An Interview with :: Amy Herter, LMFT

There’s a lot of misconception about Body-Focused Repetitive Behaviors. People think that it’s self-harm, and it’s not self-harm. The harm that might come is a side effect; it’s not the intention. So, it’s kind of a release of tension that’s going on when someone is feeling sensory overload, and then the behavior kind of meets that need from that perspective.

There’s some crossover. A lot of people with autism spectrum disorder do have Body-Focused Repetitive Behaviors; there are other diagnoses that kind of can be diagnosed with it as well. Treatment is the same as far as addressing sensory needs.

The ComB Model and SCAMP

Treatment is a cognitive behavioral treatment—it’s called ComB. There’s an acronym, SCAMP, that goes along with it, where it’s Sensory, Cognitive, Affective, Motor, and Places.

Sensory and Affective Elements (Anxiety vs. Boredom)

Looking at the sensory needs that are happening, the feelings that go along with it: normally, the two feelings that go along with it are anxiety or boredom. Anxiety is usually in more focused pulling. Boredom really happens more when someone’s kind of zoned out in kind of boring activities. Sometimes they’ll start picking or pulling and not even notice they’re doing it until they’re midway through.

Cognitive Factors: Focused vs. Unfocused Behaviors

There’s a cognitive element, and that is only more on the focused pulling. Some people sometimes are not thinking at all; it’s just happening when their mind is zoned out, and that’s where sometimes people get frustrated if they go to a therapist just focusing on that. If they have a lot of unfocused pulling, they’re not thinking at all. But sometimes people have thoughts about a certain hair not belonging, or about needing to kind of correct a bump or a scab or that sort of thing, and then they get stuck in that, and so that could be the cognitive part of it.

Motor Habits and Pre-Behavior Patterns

There’s a motor element, and it’s about the motion. So there’s some kind of—usually there’s a pattern of motor movement before the pulling happens, before the picking happens, where someone is playing with their hair, twisting their hair, kind of, you know, touching their skin or touching nails. So there’s an element of that before the actual picking starts, where there’s a searching element that comes along with it too, as well.

Place-Based Strategies and Sensory Substitutes

And then you look at the places where it’s happening. It seems simplistic, but it is very helpful because some of the strategies—like blocking strategies of wearing gloves, wearing Band-Aids, wearing Vaseline on your eyelashes or eyebrows, those kind of things—you don’t want to do that all day. You want to do it in the places where it’s happening so that you can use those strategies there, so that it really targets where it’s happening. And you want to have a strategy that meets some sensory needs as well, so you have a substitute and a way to kind of get the energy out. People will sit when they really have like excess energy, and so they’re sitting there with this energy trying to kind of suppress it, and that’s a big trigger for pulling or picking.