What is Body-Focused Repetitive Behaviour?

Introduction

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

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

BFRB disorders are currently estimated to be under the obsessive-compulsive spectrum.

Cause(s)

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 BFRB 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, 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, hair nibbling.
    • Trichotemnomania, hair cutting.
    • Trichotillomania, hair pulling.
  • Eyes:
    • Mucus fishing syndrome – compulsion to remove or “fish” strands of mucus from the eye.

Treatment

Psychotherapy

Treatment can include behaviour modification therapy, medication, and family therapy. The evidence base criteria for BFRBs is strict and methodical. Individual behavioural therapy has been shown as a “probably effective” evidence-based therapy to help with thumb sucking, and possibly nail biting. Cognitive behavioural 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 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. 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.

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