Feature: Body Focused Repetitive Behaviours

Wednesday, July 5, 2017

In each issue of Strides, we highlight one anxiety-related condition. In this issue, we will feature Body Focused Repetitive Behaviours – what it is and what you can do.

What is Body-Focussed Repetitive Behaviors?

Body-Focused Repetitive Behaviours, or BFRBs, are a cluster of habitual behaviours that include hair pulling, skin picking, nail biting, nose picking, and lip or cheek biting. Currently, the most recent edition of the clinician’s diagnostic manual (DSM-5), lists both hair pulling, called Trichotillomania, and skin picking, called Skin Excoriation, as BFRBs that are of clinical concern.

What are the primary features that define hair pulling, or Trichotillomania (TTM):

  • Ongoing and repetitive pulling out of one’s hair resulting in noticeable hair loss. The most common sites are the head and face (i.e., eye brows and lashes), although individuals also pull from other areas such as the arms and legs, the pubic region, under the arm, as well as on other individuals and even from pets, such as cats and dogs. Children are less likely than adults to pull from multiple sites, often favoring a single location.
  • Repeated but unsuccessful attempts to reduce or stop the pulling.
  • Significant impairment or disruption in routine life functioning.

 What are the primary features of Skin Excoriation (SE):

  •  Ongoing and repetitive picking of one’s skin that may or may not be triggered by a visible scab or other mark (e.g., bug bite or pimple), which due to the force of picking, creates or worsens a skin lesion. The most common sites are the face, arms, and hands, although other body parts can also be a target, such as the legs and pubic areas where ingrown hairs may be more frequent.
  • Repeated but unsuccessful attempts to reduce or stop picking.
  • Significant impairment or disruption in routine life functioning, such as social isolation and/or problems with academic or job success, permanent scaring, low self-esteem, financial strain, and more.

 What are some facts about Trichotillomania and Skin Excoriation?

  • TTM occurs in 1-3% of individuals during their lifetime, and 1.5% in SE, with the average age of onset in early adolescence in both disorders.
  • Women are affected more than men with a 8:1 ratio in TTM and 3:1 in SE
  • A range of physical effects can occur in individuals with TTM including formation of Trichobezoars, hairballs, in the gastrointestinal tract that sometimes will require surgery, atypical regrowth of hair, dental damage, carpal tunnel syndrome, among other conditions.
  • A range of physical effects can occur in individuals with SE including tissue damage, scaring and infection, with surgery required in extreme cases.

For the facts and self-help strategies on Body-Focused Repetitive Behaviours, visit the section on our website - https://www.anxietycanada.com/adults/body-focused-repetitive-behaviours