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

BFRB disorders are currently estimated to be under the obsessive–compulsive spectrum. [3] They are also associated with attention deficit hyperactivity disorder (ADHD) and anxiety.[ citation needed ]

Causes

The cause of BFRBs is unknown.[ citation needed ]

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.[ citation needed ]

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: [3]

Treatment

Psychotherapy

Treatment can include behavior modification therapy, medication, and family therapy. [1] [2] The evidence base criteria for BFRBs is strict and methodical. [9] Individual behavioral therapy has been shown as a "probably effective" evidence-based therapy to help with thumb sucking, and possibly nail biting. [9] Cognitive behavioral therapy was cited as experimental evidence based therapy to treat trichotillomania and nail biting; [9] a systematic review found best evidence for habit reversal training and decoupling. [10] 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. [9]

Pharmacotherapy

Excoriation disorder and trichotillomania have been treated with inositol and N-acetylcysteine. [11]

Decoupling

Decoupling [12] is a behavioral self-help intervention for body-focused repetitive behavior (BFRB). The user is instructed to modify the original dysfunctional behavioral path by performing a counter-movement shortly before completing the self-injurious behavior (e.g., biting nails, picking skin, pulling hair). 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, [13] which was corroborated by another study in 2019. [14] Decoupling was shown to be superior to habit reversal training in treating BFRB in one direct comparison study in 2021. [15]

Prevalence

BFRBs are among the most poorly understood, misdiagnosed, and undertreated groups of disorders. [16] 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. [17]

See also

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. 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.
  4. ↑ 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.
  5. ↑ ABC News 20/20 Hair Pulling, 2006
  6. ↑ Jafferany, Mohammad; Feng, Jing; Hornung, Robin L. (2009-04-01). "Trichodaganomania: The compulsive habit of biting one's own hair" . Journal of the American Academy of Dermatology. 60 (4): 689–691. doi:10.1016/j.jaad.2008.07.055. ISSN   0190-9622. PMID   19293016.
  7. ↑ Happle, Rudolf (January 2005). "Trichotemnomania: Obsessive-compulsive habit of cutting or shaving the hair" . Journal of the American Academy of Dermatology. 52 (1): 157–159. doi:10.1016/j.jaad.2004.07.060. PMID   15627101.
  8. ↑ Reich, Stefanie; Trüeb, Ralph M. (January 2003). "Trichoteiromanie: Trichoteiromania" . JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 1 (1): 22–28. doi:10.1046/j.1610-0387.2003.02012.x. ISSN   1610-0379. PMID   16285289.
  9. 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.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ Moritz, Steffen; Rufer, Michael (2011). "Movement decoupling: A self-help intervention for the treatment of trichotillomania". Journal of Behavior Therapy and Experimental Psychiatry. 42 (1): 74–80. doi:10.1016/j.jbtep.2010.07.001. PMID   20674888.
  13. ↑ Sarris, Jerome; Camfield, David; Berk, Michael (2012). "Complementary medicine, self-help, and lifestyle interventions for Obsessive Compulsive Disorder (OCD) and the OCD spectrum: A systematic review". Journal of Affective Disorders. 138 (3): 213–221. doi:10.1016/j.jad.2011.04.051. PMID   21620478.
  14. ↑ Lee, Melissa T.; Mpavaenda, Davis N.; Fineberg, Naomi A. (2019-04-24). "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 . ISSN   1662-5153. PMC   6491945 . PMID   31105537.
  15. ↑ Moritz, Steffen; Penny, Danielle N.; Ahmed, Kaser; Schmotz, Stella (2021-04-21). "A Head-to-Head Comparison of Three Self-Help Techniques to Reduce Body-Focused Repetitive Behaviors". Behavior Modification. 46 (4): 894–912. doi:10.1177/01454455211010707. PMC   9158250 . PMID   33880943.
  16. ↑ Families & Health Archived March 28, 2009, at the Wayback Machine , American Association for Marriage and Family Therapy
  17. ↑ 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.
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