Tic or Body-Focused Repetitive Behavior: What's the Difference?
- Marla Deibler, Psy.D., ABPP,
- Sep 26
- 4 min read
The overlap and the divide between tic disorders and body-focused behaviors.
Tics and BFRBs may appear similar, but there are important distinctions.
Tics are involuntary and often linked to neurodevelopmental issues like Tourette Syndrome.
Accurate diagnosis guides effective, evidence-based treatment for each condition.
At first glance, tics and body-focused repetitive behaviors (BFRBs) can look remarkably similar. Both involve repeated behaviors that may seem involuntary, often start in childhood or adolescence, and can cause distress or impairment. But despite these surface similarities, tics and BFRBs are actually quite different in terms of what causes them, how they function, and how they’re treated.
What Are Tics?
Tics are sudden, rapid, and repetitive movements or vocal sounds. These can include things like blinking, head jerking, throat clearing, or sniffing. People with tics often describe a premonitory urge—a strong, uncomfortable feeling that builds up and is relieved when the tic is performed. While individuals can sometimes suppress a tic for a short time, doing so usually creates discomfort or tension that eventually becomes overwhelming.
Tics are largely involuntary and are associated with neurodevelopmental conditions such as Tourette Syndrome or other tic disorders. They often wax and wane over time and can become more intense during periods of stress or excitement.
What Are BFRBs?
Body-focused repetitive behaviors, or BFRBs, include behaviors such as hair pulling (trichotillomania), skin picking (excoriation disorder), and nail biting (onychophagia). These behaviors can cause physical damage to the body and are often driven by a need to self-regulate in response to internal discomforts. Unlike tics, BFRBs are more voluntary and goal-directed in nature, though they may occur outside of full awareness, especially during times of boredom, fatigue, or stress.
BFRBs are classified as part of the obsessive-compulsive and related disorders category in the DSM-5. Many people with BFRBs describe a strong urge or tension prior to engaging in the behavior and a sense of relief after the behavior is carried out, similar to what is experienced with tics. However, the behavior itself tends to be more deliberate, often serving a specific function for the person.
Key Similarities
Tics and BFRBs are often both described as belonging to an obsessive-compulsive spectrum, as they share a number of common features. Both typically emerge during childhood- adolescence and can fluctuate in severity. Stress, fatigue, and anxiety tend to make both worse. Certain co-occurring conditions may be experienced more frequently with both tics and BFRBs, such as OCD and anxiety disorders, as compared with other disorders that share fewer common features. People experiencing either condition may feel ashamed or frustrated, particularly when the behavior causes visible effects like hair loss or skin damage (as with a BFRB) or social embarrassment. And in both cases, treatment often involves some form of behavioral therapy, such as habit reversal training (HRT).
Important Differences
Despite these shared characteristics, there are several critical differences between tics and BFRBs. One major distinction is the degree of control involved. Tics are considered largely involuntary—they happen suddenly, often without much warning, and are difficult to suppress. BFRBs, while they can occur in a more automated fashion or outside of one’s awareness, are typically performed with more intention, even if the person isn’t always fully aware of doing them in the moment.
Another important difference lies in the function of the behavior. Tics generally don’t serve any particular purpose for the individual beyond reducing the discomfort of a premonitory urge. BFRBs, on the other hand, tend to be more goal-directed, such as (but not limited to) a means to manage emotions, self-soothe, create a certain sensory experience, or achieve a goal, such as pulling a hair that appears out of place or picking a scab to promote healing. This functional difference has implications for treatment.
While tic disorders and BFRBs may share some overlapping neurobiological underpinnings, they may also diverge in important ways. Research indicates that both involve motor circuitry and the basal ganglia, however emerging data suggests that BFRBs may also involve areas of the brain involved in emotion regulation and reward processing. Furthermore, while dopamine has been posited to be involved in both tic disorders and BFRBs, data suggests that serotonin and/or glutamate may also play a role in BFRB.
Tics are often treated with CBIT (Comprehensive Behavioral Intervention for Tics), which is a cognitive behavioral therapy (CBT) that builds upon a foundation of habit reversal training (HRT), and sometimes medication is used in more severe cases. BFRBs are also treated via CBT and often involve some of the same components of HRT, which focuses on increasing awareness of the behavior, identifying triggers, and teaching alternative strategies, and may include approaches like comprehensive behavioral treatment (ComB), acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT) skills, integrative behavioral therapy (IBT), and mindfulness are also frequently helpful in treating BFRBs.
Finally, the diagnostic classifications differ. Tic disorders are considered a type of neurodevelopmental disorder, while BFRBs fall under the umbrella of obsessive-compulsive and related disorders within the current diagnostic classification system, the DSM-5.
Why This Distinction Matters
Getting the diagnosis right is important—not just for clarity, but because the treatment approach can differ significantly. The more accurately we understand the behavior, the better we can support the individual in managing it.
Tic disorders and BFRBs are both complex and often misunderstood. While they may appear similar on the surface, there are important distinctions that help us to better understand and guide appropriate treatment. Recognizing these differences can lead to more compassionate care, more effective interventions, and a better quality of life for those affected.
