Body-focused repetitive behavior

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Body-focused repetitive behavior
Dermatillomania fingers.JPG
Dermatillomania (picking of the skin) of the knuckles (via mouth), illustrating disfiguration of the distal and proximal joints of the middle and little fingers

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]

Contents

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. [4] They are also associated with ADHD and anxiety.

Causes

The cause of BFRBs is unknown.[ citation needed ]

Emotional variables may have a differential impact on the expression of BFRBs. [5]

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.[ citation needed ]

Researchers are investigating a possible genetic component. [1] [6]

Onset

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

Diagnosis

Types

The main BFRB disorders are: [4]

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. [7] Cognitive behavioral therapy was cited as experimental evidence based therapy to treat trichotillomania and nail biting; [7] 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. [7]

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

Related Research Articles

<span class="mw-page-title-main">Trichotillomania</span> Medical condition

Trichotillomania (TTM), also known as hair-pulling disorder or compulsive hair pulling, is a mental disorder characterized by a long-term urge that results in the pulling out of one's own hair. A brief positive feeling may occur as hair is removed. Efforts to stop pulling hair typically fail. Hair removal may occur anywhere; however, the head and around the eyes are most common. The hair pulling is to such a degree that it results in distress and hair loss can be seen.

<span class="mw-page-title-main">Nose-picking</span> Human habit

Nose-picking is the act of extracting nasal mucus with one's finger (rhinotillexis) and may include the subsequent ingestion of the extracted mucus (mucophagy). In Western cultures, this act is generally considered to be socially deviant; parents and pediatricians have historically tried to prevent development of the habit and attempt to break it if already established. Mucophagy is a source of mockery and entertainment in the media.

Aversion therapy is a form of psychological treatment in which the patient is exposed to a stimulus while simultaneously being subjected to some form of discomfort. This conditioning is intended to cause the patient to associate the stimulus with unpleasant sensations with the intention of quelling the targeted behavior.

<span class="mw-page-title-main">Nail biting</span> Medical condition

Nail biting, also known as onychophagy or onychophagia, is an oral compulsive habit of biting one's fingernails. It is sometimes described as a parafunctional activity, the common use of the mouth for an activity other than speaking, eating, or drinking.

Psychomotor agitation is a symptom in various disorders and health conditions. It is characterized by unintentional and purposeless motions and restlessness, often but not always accompanied by emotional distress. Typical manifestations include pacing around, wringing of the hands, uncontrolled tongue movement, pulling off clothing and putting it back on, and other similar actions. In more severe cases, the motions may become harmful to the individual, and may involve things such as ripping, tearing, or chewing at the skin around one's fingernails, lips, or other body parts to the point of bleeding. Psychomotor agitation is typically found in various mental disorders, especially in psychotic and mood disorders. It can be a result of drug intoxication or withdrawal. It can also be caused by severe hyponatremia. The middle-aged and the elderly are more at risk to express it.

Impulse-control disorder (ICD) is a class of psychiatric disorders characterized by impulsivity – failure to resist a temptation, an urge, or an impulse; or having the inability to not speak on a thought. Many psychiatric disorders feature impulsivity, including substance-related disorders, behavioral addictions, attention deficit hyperactivity disorder, fetal alcohol spectrum disorders, antisocial personality disorder, borderline personality disorder, conduct disorder and some mood disorders.

<span class="mw-page-title-main">Excoriation disorder</span> Medical condition

Excoriation disorder, more commonly known as dermatillomania, is a mental disorder on the obsessive–compulsive spectrum that is characterized by the repeated urge or impulse to pick at one's own skin, to the extent that either psychological or physical damage is caused.

Stereotypic movement disorder (SMD) is a motor disorder with onset in childhood involving restrictive and/or repetitive, nonfunctional motor behavior, that markedly interferes with normal activities or results in bodily injury. To be classified as SMD, the behavior in question must not be due to the direct effects of a substance, autism, or another medical condition. The cause of this disorder is not known.

Autophagia refers to the practice of biting/consuming one's body. It is a sub category of self-injurious behavior (SIB). Commonly, it manifests in humans as nail biting and hair pulling. In rarer circumstances, it manifests as serious self mutilative behavior such as biting of one's fingers. Autophagia affects both humans and non humans. Human autophagia typically occurs in parts of the body that are sensitive to pain, such as fingers. Human autophagia is not motivated by suicidal intent, but may be related to the desire to seek pain.

Habit reversal training (HRT) is a "multicomponent behavioral treatment package originally developed to address a wide variety of repetitive behavior disorders".

<span class="mw-page-title-main">Self-destructive behavior</span> Behaviours that are harmful to the individual engaging in them

Self-destructive behavior is any behavior that is harmful or potentially harmful towards the person who engages in the behavior.

The obsessive–compulsive spectrum is a model of medical classification where various psychiatric, neurological and/or medical conditions are described as existing on a spectrum of conditions related to obsessive–compulsive disorder (OCD). "The disorders are thought to lie on a spectrum from impulsive to compulsive where impulsivity is said to persist due to deficits in the ability to inhibit repetitive behavior with known negative consequences, while compulsivity persists as a consequence of deficits in recognizing completion of tasks." OCD is a mental disorder characterized by obsessions and/or compulsions. An obsession is defined as "a recurring thought, image, or urge that the individual cannot control". Compulsion can be described as a "ritualistic behavior that the person feels compelled to perform". The model suggests that many conditions overlap with OCD in symptomatic profile, demographics, family history, neurobiology, comorbidity, clinical course and response to various pharmacotherapies. Conditions described as being on the spectrum are sometimes referred to as obsessive–compulsive spectrum disorders.

<span class="mw-page-title-main">Compulsive behavior</span> Habit and impulse disorder

Compulsive behavior is defined as performing an action persistently and repetitively. Compulsive behaviors could be an attempt to make obsessions go away. The act is usually a small, restricted and repetitive behavior, yet not disturbing in a pathological way. Compulsive behaviors are a need to reduce apprehension caused by internal feelings a person wants to abstain from or control. A major cause of compulsive behavior is said to be obsessive–compulsive disorder (OCD). "The main idea of compulsive behavior is that the likely excessive activity is not connected to the purpose to which it appears directed." There are many different types of compulsive behaviors including shopping, hoarding, eating, gambling, trichotillomania and picking skin, itching, checking, counting, washing, sex, and more. Also, there are cultural examples of compulsive behavior.

<span class="mw-page-title-main">Dermatophagia</span> Medical condition

Dermatophagia or dermatodaxia is a compulsion disorder of gnawing or biting one's own skin, most commonly at the fingers. This action can either be conscious or unconscious. Those affected with dermatophagia typically bite the skin around the nails, leading to bleeding and discoloration over time. Some people also bite on their skin on their finger knuckles which can lead to pain and bleeding just by moving their fingers. In herpetology, dermatophagia is used to correctly describe the act in which amphibians and reptiles eat the skin they shed, but this is not what occurs in humans. Those diagnosed with this disorder do not develop wounds on the bitten areas of their hands or lose any skin. Instead, they experience a thickening of the skin being repeatedly bitten. Contemporary research suggests a link between impulse-control disorders and obsessive–compulsive disorders, and this was addressed in the DSM-5 when dermatophagia and other related disorders were classified as 'other specified obsessive-compulsive related disorders' and are given the specification of body focused repetitive behavior. Further information on OCD, other anxiety disorders, dermatophagia and other related body focused repetitive behaviors can be found in the DSM-5.

<span class="mw-page-title-main">Obsessive–compulsive disorder</span> Mental and behavioral disorder

Obsessive–compulsive disorder (OCD) is a mental and behavioral disorder in which an individual has intrusive thoughts and feels the need to perform certain routines (compulsions) repeatedly to relieve the distress caused by the obsession, to the extent where it impairs general function.

Onychotillomania is a compulsive behavior in which a person picks constantly at the nails or tries to tear them off. It is not the same as onychophagia, where the nails are bitten or chewed, or dermatillomania, where skin is bitten or scratched. Onychotillomania can be categorized as a body-focused repetitive behavior in the DSM-5 and is a form of skin picking, also known as excorciation disorder.

Morsicatio buccarum is a condition characterized by chronic irritation or injury to the buccal mucosa, caused by repetitive chewing, biting or nibbling.

Nathan H. Azrin was a behavioral modification researcher, psychologist, and university professor. He taught at Southern Illinois University and was the research director of Anna State Hospital between 1958 and 1980. In 1980 he became a professor at Nova Southeastern University, and entered emeritus status at the university in 2010. Azrin was the founder of several research methodologies, including Token Economics, the Community Reinforcement Approach (CRA) on which the CRAFT model was based, Family Behavior Therapy, and habit reversal training. According to fellow psychologist Brian Iwata “Few people have made research contributions equaling Nate’s in either basic or applied behaviour analysis, and none have matched his contributions to both endeavors.”

Decoupling is a behavioral self-help intervention for body-focused and related behaviors (DSM-5) such as trichotillomania, onychophagia, skin picking and lip-cheek biting. The user is instructed to modify the original dysfunctional behavioral path by performing a counter-movement shortly before completing the self-injurious behavior. 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 Lee et al. in 2019. Whether or not the technique is superior to other behavioral interventions such as habit reversal training awaits to be tested. Decoupling is a variant of habit reversal training.

<span class="mw-page-title-main">Habit-tic deformity</span> Condition of the nail caused by external trauma to the nail matrix

Habit-tic deformity is a condition of the nail caused by external trauma to the nail matrix. The condition is characterized by ridges which run horizontally across the entire nail, most often occurring on the thumbs, as well as marked damage to or absence of cuticles.

References

  1. 1 2 3 "Scientific Advances in Trichotillomania and Related Body-Focused Repetitive Behaviors". National Institute of Mental Health . November 4, 2004. Archived from the original on July 21, 2011.
  2. 1 2 3 4 5 "AAMFT Consumer Update - Hair Pulling, Skin Picking and Biting: Body-Focused Repetitive Disorders". American Association for Marriage and Family Therapy. Archived from the original on 2009-04-25.
  3. Grant JE, Stein DJ (2014). "Body-focused repetitive behavior disorders in ICD-11". Revista Brasileira de Psiquiatria. 36 Suppl 1 (suppl 1): 59–64. doi: 10.1590/1516-4446-2013-1228 . PMID   25388613.
  4. 1 2 "Trichotillomania (TTM) & Related Body-Focused Repetitive Behaviors (BFRBs)". The Center for Emotional Health of Greater Philadelphia. Archived from the original on 2011-12-29.
  5. Teng EJ, Woods DW, Marcks BA, Twohig MP (March 2004). "Body-Focused Repetitive Behaviors: The Proximal and Distal Effects of Affective Variables on Behavioral Expression". Journal of Psychopathology and Behavioral Assessment. 26 (1): 55–64. doi:10.1023/B:JOBA.0000007456.24198.e4. S2CID   144926749.
  6. ABC News 20/20 Hair Pulling, 2006
  7. 1 2 3 4 Woods DW, Houghton DC (13 July 2015). "Evidence-Based Psychosocial Treatments for Pediatric Body-Focused Repetitive Behavior Disorders". Journal of Clinical Child and Adolescent Psychology. 45 (3): 227–40. doi: 10.1080/15374416.2015.1055860 . PMID   26167847.
  8. Lee MT, Mpavaenda DN, Fineberg NA (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. 13: 79. doi: 10.3389/fnbeh.2019.00079 . PMC   6491945 . PMID   31105537.
  9. Torales J, Barrios I, Villalba J (2017). "Alternative Therapies for Excoriation (Skin Picking) Disorder: A Brief Update". Advances in Mind-Body Medicine. 31 (1): 10–13. PMID   28183072.
  10. Families & Health Archived March 28, 2009, at the Wayback Machine , American Association for Marriage and Family Therapy
  11. Diefenbach GJ, Reitman D, Williamson DA (April 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.