Body-focused repetitive behavior

Causes

The cause of BFRBs is unknown.

Emotional variables may have a differential impact on the expression of BFRBs.

Research has suggested that the urge to repetitive self-injury is similar to a body-focused repetitive behavior but others have argued that for some the condition is more akin to a substance abuse disorder.

Researchers are investigating a possible genetic component.

Onset

BFRBs most often begin in late childhood or in the early teens.

Diagnosis

Types

The main BFRB disorders are:

• Skin

  • Dermatillomania (excoriation disorder), skin picking
  • Dermatophagia, skin biting/consumption

• Mouth

  • Morsicatio buccarum, cheek biting
  • Morsicatio labiorum, inner lip biting
  • Morsicatio linguarum, tongue biting

• Nails

  • Onychotillomania, nail picking
  • Onychophagia, nail biting

• Nose

  • Rhinotillexomania, nose picking

• Hair

  • Trichotillomania, hair pulling
  • Trichophagia, hair biting followed by consumption
  • Trichodaganomania, hair biting
  • Trichotemnomania, hair cutting
  • Trichoteiromania, hair rubbing

• Eyes

  • Mucus fishing syndrome, removing or "fishing" strands of mucus from the eye

Treatment

Psychotherapy

Treatment can include behavior modification therapy, medication, and family therapy. The evidence base criteria for BFRBs is strict and methodical. Individual behavioral therapy has been shown as a "probably effective" evidence-based therapy to help with thumb sucking, and possibly nail biting. Another form of treatment that focuses on mindfulness, stimuli, and rewards has proven effective in some people. However, no treatment was deemed well-established to treat any form of BFRBs.

Pharmacotherapy

Excoriation disorder and trichotillomania have been treated with inositol and N-acetylcysteine.

Decoupling

Decoupling is a behavioral self-help intervention for body-focused repetitive behavior (BFRB). The user is instructed to modify the original dysfunctional behavioral path by performing a counter-movement shortly before completing the self-injurious behavior (e.g., biting nails, picking skin, pulling hair). This is intended to trigger an irritation, which enables the person to detect and stop the compulsive behavior at an early stage. A systematic review from 2012 suggested some efficacy of decoupling, which was corroborated by another study in 2019. Decoupling was shown to be superior to habit reversal training in treating BFRB in one direct comparison study in 2021.

Prevalence

BFRBs are among the most poorly understood, misdiagnosed, and undertreated groups of disorders. BFRBs may affect at least 1 out of 20 people. These collections of symptoms have been known for a number of years, but only recently have appeared in widespread medical literature. Trichotillomania alone is believed to affect 10 million people in the United States.

References

References

1. (November 4, 2004). "Scientific Advances in Trichotillomania and Related Body-Focused Repetitive Behaviors". [[National Institute of Mental Health]].
2. "AAMFT Consumer Update - Hair Pulling, Skin Picking and Biting: Body-Focused Repetitive Disorders". American Association for Marriage and Family Therapy.
3. (March 2004). "Body-Focused Repetitive Behaviors: The Proximal and Distal Effects of Affective Variables on Behavioral Expression". Journal of Psychopathology and Behavioral Assessment.
4. ABC News 20/20 Hair Pulling, 2006
5. "Trichotillomania (TTM) & Related Body-Focused Repetitive Behaviors (BFRBs)". The Center for Emotional Health of Greater Philadelphia.
6. (2009-04-01). "Trichodaganomania: The compulsive habit of biting one's own hair". Journal of the American Academy of Dermatology.
7. Happle, Rudolf. (January 2005). "Trichotemnomania: Obsessive-compulsive habit of cutting or shaving the hair". Journal of the American Academy of Dermatology.
8. (January 2003). "Trichoteiromanie: Trichoteiromania". JDDG: Journal der Deutschen Dermatologischen Gesellschaft.
9. (13 July 2015). "Evidence-Based Psychosocial Treatments for Pediatric Body-Focused Repetitive Behavior Disorders". Journal of Clinical Child and Adolescent Psychology.
10. (2019). "Habit Reversal Therapy in Obsessive Compulsive Related Disorders: A Systematic Review of the Evidence and CONSORT Evaluation of Randomized Controlled Trials". Frontiers in Behavioral Neuroscience.
11. (2017). "Alternative Therapies for Excoriation (Skin Picking) Disorder: A Brief Update". Advances in Mind-Body Medicine.
12. (2011). "Movement decoupling: A self-help intervention for the treatment of trichotillomania". Journal of Behavior Therapy and Experimental Psychiatry.
13. (2012). "Complementary medicine, self-help, and lifestyle interventions for Obsessive Compulsive Disorder (OCD) and the OCD spectrum: A systematic review". Journal of Affective Disorders.
14. (2019-04-24). "Habit Reversal Therapy in Obsessive Compulsive Related Disorders: A Systematic Review of the Evidence and CONSORT Evaluation of Randomized Controlled Trials". Frontiers in Behavioral Neuroscience.
15. (2021-04-21). "A Head-to-Head Comparison of Three Self-Help Techniques to Reduce Body-Focused Repetitive Behaviors". Behavior Modification.
16. [http://www.aamft.org/families/index_nm.asp#Body-focused%20Repetitive%20Disorders Families & Health] {{webarchive. link. (March 28, 2009 , American Association for Marriage and Family Therapy)
17. (April 2000). "Trichotillomania: a challenge to research and practice". Clinical Psychology Review.