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 currently estimated to be under the obsessive-compulsive spectrum. They are also associated with

ADHD Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise age-inapp ...

and anxiety.

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 abuse, also known as drug abuse, is the use of a drug in amounts or by methods which are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, ...

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 (from Ancient Greek ''δέρμα'' — ''skin'' and ''φαγεία'' ''eating'') or dermatodaxia (from ''δήξις'', ''biting'') is a compulsion disorder of gnawing or biting one's own skin, most commonly at the fingers. This act ...

, skin nibbling * Mouth ** Morsicatio buccarum, cheek biting ** Morsicatio labiorum, inner lip biting ** Morsicatio linguarum, tongue biting * Hands ** Onychophagia, nail biting **

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. O ...

, nail picking * Nose ** Rhinotillexomania, compulsive nose picking * Hair ** Trichophagia, hair nibbling ** Trichotemnomania, hair cutting ** Trichotillomania, hair pulling * Eyes **

Mucus fishing syndrome Mucus fishing syndrome is a rare condition caused by repeated self damage to the conjunctiva. The condition causes excessive mucus production. Patients with this condition make their condition worse by removing mucus from their eyes. Causes The ...

- compulsion to remove or "fish" 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 psychology and clinical social work that works with families and couples in intimate relationsh ...

. 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 psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (suc ...

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, th ...

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 p ...

, and trichotillomania have been treated with

inositol Inositol, or more precisely ''myo''-inositol, is a carbocyclic sugar that is abundant in the brain and other mammalian tissues; it mediates cell signal transduction in response to a variety of hormones, neurotransmitters, and growth factors and ...

and N-acetylcysteine.

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