Merck Manual

Please confirm that you are a health care professional

honeypot link

Body-Focused Repetitive Behavior Disorder

By

Katharine A. Phillips

, MD, Weill Cornell Medical College;


Dan J. Stein

, MD, PhD, University of Cape Town

Last full review/revision Jan 2021| Content last modified Jan 2021
Click here for 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.

Symptoms and Signs

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. People with body-focused repetitive behavior disorder typically try to stop their behavior or to do it less often, but they are unable to do so.

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

Diagnosis

  • Clinical criteria

To meet diagnostic criteria for DSM-5 body-focused repetitive behavior disorder, 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 in functioning from the behaviors

Treatment

  • N-Acetylcysteine

  • Selective serotonin reuptake inhibitors (SSRIs) or clomipramine

  • Cognitive-behavioral therapy (usually habit reversal training)

Treatment of body-focused repetitive behavior disorder includes drugs (eg, N-acetylcysteine, SSRIs Selective Serotonin Reuptake Inhibitors (SSRIs) Several drug classes and drugs can be used to treat depression: Selective serotonin reuptake inhibitors (SSRIs) Serotonin modulators (5-HT2 blockers) Serotonin-norepinephrine reuptake inhibitors... read more , or clomipramine) and cognitive-behavioral therapy (most often habit reversal training), although data are very limited. Habit reversal training, a predominantly behavioral therapy, includes the following:

  • Awareness training (eg, self-monitoring, identification of triggers for the behavior)

  • Stimulus control (modifying situations—eg, avoiding triggers—to reduce the likelihood of initiating the body-focused behavior)

  • Competing response training (teaching patients to substitute other behaviors, such as clenching their fist, knitting, or sitting on their hands, for the body-focused behavior)

Key Points

  • Body-focused repetitive behavior disorder involves repeatedly engaging in body-focused behavior such as nail biting, lip biting, and cheek chewing.

  • These body-focused 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 behaviors, often followed by a feeling of gratification.

  • Patients with this disorder typically try to stop their behavior or to do it less often, but they cannot.

  • Treat using N-acetylcysteine or an SSRI or clomipramine and/or cognitive-behavioral therapy that includes habit reversal training.

Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
Professionals also read
Test your knowledge
Acute Stress Disorder
Acute stress disorder is a period of intrusive recollections that occurs after witnessing or experiencing a traumatic event. The characteristics of this disorder differ from those of posttraumatic stress disorder in which of the following ways?
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
 

Also of Interest

 
TOP