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Last Updated on : 15th Feb, 2016
 
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Body-focused Repetitive Disorders in Youth

“Body-focused repetitive behaviors (BFRBs) are habits directed at one’s own body. When such behaviors occur at a high frequency or intensity, they can produce physical and or psychosocial problems. If BFRBs result in impairment, they can be considered BFRB disorders (BFRBDs). BFRBDs are currently classified under various diagnostic labels in the Obsessive-Compulsive and Related Disorders category of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2013). Examples include chronic hair pulling (trichotillomania [TTM]), skin picking (excoriation disorder), nail biting (onychophagia), cheek biting, and thumb sucking...In most cases, BFRBs are common, harmless habits....As opposed to the occasional and benign BFRBs present in many individuals, BFRBDs can lead to substantial physical and medical consequences. TTM can lead to scarring and hair loss, and for the minority...who ingest pulled hairs, masses of undigested hair (known as trichobezoars) can form and lead to significant medical complications such as bowel obstruction, intestinal bleeding, acute pancreatitis, obstructive jaundice, or a perforated bowel. Other BFRBDs can result in repetitive strain injuries, dental malocclu- sions, permanent scarring, infections, and excessive bleeding.”
Woods and Houghton, (in press, Journal of Clinical Child & Adolescent Psychology)
                    
Fortunately, there is some evidence to support the use of individual behavior therapy for trichotillomania and thumb sucking and emerging though still tentative evidence to support its use for excoriation, cheek biting, and nail biting. CBT has also demonstrated some early evidence for trichotillomania and nail biting. More details are available in the table.    

Treatments for Habit Disorders in Youth

Levels Trichotillomania Excoriation Nail Biting Cheek Biting Thumb Sucking
Level 1: Well Established
  • None
  • None
  • None
  • None
  • None
Level 2: Probably Efficacious
  • None
  • None
  • None
  • None
  • Individual Behavior Therapy
Level 3: Possibly Efficacious
  • Individual Behavior Therapy
  • None
  • None
  • None
  • None
Level 4: Experimental
  • Individual CBT
  • Individual Behavior Therapy
  • Individual Behavior Therapy
  • Multicomponent CBT
  • Individual Behavior Therapy
  • None
Level 5: Questionable efficacy
  • Individual Massed Negative Practice
  • None
  • None
  • None
  • None

Note: CBT = Cognitive Behavioral Therapy

Source: Woods, D. W., & Houghton, D. C. (2016). Evidence-Based Psychosocial Treatments for Pediatric Body-Focused Repetitive Behavior Disorders. Journal of Clinical Child & Adolescent Psychology, http://doi.org/10.1080/15374416.2015.1055860

 
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