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Body-Focused Repetitive Behavioral Disorder

by Katharine A. Phillips, MD, Dan J. Stein, MD, PhD

In body-focused repetitive behavior disorder, people repeatedly engage in activities such as nail biting, lip biting, or cheek chewing and repeatedly try to stop the activities.

Body-focused repetitive behavior disorder is one of the obsessive-compulsive and related disorders (see Obsessive-Compulsive Disorder (OCD)). People with the disorder compulsively pick, pull, or tug at one or more parts of their body. They may bite their nails or lips, chew their cheeks, or pick at their nails.

Some patients do these activities somewhat automatically—without thinking about it. Others are more conscious of the activity.

People do not do these activities because they are obsessed with or concerned about their appearance. However, they may feel tense or anxious just before they do them, and doing them may relieve that feeling. Afterward, they often feel gratified. People may also be distressed by their loss of control and repeatedly try to stop the activity.

If people bite or pick at their nails a lot, the nails may become deformed. Grooves and ridges may develop in the nails, or blood may collect under the nail, producing a purple-black spot.

Diagnosis

Doctors diagnosis this disorder based on symptoms:

  • Picking at or otherwise manipulating a body part, sometimes resulting in damage

  • Repeatedly trying to stop the activity

  • Feeling greatly distressed or being less able to function because of the activity

Treatment

Treatment may include drugs, such as antidepressants, and cognitive-behavioral therapy.

Cognitive-behavioral therapy that specifically focuses on this disorder may lessen symptoms. An example is habit reversal therapy. For this therapy, people are taught to become more aware of what they are doing and to identify situations that trigger the activity. They are also taught strategies to help them stop themselves from doing the activity—for example, by substituting a different activity for it.