Body-focused repetitive behavior

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Body-focused repetitive behavior
Other names: Body-focused repetitive behavior disorder (BFRBD)
Dermatillomania fingers.JPG
Knuckle biting resulting in disfiguration of the skin over the joints of the middle and little fingers
SpecialtyPsychiatry
SymptomsNail biting, lip biting, cheek chewing[1]
Differential diagnosisHair pulling disorder, skin picking disorder, stereotypic movement disorder, self-harm, normal habits[1][2]
TreatmentCounselling, medications[3]
MedicationSSRIs, N-acetylcysteine[3]

Body-focused repetitive behavior (BFRB) is a group of psychiatric disorders were people repeatedly harm part of their body by either pulling or picking at it.[4] Specific behaviors may include nail biting, lip biting, or cheek chewing.[1] People are unable to stop these behaviors despite trying to do so.[3] Complications may include nail damage.[3]

It is within the category of obsessive-compulsive and related disorders.[1] In the DSM-5, body-focused repetitive behavior disorder (BFRBD) is only diagnosed if the symptoms are not better explained by hair pulling disorder or skin picking disorder.[1] Other sources; however, include those two disorders as types of BFRBD.[4] Diagnosis requires the behavior to occur to such a degree that functioning is impaired or distress occurs.[3][2] Additionally the behavior must be unrelated to efforts to change ones appearance.[3]

Treatment may include counselling, such as cognitive behavioral therapy, and medications, such as SSRIs or N-acetylcysteine.[3] Cognitive behavioral therapy may involve increasing awareness around when the behavior occurs, efforts to avoid triggers, and attempts to replace the specific behavior with something else like knitting.[3] While these behaviors have been described throughout history, it was in the late 1800s that they were named as health problem.[5] Hair pulling disorder was first included in the DSM in 1987 while skin picking disorder was officially included in 2013.[5]

Causes

The cause of BFRBs is unknown.

Emotional variables may have a differential impact on the expression of BFRBs.[6]

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.[7][8]

Onset

BFRBs most often begin in late childhood or in the early teens.[9]

Diagnosis

Body-focused repetitive behavior disorders (BFRBDs) in ICD-11 is in development.[10]

Types

The main BFRB disorders are:[11]

Treatment

Counselling

Treatment can include behavior modification therapy, medication, and family therapy.[7][9] The evidence base criteria for BFRBs is strict and methodical.[12] Individual behavioral therapy has been shown as a "probably effective" evidence-based therapy to help with thumb sucking, and possibly nail biting.[12] Cognitive behavioral therapy was cited as experimental evidence based therapy to treat trichotillomania and nail biting.[12] 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.[12]

Medications

Excoriation disorder, and trichotillomania have been treated with inositol and N-acetylcysteine.[13]

Prevalence

BFRBs are among the most poorly understood, misdiagnosed, and undertreated groups of disorders.[14] BFRBs may affect at least 1 out of 20 people.[9] 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.[15]

See also

References

  1. 1.0 1.1 1.2 1.3 1.4 Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). American Psychiatric Association. 2013. pp. 263-264. doi:10.1176/appi.books.9780890425596.156852. ISBN 978-0-89042-555-8. Cite has empty unknown parameter: |1= (help)
  2. 2.0 2.1 Geddes, John R.; Andreasen, Nancy C. (2020). New Oxford Textbook of Psychiatry. Oxford University Press. p. 988. ISBN 978-0-19-871300-5.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 "Body-Focused Repetitive Behavior Disorder - Psychiatric Disorders". Merck Manuals Professional Edition. Retrieved 18 February 2021.
  4. 4.0 4.1 Sampaio, DG; Grant, JE (2018). "Body-focused repetitive behaviors and the dermatology patient". Clinics in dermatology. 36 (6): 723–727. doi:10.1016/j.clindermatol.2018.08.004. PMID 30446195.
  5. 5.0 5.1 Fontenelle, Leonardo F.; Yücel, Murat. A Transdiagnostic Approach to Obsessions, Compulsions and Related Phenomena. Cambridge University Press. p. 367. ISBN 978-1-107-19577-6.
  6. Teng; et al. (2004), "Body-Focused Repetitive Behaviors: The Proximal and Distal Effects of Affective Variables on Behavioral Expression", Journal of Psychopathology and Behavioral Assessment, 26: 55–64, doi:10.1023/B:JOBA.0000007456.24198.e4
  7. 7.0 7.1 Scientific Advances in Trichotillomania and Related Body-Focused Repetitive Behaviors Archived July 21, 2011, at the Wayback Machine, November 4, 2004, National Institute of Mental Health
  8. ABC News 20/20 Hair Pulling, 2006
  9. 9.0 9.1 9.2 9.3 AAMFT Consumer Update - Hair Pulling, Skin Picking and Biting: Body-Focused Repetitive Disorders Archived 2009-04-25 at the Wayback Machine, American Association for Marriage and Family Therapy
  10. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462014000400059
  11. Trichotillomania (TTM) & Related Body-Focused Repetitive Behaviors (BFRBs) Archived 2011-12-29 at the Wayback Machine, The Center for Emotional Health of Greater Philadelphia
  12. 12.0 12.1 12.2 12.3 Woods, Douglas W.; Houghton, David C. (13 July 2015). "Evidence-Based Psychosocial Treatments for Pediatric Body-Focused Repetitive Behavior Disorders". Journal of Clinical Child & Adolescent Psychology. 45 (3): 227–240. doi:10.1080/15374416.2015.1055860. PMID 26167847.
  13. Torales J, Barrios I, Villalba J (2017). "Alternative Therapies for Excoriation (Skin Picking) Disorder: A Brief Update". Adv Mind Body Med. 31 (1): 10–13. PMID 28183072.
  14. Families & Health Archived March 28, 2009, at the Wayback Machine, American Association for Marriage and Family Therapy
  15. Diefenbach GJ, Reitman D, Williamson DA (2000). "Trichotillomania: A challenge to research and practice". Clinical Psychology Review. 20 (3): 289–309. doi:10.1016/S0272-7358(98)00083-X. PMID 10779896.

External links

Classification