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Body-Focused Repetitive Behavior Disorder

By Katharine A. Phillips, MD, Professor of Psychiatry and Human Behavior;, Warren Alpert Medical School of Brown University;Private Practice of Psychiatry ; Dan J. Stein, MD, PhD, Professor and Chair, Department of Psychiatry, University of Cape Town

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Patient Education

Body-focused repetitive behavior disorder is characterized by body-focused repetitive behaviors (eg, nail biting, lip biting, cheek chewing) and attempts to stop the behaviors.

Body-focused repetitive behavior disorder is an example of another specified obsessive-compulsive and related disorder (see Obsessive-Compulsive Disorder (OCD)). Patients with this disorder repeatedly engage in body-focused activities (eg, nail biting, lip biting, cheek chewing).

Some patients engage in these activities somewhat automatically (ie, without full awareness); others are more conscious of the activity. The behaviors are not triggered by obsessions or concerns about appearance but may be preceded by a feeling of tension or anxiety that is relieved by the behavior, which is often also accompanied by a feeling of gratification.

Severe nail biting or nail picking (onychotillomania) can cause significant nail deformities (eg, washboard deformity, or habit-tic nails) and subungual hemorrhages.


To meet diagnostic criteria, patients must typically

  • Have body-focused repetitive behaviors other than hair pulling or skin picking

  • Make repeated attempts to reduce or stop the behaviors

  • Experience significant distress or impairment from the behaviors


Treatment includes drugs (eg, SSRIs) and cognitive-behavioral therapy. It is similar to that for trichotillomania (hair-pulling disorder—see Trichotillomania : Treatment) and excoriation disorder (see Excoriation (Skin-Picking) Disorder : Treatment).