Body-focused repetitive behavior disorder is characterized by body-focused repetitive behaviors other than skin picking (excoriation) or hair pulling (trichotillomania) (eg, nail biting, lip biting, cheek chewing) and attempts to stop the behaviors.
Body-focused repetitive behavior disorder is an example of an "other specified obsessive-compulsive and related disorder" in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR). This is in contrast to trichotillomania (hair-pulling disorder) and excoriation (skin-picking) disorder, also body-focused repetitive behaviors, which are classified as separate disorders.
Symptoms and Signs of Body-Focused Repetitive Behavior Disorder
Patients with this disorder repeatedly engage in repetitive 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. Other behaviors can cause bleeding.
Diagnosis of Body-Focused Repetitive Behavior Disorder
Psychiatric assessment
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR) describes body-focused repetitive behavior disorder as follows (1):
Body-focused repetitive behaviors other than hair pulling or skin picking
Repeated attempts to reduce or stop the behaviors
Significant distress or significant impairment in functioning because of the behaviors
Diagnosis reference
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed, Text Revision. American Psychiatric Association Publishing; 2022:293-294.
Treatment of Body-Focused Repetitive Behavior Disorder
Cognitive-behavioral therapy (specifically, habit reversal training)
Behavioral therapy, specifically habit reversal training, may be effective in treating body-focused repetitive behavior disorder (1).
High-quality studies have not examined pharmacotherapy for body-focused repetitive behavior disorders other than trichotillomania and excoriation disorder, but a similar approach may be considered, potentially including N-acetylcysteine, memantine, selective serotonin reuptake inhibitors (-acetylcysteine, memantine, selective serotonin reuptake inhibitors (SSRIs), and clomipramine (), and clomipramine (2).
Treatment reference
1. Moritz S, Penney D, Bruhns A, Weidinger S, Schmotz S. Habit Reversal Training and Variants of Decoupling for Use in Body-Focused Repetitive Behaviors. A Randomized Controlled Trial. Cognit Ther Res. 2023;47(1):109-122. doi:10.1007/s10608-022-10334-9
2. Lee MT, Mpavaenda DN, Fineberg NA. Habit Reversal Therapy in Obsessive Compulsive Related Disorders: A Systematic Review of the Evidence and CONSORT Evaluation of Randomized Controlled Trials. Front Behav Neurosci. 2019;13:79. Published 2019 Apr 24. doi:10.3389/fnbeh.2019.00079
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 do it less often, but they cannot.
Treat with cognitive-behavioral therapy (usually habit reversal training) and sometimes medications, including N-acetylcysteine, SSRIs, or clomipramine.-acetylcysteine, SSRIs, or clomipramine.
Drugs Mentioned In This Article
