Basic principles of operant conditioning tell us that behaviors are usually maintained because they deliver pleasure (positive reinforcement), or because they relieve some source of displeasure, like anxiety and tension (negative reinforcement). The answer to the "Why?" in terms of body-focused, repetitive behaviors, such as hair pulling, skin picking, and nail biting, may be more an "AND" situation: These behaviors are both positively AND negatively reinforced. While they may provide subtle stimulation, they are also an important source of distraction or dissociation... which brings me to my next "AND"...

Body-focused, repetitive, behaviors, better known as "BFRBs," are behaviors AND much more than just behaviors. They are physical means of emotional coping. BFRBs allow us to reduce our attention (cognitive narrowing) to a simpler and thus more tolerable level of experience - basic, objective, and rote sensations of the body. In this process, we get to distance ourselves from all of the harsh judgments we hold about ourselves, and fear that others may hold about us. This explains why BFRBs often arise while we are doing or thinking about a task we tie to our performance; for example, writing a paper. It is also our mere awareness of ourselves in these behaviors that keep them going. We judge ourselves for succumbing to pulling, picking, and biting and not ___(fill in the blank with whatever else we are "supposed" to be doing)___, and that makes returning to reality even harder. We wrap ourselves up in our sensations to create an autistic bubble where we are insulated from uncomfortable, emotional feelings.

Stay tuned for more on the autistic bubble and treatment implications...