Abstract

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

Body-focused repetitive behavior disorders (BFRBDs) in ICD-11 is in development.

BFRB disorders are not generally considered obsessive-compulsive disorders.

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 disorder.

Researchers are investigating a possible genetic component.

Diagnosis | Types

The main BFRB disorders are:

- Skin

- Dermatillomania (excoriation disorder), skin picking

- Dermatophagia, skin nibbling

- Mouth

- Morsicatio buccarum, cheek biting

- Morsicatio labiorum, inner lip biting

- Morsicatio buccarum, tongue biting

- Hands

- Onychophagia, nail biting

- Onychotillomania, nail picking

- Nose

- Rhinotillexomania, compulsive nose picking

- Hair

- Trichophagia, hair nibbling

- Trichotemnomania, hair cutting

- Trichotillomania, hair pulling

Treatment | Psychotherapy

Treatment can include behavior modification therapy, medication, and family therapy. 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 was cited as experimental evidence based therapy to treat trichotillomania and nail biting. 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.

Treatment | Pharmacotherapy

Excoriation disorder, and trichotillomania have been treated with inositol and N-acetylcysteine.

Prevalence

BFRBs are among the most poorly understood, misdiagnosed, and undertreated groups of disorders. BFRBs may affect at least 1 out of 20 people. Trichotillomania alone is believed to affect 10 million people in the United States.