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| Body-focused repetitive behavior | |
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| Dermatillomania (picking of the skin) of the knuckles (via mouth), illustrating disfiguration of the distal and proximal joints of the middle and little fingers |
Body-focused repetitive behavior (BFRB) is an umbrella name for impulse control[1] behaviors involving compulsively damaging one's physical appearance or causing physical injury.[2]
Body-focused repetitive behavior disorders (BFRBDs) in ICD-11 is in development.[3]
BFRB disorders are currently estimated to be under the obsessive-compulsive spectrum.[4] They are also associated with ADHD and anxiety.
The cause of BFRBs is unknown.[citation needed]
Emotional variables may have a differential impact on the expression of BFRBs.[5]
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.[citation needed]
Researchers are investigating a possible genetic component.[1][6]
BFRBs most often begin in late childhood or in the early teens.[2]
The main BFRB disorders are:[4]
Treatment can include behavior modification therapy, medication, and family therapy.[1][2] The evidence base criteria for BFRBs is strict and methodical.[7] Individual behavioral therapy has been shown as a "probably effective" evidence-based therapy to help with thumb sucking, and possibly nail biting.[7] Cognitive behavioral therapy was cited as experimental evidence based therapy to treat trichotillomania and nail biting;[7] a systematic review found best evidence for habit reversal training and decoupling.[8] 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.[7]
Excoriation disorder, and trichotillomania have been treated with inositol and N-acetylcysteine.[9]
BFRBs are among the most poorly understood, misdiagnosed, and undertreated groups of disorders.[10] BFRBs may affect at least 1 out of 20 people.[2] 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.[11]
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