Body-focused repetitive behavior
|Body-focused repetitive behavior|
|Other names: Body-focused repetitive behavior disorder (BFRBD)|
|Knuckle biting resulting in disfiguration of the skin over the joints of the middle and little fingers|
|Symptoms||Nail biting, lip biting, cheek chewing|
|Differential diagnosis||Hair pulling disorder, skin picking disorder, stereotypic movement disorder, self-harm, normal habits|
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. Specific behaviors may include nail biting, lip biting, or cheek chewing. People are unable to stop these behaviors despite trying to do so. Complications may include nail damage.
It is within the category of obsessive-compulsive and related disorders. 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. Other sources; however, include those two disorders as types of BFRBD. Diagnosis requires the behavior to occur to such a degree that functioning is impaired or distress occurs. Additionally the behavior must be unrelated to efforts to change ones appearance.
Treatment may include counselling, such as cognitive behavioral therapy, and medications, such as SSRIs or N-acetylcysteine. 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. While these behaviors have been described throughout history, it was in the late 1800s that they were named as health problem. Hair pulling disorder was first included in the DSM in 1987 while skin picking disorder was officially included in 2013.
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.
BFRBs most often begin in late childhood or in the early teens.
The main BFRB disorders are:
- Morsicatio buccarum, cheek biting
- Morsicatio labiorum, inner lip biting
- Morsicatio linguarum, tongue biting
- Mucus fishing syndrome - compulsion to remove or "fish" strands of mucus from the eye
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. Cognitive behavioral therapy was cited as experimental evidence based therapy to treat trichotillomania and 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.
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.
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