Body-focused repetitive behavior explained

Body-focused repetitive behavior (BFRB) is an umbrella name for impulse control^[1] behaviors involving compulsively damaging one's physical appearance or causing physical injury.^[2]

Body-focused repetitive behavior disorders (BFRBDs) in ICD-11 is in development.^[3]

BFRB disorders are currently estimated to be under the obsessive-compulsive spectrum. They are also associated with ADHD and anxiety.

Causes

The cause of BFRBs is unknown.

Emotional variables may have a differential impact on the expression of BFRBs.^[4]

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.^{[1] [5]}

Onset

BFRBs most often begin in late childhood or in the early teens.^[2]

Diagnosis

Types

The main BFRB disorders are:^[6]

• Skin
  • Dermatillomania (excoriation disorder), skin picking
  • Dermatophagia, skin nibbling
• Mouth
  • Morsicatio buccarum, cheek biting
  • Morsicatio labiorum, inner lip biting
  • Morsicatio linguarum, tongue biting
• Nails
  • Onychophagia, nail biting
  • Onychotillomania, nail picking
• Nose
  • Rhinotillexomania, compulsive nose picking^[2]
• Hair
  • Trichophagia, hair nibbling
  • Trichotemnomania, hair cutting
  • Trichotillomania, hair pulling
• Eyes
  • Mucus fishing syndrome - compulsion to remove or "fish" strands of mucus from the eye

Treatment

Psychotherapy

Treatment can include behavior modification therapy, medication, and family therapy.^{[1] [2]} The evidence base criteria for BFRBs is strict and methodical.^[7] 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; a systematic review found best evidence for habit reversal training and decoupling.^[8] 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.^[9]

Prevalence

BFRBs are among the most poorly understood, misdiagnosed, and undertreated groups of disorders.^[10] BFRBs may affect at least 1 out of 20 people.^[2] 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.^[11]

See also

• Stereotypic movement disorder
• Rhythmic Movement Disorder
• Body dysmorphic disorder
• Habit reversal training
• Decoupling treatment

Notes and References

1. Web site: Scientific Advances in Trichotillomania and Related Body-Focused Repetitive Behaviors. https://web.archive.org/web/20110721054811/http://wwwapps.nimh.nih.gov/research-funding/scientific-meetings/2004/scientific-advances-in-trichotillomania-and-related-body-focused-repetitive-behaviors.shtml. July 21, 2011. November 4, 2004. National Institute of Mental Health.
2. Web site: AAMFT Consumer Update - Hair Pulling, Skin Picking and Biting: Body-Focused Repetitive Disorders. https://web.archive.org/web/20090425095847/http://www.aamft.org/families/Consumer_Updates/Body-focusedRepetitiveDisorders.asp. 2009-04-25. American Association for Marriage and Family Therapy.
3. Grant JE, Stein DJ . Body-focused repetitive behavior disorders in ICD-11 . Revista Brasileira de Psiquiatria . 36 Suppl 1 . suppl 1 . 59–64 . 2014 . 25388613 . 10.1590/1516-4446-2013-1228 . free .
4. Teng EJ, Woods DW, Marcks BA, Twohig MP . Body-Focused Repetitive Behaviors: The Proximal and Distal Effects of Affective Variables on Behavioral Expression . Journal of Psychopathology and Behavioral Assessment . March 2004 . 26 . 1 . 55–64 . 10.1023/B:JOBA.0000007456.24198.e4 . 144926749 .
5. ABC News 20/20 Hair Pulling, 2006
6. Web site: Trichotillomania (TTM) & Related Body-Focused Repetitive Behaviors (BFRBs). https://web.archive.org/web/20111229195155/http://www.thecenterforemotionalhealth.com/Trichotillomania_(TTM).html. 2011-12-29. The Center for Emotional Health of Greater Philadelphia.
7. Woods DW, Houghton DC . Evidence-Based Psychosocial Treatments for Pediatric Body-Focused Repetitive Behavior Disorders . Journal of Clinical Child and Adolescent Psychology . 45 . 3 . 227–40 . 13 July 2015 . 26167847 . 10.1080/15374416.2015.1055860 . free .
8. Lee MT, Mpavaenda DN, Fineberg NA . 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 . 13 . 79 . 2019 . 31105537 . 6491945 . 10.3389/fnbeh.2019.00079 . free .
9. Torales J, Barrios I, Villalba J . Alternative Therapies for Excoriation (Skin Picking) Disorder: A Brief Update . Advances in Mind-Body Medicine . 31 . 1 . 10–13 . 2017 . 28183072 .
10. http://www.aamft.org/families/index_nm.asp#Body-focused%20Repetitive%20Disorders Families & Health
11. Diefenbach GJ, Reitman D, Williamson DA . Trichotillomania: a challenge to research and practice . Clinical Psychology Review . 20 . 3 . 289–309 . April 2000 . 10779896 . 10.1016/S0272-7358(98)00083-X .