A Cycle of Stress: A Study of Increased COVID-19 Exposure Through Body-Focused Repetitive Behaviors

Author: Hannah Pescaru

Body-focused repetitive behaviors (BFRBs) are behaviors in which an individual repeatedly fidgets with his or her own body in ways that leave physical harm (Roberts et al. 2013). BFRBs―including trichotillomania (hair-pulling), dermatillomania (skin-picking), and onychophagia (nail-biting)―can be subclinical and relatively common, but they can also be more severe, albeit rarer (Houghton et al. 2017).

BFRBs are still a novel topic in the research world, but some studies have suggested a greater predisposition to the disorders through genetics or experienced stress (Duke et al. 2009; Novak et al. 2009). The added anxiety and stress of the COVID-19 pandemic could greatly increase this difficulty (Grant et al. 2015). Since the spread of the COVID-19 virus is expedited through contact with one’s face and orifices, individuals with BFRBs could be at a greater risk for contracting the virus. This could potentially lead to BFRB patients stressing over their chances of being infected with COVID-19, leading to more engagement in their behaviors in order to relieve that stress.

Body-focused repetitive behaviors are also associated with increased sensory sensitivity, which are potential abnormalities in the sensory process (Houghton et al. 2017). This sensory sensitivity could mean that individuals with BFRBs are more prone to feelings of anxiety and stress after consuming media covering COVID-19. BFRBs were also found to be maladaptive emotional regulation mechanisms, with higher feelings of perceived stress leading to greater disease severity (Grant et al. 2015). Individuals with BFRBs were also proven to show an increased reaction time in which to control these feelings of stress (Murphy et al. 2016). The synthesis of these studies offer an explanation as to how body-focused repetitive behaviors are exacerbated by feelings of stress and anxiety. This data can be extrapolated to the stress of the COVID-19 pandemic; an individual with a BFRB perceives stress more acutely and handles it with more difficulty than the average person, which indicates that BFRB engagement rate is higher now during the pandemic.

The engagement in BFRBs leads to a greater risk of infection. Onychophagia specifically was shown to increase risk of infection of enterobacteriaceae, a family of bacteria that can cause illnesses ranging from pneumonia to urinary tract infections (Kamal et al. 2015; Reddy et al. 2013). Onychophagia is the practice of keeping one’s hands close to his or her mouth from a few seconds to half a minute (Sachan et al. 2012). In this time, the fingers act as carriers of microorganisms from the external oral environment into the oral cavity, whose warm and moist environment can support the growth of these microorganisms (Kamal et al. 2015; Reddy et al. 2013). This data can be extrapolated to the transmission of the COVID-19 virus, which is highly contagious and can last on surfaces from a few hours to day. Consequently, during the pandemic, individuals with BFRBs are experiencing a cycle in which their own behaviors aggravate their conditions mentally, emotionally, and physically.

Some of the potential prevention methods to protect this population from the stress of COVID-19 infections include cognitive-behavioral therapy (Gunter et al. 2009). This primarily behavioral therapy involves awareness training, stimulus control, and competing response training, which identifies and suppresses each patient’s personal triggers and finds behavioral substitutes to prevent engagement in the BFRB (Phillips et al. 2021). Loved ones also play a critical role in the treatment by creating a supportive and positive environment and offering vital encouragement to boost the individual’s self-confidence (Baghchechi et al. 2020).

To conclude, individuals with body-focused repetitive behaviors are more inclined to touch their faces and facial orifices than the average person, increasing their risk of contracting COVID-19. This added anxiety and pressure further contributes to behavior engagement, resulting in a cycle of immense stress for the individual in a time when the world is already facing the stress of a global pandemic. As a result, we should continue to support this population by offering even greater support and prevention methods to ensure that we all persevere.


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