Body-focused repetitive behavior (BFRB) is an umbrella name for

impulse control Inhibitory control, also known as response inhibition, is a cognitive process – and, more specifically, an executive function – that permits an individual to inhibit their impulses and natural, habitual, or dominant behavioral re ...

behaviors involving compulsively damaging one's physical appearance or causing physical injury. Body-focused repetitive behavior disorders (BFRBDs) in

ICD-11 The ICD-11 is the eleventh revision of the International Classification of Diseases (ICD). It replaces the ICD-10 as the global standard for recording health information and causes of death. The ICD is developed and annually updated by the World H ...

is in development. BFRB disorders are currently estimated to be under the obsessive-compulsive spectrum. They are also associated with ADHD and

anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...

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.

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, 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 * Hands ** Onychophagia, nail biting ** Onychotillomania, nail picking * Nose ** Rhinotillexomania, compulsive nose picking * Hair **

Trichophagia Trichophagia is the compulsive eating of hair associated with trichotillomania (hair pulling). In trichophagia, people with trichotillomania also ingest the hair that they pull; in extreme cases this can lead to a hair ball ( trichobezoar). The te ...

, hair nibbling ** Trichotemnomania, hair cutting **

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 remov ...

, hair pulling * Eyes ** Mucus fishing syndrome - compulsion to remove or "fish" strands of mucus from the eye

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; a systematic review found best evidence for habit reversal training 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, 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 remov ...

have been treated with inositol and

N-acetylcysteine Acetylcysteine, also known as ''N''-acetylcysteine (NAC), is a medication that is used to treat paracetamol overdose and to loosen thick mucus in individuals with chronic bronchopulmonary disorders like pneumonia and bronchitis. It has been used ...

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