Body-focused repetitive behavior

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Body-focused repetitive behavior
Video explanation
Classification and external resources
ICD-10 Xxx.x
ICD-9-CM xxx

Body-focused repetitive behavior (BFRB) is an umbrella name for impulse control[1] behaviors involving compulsively damaging one's physical appearance or causing physical injury.[2]

Body-focused repetitive behavior disorders (BFRBDs) in ICD-11 is in development.[3]

BFRB disorders are not generally considered obsessive-compulsive disorders.[4]

The main BFRB disorders are:[4]


Dermatillomania of the knuckles (via mouth) illustrating disfiguration of the distal and proximal joints of the middle and little fingers.

The cause of BFRBs is unknown.

Emotional variables may have a differential impact on the expression of BFRBs.[5]

Research has suggested that the urge to repetitive self-injury is similar to a body-focused repetitive behavior but others have argued that for some the condition is more akin to a substance abuse disorder.

Researchers are investigating a possible genetic component.[1][6]


BFRBs most often begin in late childhood or in the early teens.[2]


BFRBs are among the most poorly understood, misdiagnosed, and undertreated groups of disorders.[7] BFRBs may affect at least 1 out of 20 people.[2] Trichotillomania alone is believed to affect 10 million people in the United States.[8]



Treatment can include behavior modification therapy, medication, and family therapy.[1][2] The evidence base criteria for BFRBs is strict and methodical.[9] Individual behavioral therapy has been shown as a "probably effective" evidence-based therapy to help with thumb sucking, and possibly nail biting.[9] Cognitive behavioral therapy was cited as experimental evidence based therapy to treat trichotillomania and nail biting.[9] Another form of treatment that focuses on mindfulness, stimuli and rewards has proven effective in some people. However, no treatment was deemed well-established to treat any form of BFRBs.[9]


Excoriation disorder, and trichotillomania have been treated with inositol and N-acetylcysteine.[10]

See also[edit]


  1. ^ a b c Scientific Advances in Trichotillomania and Related Body-Focused Repetitive Behaviors Archived July 21, 2011, at the Wayback Machine., November 4, 2004, National Institute of Mental Health
  2. ^ a b c d e AAMFT Consumer Update - Hair Pulling, Skin Picking and Biting: Body-Focused Repetitive Disorders, American Association for Marriage and Family Therapy
  3. ^
  4. ^ a b Trichotillomania (TTM) & Related Body-Focused Repetitive Behaviors (BFRBs), The Center for Emotional Health of Greater Philadelphia
  5. ^ Teng; et al. (2004), "Body-Focused Repetitive Behaviors: The Proximal and Distal Effects of Affective Variables on Behavioral Expression", Journal of Psychopathology and Behavioral Assessment, 26: 55–64, doi:10.1023/B:JOBA.0000007456.24198.e4 
  6. ^ ABC News 20/20 Hair Pulling, 2006
  7. ^ Families & Health Archived March 28, 2009, at the Wayback Machine., American Association for Marriage and Family Therapy
  8. ^ Diefenbach GJ, Reitman D, Williamson DA (2000). "Trichotillomania: A challenge to research and practice". Clinical Psychology Review. 20 (3): 289–309. PMID 10779896. doi:10.1016/S0272-7358(98)00083-X. 
  9. ^ a b c d Woods, Douglas W.; Houghton, David C. (13 July 2015). "Evidence-Based Psychosocial Treatments for Pediatric Body-Focused Repetitive Behavior Disorders". Journal of Clinical Child & Adolescent Psychology. 45: 1–14. doi:10.1080/15374416.2015.1055860. 
  10. ^ Torales J, Barrios I, Villalba J. "Alternative Therapies for Excoriation (Skin Picking) Disorder: A Brief Update". Adv Mind Body Med. 31: 10–13. PMID 28183072. 

External links[edit]