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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 Jun 2021| Content last modified Jun 2021
Click here for the Professional Version

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 engage in nail biting or lip biting, and such behaviors may relieve this feeling.

  • Doctors diagnose the disorder when people pick at or bite parts of their body enough to cause damage, 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 classified as an obsessive-compulsive and related 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. They are classified as separate disorders in DSM-5, but as subheadings of body-focused repetitive behavior disorder in ICD-11.

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 engage in these behaviors 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 have a sense of gratification. 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 diagnose body-focused repetitive behavior disorder based on symptoms:

  • Picking at or otherwise manipulating a body part, sometimes resulting in bodily 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. The most highly recommended type of cognitive-behavioral therapy 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

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