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Body Focused Process Addictions (BFPAs)
A New Categorization by Chaille DeFaria PCC, CDWF and Karen Pickett LMFT
All addictions are tough. But what if you’re addicted to something you can never get away from? Your body.
Body Focused Process Addictions (BFPAs) include pulling out hair, picking at skin, biting at nails, talking excessively and more.
After extensive research, our model is the only comprehensive approach to treating Body Focused Process Addictions, also known as Behavioral Addictions. We have incorporated the subtleties that are not defined in any other approach. From our firsthand experience reading between the lines of the limited research to date and treatment approaches used up until now, we have found our BFPA model to be the only effective and all-inclusive treatment available.
For lack of a better term, BFPAs have in recent years been called Body-Focused Repetitive Behaviors or BFRBs. The focus on behavioral change is important but misleading. Habit Reversal Training (HRT), a key component of the BFRB treatment model, implies that what are actually complex Process Addictions are little more than “bad habits” that anyone with enough willpower can change. We know from our extensive experience treating those with BFPAs that these conditions are complex.
BFBAs are also not an Obsessive Compulsive Disorder (OCD) even though Trichotillomania and Skin Picking Disorder are currently included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) under OCD. A key mistake that treatment providers who view BFPAs as OCD make is using Exposure and Response Prevention (ERP) as a means to treat BFPAs. ERP works for OCD compulsions because those behaviors are anxiety-based and co-occur with anxiety-based thoughts. BFPAs may coexist with anxiety but they are also associated with a full range of emotional states including boredom, sadness, etc, and are not associated with magical thinking as OCD most often is.
Those with BFPAs usually find pleasure or accomplishment in doing the behaviors while those with OCD often find their compulsions tiring.
“A Clinical Guide to Treating Behavioral Addictions” by Amanda L. Giordano published in 2022 includes trichotillomania and skin picking (excoriation) disorder in the category of Nonsuicidal Self-Injury (NSSI) along with cutting, burning and head banging. Those of us who work with BFPAs have long known that the emotional experiences of those with BFPAs are the reverse of those with NSSI behaviors.
Giordano writes: “Directly following the NSSI, they (people who engage in NSSI behaviors) record feeling calm, powerful, and in control, having the thought “I am stronger than they think, and watching the wound for several minutes.”
Those with BFPAs report a strong sense of shame, remorse, guilt, and loss of control after engaging in the behaviors, in strong contrast to a sense of power and control reported by those with NSSIs.
To understand BFPA’s is undoubtedly complex and comprehensive, but then we ask ourselves: if treatment is available why has most treatment failed? Something has clearly been missing along the way. The key ingredient. We have found it. To have experienced a BFPA is to have lived with one…or to know one. To manage or fix a behavior is to understand how it operates in our life. Not to do so is to have it rule us. We are sharing our Body Focused Process Addiction model as the key ingredient that has been missing.
It is available to you now. Ask us how.