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Body-focused repetitive behaviors (BFRBs), such as hair-pulling and skin-picking, have been described by physicians from Hippocrates onward. The descriptions have not been theory-neutral; clinicians and researchers have applied specific conceptual frameworks to understand such behaviors and to intervene accordingly. These include what might be termed "turns" to psychoanalysis, cognitive behaviorism, psychopharmacology, nosology, neuroscience, consumer advocacy, and global mental health. It is timely to consider lessons learned from this range of conceptual frameworks, each of which has both strengths and limitations. Rather than advocating for yet another paradigm shift to advance knowledge and treatment of BFRBs, we suggest that scientific pluralism is useful for clinicians and researchers and potentially allows iterative and integrative progress in this field.