Examples of OCD behaviors include:
- Handwashing to prevent illness
- Repeating actions a certain number of times
- Checking stoves, locks, or light switches
- Mentally “undoing” bad thoughts
The Role of Obsessions and Compulsions
OCD is about preventing harm or danger—even if that danger isn’t real. A person might spend hours completing rituals to prevent a feared outcome, like hurting someone or getting sick.
In contrast, someone with a BFRB doesn’t usually believe their behavior is preventing harm. Instead, they’re responding to an urge, sensation, or emotion—not a fear.
That’s the key difference.
Key Differences Between BFRBs and OCD
1. Thought Patterns and Triggers
Intrusive Thoughts vs. Sensory Discomfort
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OCD starts with obsessions—unwanted, intrusive thoughts or fears. The behaviors (compulsions) come next, done to reduce the anxiety those thoughts cause.
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Example: “If I don’t tap this five times, something bad will happen.”
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BFRBs, on the other hand, often begin with a physical sensation or emotional state—like tension, boredom, or an “off” feeling in the skin or hair.
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Example: “This bump on my skin feels wrong. I need to fix it.”
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BFRBs are not driven by fear of a consequence, while OCD behaviors usually are.
Awareness During the Behavior
- Many people with BFRBs enter a “trance-like” state while biting or picking, only realizing it after the damage is done.
- People with OCD are usually highly aware of their rituals and perform them with full attention to reduce fear or prevent something bad from happening.
This awareness difference can help you determine where you fall on the spectrum.
2. Function and Relief
Reducing Anxiety vs. Seeking Sensory Satisfaction
- In OCD, compulsions are done to avoid or prevent something bad (like illness, disaster, or guilt). The relief comes from reducing that anxiety.
- In BFRBs, the behavior is done to satisfy a sensory or emotional urge. The relief is often more about comfort or “fixing” something that feels wrong—not preventing catastrophe.
BFRBs can even feel pleasurable or calming in the moment, which is rarely the case for OCD rituals.
Emotional Cycles Post-Behavior
- After an OCD ritual, people may still feel anxious or frustrated, especially if the urge returns.
- After a BFRB, people often feel guilt, shame, or confusion, especially when they see the physical damage they’ve caused.
The emotional aftermath is different—but equally intense.
3. Behavior Type and Control
Repetitive Actions vs. Ritualistic Routines
- OCD compulsions are often ritualized—meaning they have a specific order, number of repetitions, or mental rules that must be followed just right.
- BFRBs are repetitive, but not usually ritualized. You might pick for 10 minutes straight without any counting, rules, or structure—just a repetitive urge.
This difference is subtle but important.
How “Voluntary” the Behavior Feels
- BFRBs can feel more automatic or subconscious, especially in calm settings like watching TV.
- OCD compulsions are often deliberate and time-consuming, even if they feel involuntary due to intense anxiety.
This is why many people with BFRBs say things like “I didn’t even realize I was doing it,” while people with OCD might say “I can’t stop until it feels right.”
4. Co-Occurrence and Misdiagnosis
Why Some People Have Both
Here’s the twist: some people experience both BFRBs and OCD, or show overlapping traits. For example:
- Picking skin and checking locks
- Pulling hair and avoiding “bad luck” numbers
This doesn’t mean the conditions are the same—but it means they may share a neurological root involving anxiety, impulsivity, or sensory sensitivity.
How to Get the Right Diagnosis
To figure out whether it’s OCD, BFRB, or both, a qualified therapist or psychiatrist will assess:
- Your thought patterns before the behavior
- Your emotional state during/after the behavior
- How much control you feel over the behavior
- The behavior’s function (relief, avoidance, satisfaction, etc.)
Getting the right diagnosis means getting the right help—and the right tools.
Quick Comparison: BFRB vs. OCD
| Feature | BFRB | OCD |
|---|---|---|
| Main Trigger | Sensory urge or tension | Intrusive thoughts or fears |
| Primary Emotion | Urge, boredom, perfectionism | Anxiety, dread, guilt |
| Goal of Behavior | Relief or satisfaction | Prevent something bad |
| Type of Behavior | Repetitive, automatic | Ritualistic, intentional |
| Awareness Level | Often subconscious | Usually highly aware |
| Aftereffects | Shame, regret, physical damage | Temporary relief, recurring anxiety |
| Examples | Hair pulling, skin picking | Checking, cleaning, counting |
Take the Quiz: Is It BFRB, OCD, or Both?
10-Question Self-Assessment
Instructions: For each question, answer A or B. Keep track of your answers to see your results at the end.
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What usually triggers your behavior?
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A: I feel a bump, tension, or physical urge.
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B: I have a thought like “What if something bad happens?”
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How do you feel during the behavior?
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A: Calm or zoned out, sometimes it feels satisfying.
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B: Anxious, and I feel like I have to do it perfectly or repeatedly.
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Are there specific “rules” or rituals around what you do?
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A: No, I just do it when the urge hits.
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B: Yes, I repeat things a certain number of times or in a specific order.
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How aware are you when doing it?
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A: I often don’t realize I’m doing it until after it’s done.
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B: I’m very aware, but I feel like I have to do it.
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What happens if you try to stop?
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A: I feel uncomfortable or restless, but not scared.
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B: I feel panicky or anxious, like something bad might happen.
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What emotion do you feel after the behavior?
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A: Regret, shame, or guilt about how I look.
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B: Slight relief, but often the anxiety comes back.
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Do you feel the behavior prevents something bad?
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A: No, I do it to fix or soothe something I feel.
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B: Yes, I do it to stop a fear or bad outcome.
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Does it interfere with your daily life?
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A: Yes, I hide it and feel embarrassed.
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B: Yes, it takes up a lot of time and energy.
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Can you stop when distracted or interrupted?
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A: Often, yes—it breaks the cycle.
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B: No, I feel the need to go back and finish it.
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Have you ever had both picking/biting and checking/washing behaviors?
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A: Only one or the other.
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B: I’ve had both at different times.
Scoring and Results Guide
Count how many A and B answers you chose:
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Mostly A’s: Your behavior is more aligned with BFRBs like skin picking or nail biting. Your actions are likely automatic, sensory-driven, and rooted in self-soothing.
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Mostly B’s: Your behavior reflects more OCD-like patterns, with obsessive thoughts and compulsive rituals tied to anxiety and fear.
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Mix of A’s and B’s: You may experience both BFRBs and OCD, or a condition with overlapping symptoms. A mental health professional can help clarify your diagnosis and tailor treatment to fit both.
What to Do If You’re Unsure
Talk to a Professional (What to Expect)
Whether you scored A, B, or both—it’s a good idea to talk to a licensed:
- Therapist (LPC, LCSW, or psychologist)
- Psychiatrist (for medication and diagnosis)
They’ll ask about your behavior, your thoughts, your stressors, and how much control you feel over your actions. Don’t worry—there’s no judgment. Their goal is to help you feel better and give you tools that actually work.
You can bring this quiz with you—it helps start the conversation.
BFRB and OCD Treatment Overlaps
The good news? There’s overlap in how both conditions are treated.
Helpful therapies include:
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CBT (Cognitive Behavioral Therapy) – for thinking and behavior patterns
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HRT (Habit Reversal Training) – great for BFRBs
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ERP (Exposure and Response Prevention) – core method for OCD
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ACT (Acceptance and Commitment Therapy) – builds emotional resilience
Even if you’re not sure what you have, you can start with one tool—like tracking triggers, using fidget tools, or practicing mindfulness.
Healing starts with curiosity—not perfection.
Tools and Support Options
Therapy Types That Help Most
If you’re struggling with either BFRBs or OCD (or both), here are the most effective, science-backed therapies to explore:
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CBT (Cognitive Behavioral Therapy)
Helps reframe the thoughts and behaviors tied to urges or compulsions. Ideal for both OCD and BFRBs.
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HRT (Habit Reversal Training)
Focuses on awareness and substitution—especially effective for BFRBs like skin picking, hair pulling, and nail biting.
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ERP (Exposure and Response Prevention)
Core OCD treatment that teaches you to face triggers without engaging in compulsions. Powerful for fear-driven behaviors.
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ACT (Acceptance and Commitment Therapy)
Helps you tolerate distressing emotions without needing to act on them. Great for building long-term emotional resilience.
Bonus: Many therapists now offer blended approaches to treat co-occurring BFRB + OCD symptoms.
Resources for BFRB and OCD Communities
You’re not alone—and there’s strength in connecting with others who get it.
Top organizations and resources:
- The TLC Foundation for BFRBs
Community, toolkits, and support groups for hair pulling, skin picking, and more. - IOCDF (International OCD Foundation)
Articles, provider directories, and events for individuals with OCD. - [Reddit: r/trichotillomania, r/OCD, r/BFRBs]
Peer support, recovery stories, and advice from people who truly understand. - YouTube & TikTok: Search “BFRB recovery” or “living with OCD”
Real stories, tips, and encouragement from creators who’ve been through it.
The more you learn, the more empowered you become—and that’s when recovery starts to feel possible.
Conclusion
BFRBs and OCD both involve powerful urges, repeated behaviors, and deep emotional impact—but they come from different places in the brain and body.
- OCD is fear-driven, ritualized, and focused on preventing perceived harm.
- BFRBs are sensory-driven, soothing, and focused on physical or emotional release.
Knowing which one you’re dealing with (or if it’s both) is the first step toward healing. And healing doesn’t mean perfection—it means feeling more in control, more compassionate, and more connected to yourself.
Use the quiz. Track your triggers. Try the tools. And if you need support, don’t hesitate to reach out. The right help is out there—and you’re worthy of it.
FAQs
Can BFRBs turn into OCD over time?
Not exactly. While both conditions can coexist, a BFRB won’t “become” OCD. However, stress or trauma can lead to the emergence of OCD symptoms, especially in people with existing anxiety or perfectionism.
Is skin picking a type of OCD?
It’s related, but not the same. Skin picking is categorized as a BFRB in the same diagnostic group as OCD, but it’s typically not driven by obsessions or fears.
What kind of therapist should I see for BFRBs or OCD?
Look for someone trained in CBT, HRT (for BFRBs), and ERP (for OCD). Use directories like Psychology Today or IOCDF.org to find specialists.
Can mindfulness help both conditions?
Yes! Mindfulness teaches you to pause, observe your urges without acting on them, and ride the wave of discomfort. It’s helpful for both OCD compulsions and BFRB impulses.
Do I need medication for either one?
Not always. Some people benefit greatly from therapy alone. However, SSRIs are commonly prescribed for OCD, and sometimes for severe BFRBs. Your provider can help you decide if meds are right for you.
