Obsessive-compulsive disorder (OCD) and body-focused repetitive behaviors (BFRBs) are often mistaken for one another. Both can severely affect daily functioning and are marked by repetitive actions that seem impossible to resist.

However, their underlying causes, emotional dynamics, and treatment methods are not the same. Understanding these distinctions helps ensure people receive the right care.

Where They Overlap

1. Repetitive patterns – Both involve behaviors that feel uncontrollable, such as repeatedly washing hands (OCD) or pulling hair (trichotillomania).
2. Relief cycles – Individuals often describe mounting tension that is temporarily eased by the action.
3. Co-existence – A person may live with both conditions, for example, OCD rituals along with compulsive skin picking.
4. Brain mechanisms – Research indicates overlapping neural circuits in habit formation and emotion regulation.
   

Key Differences

1. Classification – Both are listed in DSM-5-TR under obsessive-compulsive and related disorders, but BFRBs are distinct diagnoses.
2. Awareness – BFRBs often happen outside of awareness, while OCD compulsions are intentional and distress-driven.
3. Thoughts and purpose – OCD behaviors are fueled by intrusive fears, while BFRBs are usually driven by sensory urges or emotions like boredom or tension.
4. Behavioral style – OCD rituals follow strict rules, whereas BFRBs are usually flexible and not bound by rigid patterns.
5. Experience – OCD compulsions are ego-dystonic (unwanted and distressing), while BFRBs may feel ego-syntonic (momentarily satisfying despite later regret).
6. Treatment – OCD responds best to exposure and response prevention (ERP) and often SSRIs, while BFRBs are treated with behavioral approaches such as habit reversal training (HRT), comprehensive behavioral therapy (ComB), mindfulness, and acceptance-based strategies.
   

Why This Matters

Confusing the two can delay effective treatment. By recognizing what makes them different, clinicians can provide targeted interventions, and individuals can reduce self-blame and access the most effective tools for recovery.