Parental Practices and BFRBs In Children: What New Research Has To Say

Dr. Dawn Ferrara
May 27th, 2021

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What causes a child to develop a body-focused repetitive behavior (BFRB) like skin picking, hair pulling, or nail-biting? It’s the question that every parent of a child with a BFRB asks.

It’s also a question that researchers have asked too. To date, studies have largely focused on adults with BFRBs and the role of factors such as temperament, environment, emotional or medical issues, and even genetics. Those studies suggest that there are certainly biological and environmental influences at play. What isn’t so clear is what factors are at play in the development of BRFBs in children.

It is well established that early childhood experiences and modeling play a key role in a child’s psychological development. Factors such as parental warmth, parenting style, and other parenting behaviors have been linked to the development of maintenance of mental health issues in children. So, it’s not surprising that since BFRBs often emerge in childhood, researchers would be interested in understanding more about how, or if, certain parenting practices can influence the development or maintenance of BFRBs in children. And a new study does just that.

The Study

Children learn and develop behaviors in part from those around them and in particular, their primary role models, usually their parents. Anxiety is a symptom frequently associated with BFRBs. Given what is known about the link between BFRBs and anxiety, researchers asked the question of whether certain parenting behaviors, known as anxiogenic or anxiety-provoking parenting, could influence the development of BFRBs in children.

Anxiogenic parenting is certain parenting behavior that can worsen anxiety in a child. Those behaviors include lack of emotional warmth, conflict, over-involvement, enabling children to avoid situations that make them anxious, and the parent exhibiting their own anxious behaviors in front of their children. The study sought to determine whether anxiogenic parenting is related to the development and severity of BFRBs in children.

The Findings

The study found that anxiety indeed plays a role in BFRBs but not necessarily via parenting style. While an anxiogenic parenting style slightly increased the risk of a child developing a BFRB such as skin picking or nail-biting, the child’s own anxiety seemed to play a more functional role in the development of a BFRB. There was not evidence to support that anxious parenting causes BFRBs. What wasn’t clear was how the parent’s and the child’s anxieties may intersect. Because anxiety is generally present with BFRBs, the researchers suggested that addressing the anxiety as part of the child’s BFRB treatment could be beneficial.  

What A Parent Can Do?

Being a parent of a child with a BFRB can be challenging. BFRBs are complex and sometimes confusing in how they present, especially in children. Kids are not always to fully express what they’re experiencing. Knowing how best to help them isn’t always clear. The good news is, there is help and hope.

The first step in helping your child is to seek out treatment. BFRBs can certainly have a medical component and often a pediatrician or dermatologist is the first step to address the physical injury associated with picking or pulling. However, BFRBs are primarily a mental health issue and classified as OCD-related disorders. What this means is that therapy is the primary approach to treatment. And, not just any therapy.

It’s important to know that there is currently no medication to treat BFRBs. The gold standard of treatment is a specific type of Cognitive Behavioral Therapy (CBT) that includes Habit Reversal Training (HRT). CBT is considered the most effective way to treat skin picking because it empowers the person to think constructively and find effective ways to cope. This type of therapy requires a skilled therapist trained in the treatment of BFRBs. offers a program for parents with children who struggle with BFRBs such as skin picking. The program, built on Cognitive Behavioral Therapy and an evidence-based approach to treating BFRBs, is tailored to meet your child’s needs. You’ll work with therapists who are experts in the treatment of skin picking to learn practical and effective ways to help your child reduce their skin picking behaviors. You’ll learn skills for parenting and ways to enhance communication with your child. The program offers a secure, text-based interface so that you can access your therapist when and where it works best for you. It’s convenient and affordable. The program is the only internet-based program specifically designed for parents and children who struggle with BFRBs like skin picking.

You might be thinking, “Why would I need therapy? I’m the parent.” As the parent of a child who picks, you will encounter situations that you may not understand or be prepared for. BFRBs are complex and sometimes confusing disorders that most parents are not prepared to deal with. The program will help you to better understand the disorder while you learn specific strategies to help your child learn to manage their urges to pick at their skin. You’ll have a therapeutic partner in your journey to help you address the challenging situations that are bound to arise and give you a place to find support and guidance. You are a key part of your child’s journey of healing. Therapy can help you be strong and confident as you navigate this journey with them.

On the site, you can also interact with other parents. The site offers a forum moderated by qualified therapists where you can connect with others, ask a question, or offer support to someone else.

There is hope and help for children who struggle with skin picking and other BFRBs. The Program for Parents can help them find healthy ways to cope and heal.


1. Caron, A., Weiss, B., Harris, V., & Catron, T. (2006). Parenting behavior dimensions and child psychopathology: specificity, task dependency, and interactive relations. Journal of clinical child and adolescent psychology: the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 5335(1), 34–45.

2. Murphy, Y. E., Brennan, E., & Flessner, C. (2019). Anxiogenic parenting practices as predictors of pediatric body-focused repetitive behaviors. Journal of Obsessive-Compulsive and Related Disorders21, 46-54. doi:10.1016/j.jocrd.2018.12.002

Dr. Dawn Ferrara


With over 25 years of clinical practice, Dawn brings experience, education and a passion for educating others about mental health issues to her writing. She holds a Master’s Degree in Marriage and Family Counseling, a Doctorate in Psychology and is a Board-Certified Telemental Health Provider. Practicing as a Licensed Professional Counselor and Licensed Marriage and Family Therapist, Dawn worked with teens and adults, specializing in anxiety disorders, work-life issues, and family therapy. Living in Hurricane Alley, she also has a special interest and training in disaster and critical incident response. She now writes full-time, exclusively in the mental health area, and provides consulting services for other mental health professionals. When she’s not working, you’ll find her in the gym or walking her Black Lab, Riley.

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