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.

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:

Even when adults are loving and well-intentioned, repeated reminders to stop,........

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