Body-focused repetitive behavior (BFRB) is an umbrella name for impulse-control behaviors involving compulsively damaging one's physical appearance or causing physical injury. BFRB disorders are currently estimated to be under the obsessive–compulsive spectrum. They are also associated with

attention deficit hyperactivity disorder Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by symptoms of inattention, hyperactivity, impulsivity, and emotional dysregulation that are excessive and pervasive, impairing in multiple con ...

(ADHD) and

anxiety Anxiety is an emotion characterised by an unpleasant state of inner wikt:turmoil, turmoil and includes feelings of dread over Anticipation, anticipated events. Anxiety is different from fear in that fear is defined as the emotional response ...

Causes

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 Substance misuse, also known as drug misuse or, in older vernacular, substance abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of substance-related disorder, differing definition ...

disorder. Researchers are investigating a possible genetic component.

Onset

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

Diagnosis

Types

The main BFRB disorders are: * Skin ** Dermatillomania (excoriation disorder), skin picking **

Dermatophagia Dermatophagia () or dermatodaxia () is a Compulsive behavior, 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 (dis ...

, skin nibbling * Mouth **

Morsicatio buccarum Morsicatio buccarum is a condition characterized by chronic irritation or injury to the buccal mucosa (the lining of the inside of the cheek within the mouth), caused by repetitive chewing, biting, or nibbling. Signs and symptoms The lesions are ...

, cheek biting ** Morsicatio labiorum, inner lip biting ** Morsicatio linguarum, tongue biting * Nails **

Onychotillomania 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. ...

, nail picking ** Onychophagia, nail biting * Nose ** Rhinotillexomania, nose picking * Hair **

Trichotillomania 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 rem ...

, hair pulling **

Trichophagia Trichophagia is a form of disordered eating in which persons with the disorder suck on, chew, swallow, or otherwise eat hair. Citing The term is derived from ancient Greek θρίξ, ("hair") and φαγεῖν, ("to eat"). Tricho-phagy refers onl ...

, hair nibbling followed by consumption ** Trichodaganomania, hair biting ** Trichotemnomania, hair cutting ** Trichoteiromania, hair rubbing * Eyes ** Mucus fishing syndrome, removing or "fishing" strands of mucus from the eye

Treatment

Psychotherapy

Treatment can include behavior modification therapy, medication, and

family therapy Family therapy (also referred to as family counseling, family systems therapy, marriage and family therapy, couple and family therapy) is a branch of psychotherapy focused on families and couples in intimate relationships to nurture change and ...

. 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 Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD, and anxiety disorders. Cognitive behavioral therapy focuses on challenging and chang ...

was cited as experimental evidence based therapy to treat trichotillomania and nail biting; a systematic review found best evidence for

habit reversal training Habit reversal training (HRT) is a "multicomponent behavioral treatment package originally developed to address a wide variety of repetitive behavior disorders". Behavioral disorders treated with HRT include tics, trichotillomania, nail biting, ...

and decoupling. 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 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 ...

and

trichotillomania 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 rem ...

have been treated with

inositol In biochemistry, medicine, and related sciences, inositol generally refers to ''myo''-inositol (formerly ''meso''-inositol), the most important stereoisomer of the chemical compound cyclohexane-1,2,3,4,5,6-hexol. Its elemental formula, formula is ...

and N-acetylcysteine.

Decoupling

Decoupling 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 Self-harm refers to intentional behaviors that cause harm to oneself. This is most commonly regarded as direct injury of one's own skin tissues, usually without suicidal intention. Other terms such as cutting, self-abuse, self-injury, and s ...

(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 Compulsive behavior (or compulsion) 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 ...

at an early stage. A systematic review from 2012 suggested some efficacy of decoupling, which was corroborated by another study in 2019. Decoupling was shown to be superior to habit reversal training in treating BFRB in one direct comparison study in 2021.

Prevalence

BFRBs are among the most poorly understood, misdiagnosed, and undertreated groups of disorders.Families & Health
, American Association for Marriage and Family Therapy 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.

References

External links

{{Medical resources , ICD10 = {{ICD10, Xxx.x , ICD9 = {{ICD9, xxx , ICDO = , OMIM = , DiseasesDB = , MedlinePlus = , eMedicineSubj = , eMedicineTopic = , MeSH = , GeneReviewsNBK = , GeneReviewsName = , Orphanet = Conditions of the skin appendages Neurocutaneous conditions Self-harm