When Childhood Obesity News published a series of posts about Body-Focused Repetitive Behaviors (BFRBs) the first one compared compulsive repetitive behaviors like fingernail gnawing with compulsive eating. For starters, they happen under many of the same circumstances. The person is obliged to stay in one position (riding in a car, sitting in class) or has voluntarily become lodged in a sedentary pose (watching TV, reading) and engages in some kind of compulsive behavior.

There is also a shared element of intentionality. Momentarily unable to engage in a compulsive behavior, a person might look forward to being home alone, where the scab on the scalp can really be properly addressed, or the bag of cookies can be reduced to crumbs.

At other times, both compulsive eating and BFRBs are totally unconscious. Husbands drive their wives crazy with beard-stroking, and wives drive their husbands crazy with hair-twiddling. Or a person studying for an exam might realize with horror that she has unknowingly pulled out a whole patch of hair. Another student might realize with equal horror that he has consumed a party-size bag of chips.

At any rate, that post elicited a response from a reader named Josh, who wrote:

This is accurate to the letter. I stumbled upon this article a few hours after a binge-episode. What do you know — I’d been picking my head/face as I was reading, semi-consciously. I’m thinking the stress leading to the compulsive acts comes from excessive energy input/minimal output (the impulsive behaviors act as an attempt by our bodies to expend the excess energy… [T]his is why exercise has the effect of calming the impulses). The dieting, binge/restriction cycle, obesity, etc is a symptom of a disconnect from our Internal Hunger Cues.

Dr. Pretlow replied to the comment:

Josh, I feel your pain and frustration. Fortunately, there are methods that help BRFB’s, which work equally well for compulsive overeating. You are correct that, like BRFB’s, compulsive eating involves the expenditure of nervous energy, but also accomplishes displacement/distraction from the stress. Internal hunger cues are completely overridden by the urgent need to cope with the stress. Squeezing your hands together and taking a deep breath, holding it for a sec, and letting it out helps to expend the nervous energy. Letting the urge to binge come over you like a wave, but relaxing, “surfing” the urge, not acting on it, and distracting yourself can help avoid bingeing. Writing down your stresses and a plan to deal with each stress also helps. Plus, stay out of the kitchen, call a friend, or go dance it off.

There are also shared characteristics between BFRBs and another alphabetical problem, OCD (Obsessive-Compulsive Disorder), in which things must be done only one way, at the risk of violating some universal law. A person might feel that it is a rule to eat cookies only in a certain mathematical progression. You can eat three, but if you mess up and eat four, then you have to go to the next multiple of three, and eat six. Or, a person might hold a belief that the whole package of cookies has to be finished at one sitting, because to do otherwise would open the door to existential chaos.

Since there is no possibility of doing deep psychoanalysis on every person with a problem, therapeutic modalities are needed that can override a certain amount of mental/emotional disturbance, and work effectively for people with a wide range of underlying dysfunctions.

Your responses and feedback are welcome!

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