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When a young child pulls their hair, picks their skin, or bites their nails to the point of injury, it’s natural for the adults in their lives to want to focus on stopping the behavior. Parents want to prevent their child from experiencing harm, and clinicians want to help the child gain control and relieve their parents of worry. But with body-focused repetitive behaviors (BFRBs), especially in young children, control is rarely the place to start.
BFRBs are not just habits to be eliminated; they are part of how a child is learning to respond to internal experiences. That means our work, as treatment providers, needs to extend the focus beyond the behavior itself. It has to include how the child relates to their thoughts, feelings, sensations, and,critically, the story they are beginning to tell about themselves.
How Children Learn “What Kind of Kid I Am”
Young children are constantly drawing conclusions about who they are based on how the world responds to them. When a child has a BFRB, those conclusions can form early and quietly:
- “My body is a problem.”
- “I can’t help myself.”
- “I make adults worried or upset.”
- “I should hide this.”
Even when adults are loving and well-intentioned, repeated reminders to stop, critical behavior monitoring, or heightened concern can unintentionally strengthen these stories. Over time, the child may begin to fuse with an identity of being “the kid with the problem” or “the kid who can’t stop,” rather than seeing urges and behaviors as experiences that come and go—something that’s not who they are but is just what they temporarily experience.
We want to help children defuse from these early self-stories and develop narratives based on who and how they want to be, rather than what they fear they are becoming. Likewise, we want to help the child to notice their internal experiences with curiosity.
When children can understand, even in simple terms, “this is something my body does sometimes,” rather than “this is who I am,” shame softens and flexibility grows. That flexibility is often what makes change possible.
BFRBs Are Not the Enemy
BFRB urges are not problems to be eliminated. They are a form of internal communications: signals. Think of it like this: Sensations and urges rise. Emotions build. Thoughts show up. These can SET them up to experience a BFRB.
Young children don’t always have the skills to notice these experiences, make room for them, or choose how to respond. So their bodies do what bodies are good at: They act.
BFRBs often function as a quick way to regulate discomfort, stimulation, boredom, or overwhelm, to name a few. If therapy focuses only on getting rid of urges or stopping behaviors, children may learn that internal discomfort is dangerous or unacceptable. That can actually increase struggle, and, paradoxically, decrease the child’s sense of self-efficacy and increase the behavior over time.
In this way, BFRBs can function as an early communication system. The behavior may be saying:
- “This feels too big.”
- “I don’t know how to settle.”
- “I need comfort.”
- “I’m overloaded and don’t know how to ask for help.”
When therapy focuses solely on suppressing the behavior, without also helping the child develop a sense of who and how they want to be, self-awareness, self-compassion, self-regulation skills, and ways to communicate effectively, we risk silencing an important internal signal that is trying to guide the child toward what they need.
We want them to understand that “Uncomfortable sensations, emotions, and thoughts can be here. In fact, they are sometimes unavoidable. And, I can still be OK.”
Treating BFRBs Without Making the Child the Problem
When we slow down enough to start with understanding “who does this child want to become?” our work shifts. We shift from what they want to stop to who they want to be, from control to curiosity and compassion, from suppression to skill-building, and from “fixing” to supporting flexibility.
Body-Focused Repetitive Behaviors Essential Reads
For young children with BFRBs, this means therapy that:
- Normalizes urges instead of pathologizing them
- Builds self-image alongside skills and strategies for noticing, understanding, and responding
- Strengthens communication rather than increasing secrecy
- Teaches children they can have hard experiences and still move toward what matters
When we do this well, we’re not just helping a child reduce a behavior, although this can often be a result. Most importantly, we’re helping them build a healthy relationship with their inner world, one they’ll carry with them through life, whether or not their BFRB is present. And that may be the most durable outcome of all.
