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.
Nose picking is the act of extracting mucus and 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.
Trichophagia is a form of disordered eating in which persons with the disorder suck on, chew, swallow, or otherwise eat hair. The term is derived from ancient Greek θρίξ, thrix ("hair") and φαγεῖν, phagein. Tricho-phagy refers only to the chewing of hair, whereas tricho-phagia is ingestion of hair, but many texts refer to both habits as just trichophagia. It is considered a chronic psychiatric disorder of impulse control. Trichophagia belongs to a subset of pica disorders and is often associated with trichotillomania, the compulsive pulling out of ones own hair. People with trichotillomania often also have trichophagia, with estimates ranging from 48-58% having an oral habit such as biting or chewing, and 4-20% actually swallowing and ingesting their hair. Extreme cases have been reported in which patients consume hair found in the surrounding environment, including other people's and animals' hair. In an even smaller subset of people with trichotillomania, their trichophagia can become so severe that they develop a hairball. Termed a trichobezoar, these masses can be benign, or cause significant health concerns and require emergency surgery to remove them. Rapunzel syndrome is a further complication whereby the hairball extends past the stomach and can cause blockages of gastrointestinal system.
Hoarding disorder (HD) or Plyushkin's disorder, is a mental disorder characterised by persistent difficulty in parting with possessions and engaging in excessive acquisition of items that are not needed or for which no space is available. This results in severely cluttered living spaces, distress, and impairment in personal, family, social, educational, occupational, or other important areas of functioning. Excessive acquisition is characterized by repetitive urges or behaviours related to amassing or buying property. Difficulty discarding possessions is characterized by a perceived need to save items and distress associated with discarding them. Accumulation of possessions results in living spaces becoming cluttered to the point that their use or safety is compromised. It is recognised by the eleventh revision of the International Classification of Diseases (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).
Nail biting, also known as onychophagy or onychophagia, is an oral compulsive and unhygienic 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 and is always an indicative for discharge. 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, autism spectrum disorder, fetal alcohol spectrum disorders, antisocial personality disorder, borderline personality disorder, conduct disorder and some mood disorders.
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 is 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 off 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".
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.
Compulsive behavior is defined as performing an action persistently and repetitively. Compulsive behaviors could be an attempt to make obsessions go away. 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). "Compulsive behavior is when someone keeps doing the same action because they feel like they have to, even though they know these actions do not align with their goals." 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.
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 and it is considered to be a type of pica. 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.
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 excoriation 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.
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.
