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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
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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 other specified obsessive-compulsive and related disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). DSM-5 classifies trichotillomania (hair-pulling disorder) and excoriation (skin-picking) disorder as separate disorders in the chapter on obsessive-compulsive and related disorders; these behaviors are also types of body-focused repetitive 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, 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)

Treatment is similar to that for trichotillomania (hair-pulling disorder) and excoriation (skin-picking) disorder.

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.

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