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Body-Focused Repetitive Behavioral Disorder

By

Katharine A. Phillips

, MD, Weill Cornell Medical College;


Dan J. Stein

, MD, PhD, University of Cape Town

Last full review/revision Sep 2018| Content last modified Sep 2018
Click here for the Professional Version
NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
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In body-focused repetitive behavior disorder, people repeatedly engage in activities that involve their body, such as nail biting, lip biting, or cheek chewing, and repeatedly try to stop the activities.

  • People with body-focused repetitive behavior disorder may feel tense or anxious just before they do it, and picking at or biting parts of their body may relieve that feeling.

  • Doctors diagnose the disorder when people pick at or bite parts of their body enough to damage it, try to stop their behavior and cannot, and are significantly distressed by their behavior or function less well because of it.

  • Cognitive-behavioral therapy that specifically focuses on body-focused repetitive behavior disorder and certain antidepressants or N-acetylcysteine may help lessen symptoms.

Body-focused repetitive behavior disorder is similar to obsessive-compulsive disorder. People with body-focused repetitive behavior 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.

Hair pulling and skin picking are also body-focused repetitive behaviors but are classified as separate disorders.

Symptoms

Some people with body-focused repetitive behavior disorder 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 (as occurs in body dysmorphic disorder). 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 or do it less often, but they cannot.

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

  • A doctor's evaluation, based on specific diagnostic criteria

Doctors diagnosis body-focused repetitive behavior disorder based on symptoms:

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

  • Repeatedly trying to reduce or stop the activity

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

Treatment

  • Drugs

  • Cognitive-behavioral therapy

Treatment of body-focused repetitive behavior disorder may include drugs, such as selective serotonin reuptake inhibitor antidepressants and N-acetylcysteine, 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 do the following:

  • Become more aware of what they are doing

  • Identify situations that trigger the activity

  • Use strategies to help them stop themselves from doing the activity—for example, by substituting a different activity (such as clenching their fist, knitting, or sitting on their hands) for it

Drugs Mentioned In This Article

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