China
Africa
Explore chapters and articles related to this topic
The who, what, where, when, why and how of picking, pulling and biting behaviors
Published in Stacy K. Nakell, Treatment for Body-Focused Repetitive Behaviors, 2023
From the lens of an enhanced CBT approach, Jones et al. (2018) define trichotillomania and excoriation disorders as, “body-focused repetitive behavior (BFRB) disorders categorized by compulsive removal of hair and skin, respectively. Accompanied by either distress and/or functional impairment, these disorders are often quite burdensome to the individuals afflicted and are notoriously difficult to treat” (p. 728). This definition fails to capture many of the nuances in my definition, with a very clinical focus and divorced from the underlying psychological roots. The enhanced CBT lens is focused specifically on the behaviors themselves, while my lens focuses outward on how and why a relationship has been formed with behaviors that hurt the skin. The behavior-focused lens may well be why BFRBs have proven to be notoriously difficult to treat, because they are often related to complicated psychosocial factors that can’t be fixed or solved in a few sessions.
Onychotillomania
Published in Nilton Di Chiacchio, Antonella Tosti, Therapies for Nail Disorders, 2020
While traditionally separated from other behavioral disorders of the nail unit, onychotillomania can be conceptualized as an umbrella term, with many shared and some contrasting features with other self-induced nail disorders such as habit tic deformity, onychophagia, and median nail dystrophy (Figure 18.1). Habit tic deformity is a variant of onychotillomania that results from compulsive rubbing of the thumbnail and proximal nail fold by the adjacent index finger, causing horizontal ridges and depressions (Figures 18.2 through 18.4). Other self-induced nail disorders include onychophagia (biting or chewing of the distal nail plate and nail folds) and median nail dystrophy (repeated manipulation of cuticle and nail fold resulting in a midline, longitudinal canal formation or split) (Figure 18.2). Self-inflicted nail disorders have traditionally been categorized as a subset of traumatic nail abnormalities, but occur independently of external insults.1 A novel classification scheme of onychotillomania was proposed in 2015 to encompass all self-induced nail disorders.2 Although relatively misunderstood, these disorders are thought to be associated with underlying psychological dysfunction or psychiatric disease, and may be better classified as body-focused repetitive behaviors (BFRBs).3–7
Nail tic disorders
Published in Archana Singal, Shekhar Neema, Piyush Kumar, Nail Disorders, 2019
For a better understanding of nail tic disorders, basic awareness about psycho-dermatological disorders is necessary. These are classified into the following broad categories2: Physio-psychological Disorders: In physio-psychological disorders, the dermatological manifestations are not caused by stress but appear to be precipitated by stress factor. These include disorders such as psoriasis, atopic dermatitis, acne excoriee, urticaria, hyperhidrosis, and seborrheic dermatitis.2Primary Psychiatric Disorders: In primary psychiatric disorders, patients develop dermatological manifestations as a result of psychiatric illness. They include broad categories: disorders of dermatological beliefs, body awareness, impulse control disorders, factitious disorders, psychogenic pruritus, cutaneous phobias, and atypical pain disorders. Among these, a few nail tic disorders such as onychotillomania fall into the group of impulse control disorders.3Body-focused repetitive behaviors (BFRBs) is another entity recognized under the Diagnostic and Statistical Manual 5th edition (DSM-5) and is defined as motoric acts that become habitual and cause functional impairment.4 These nervous habits become problematic when they interfere with the person’s everyday functioning. When these BFRBs cross this line, then they are classified as impulse control disorders.5 Nail tic disorders such as onychophagia are included in this category as “Other Unspecified Obsessive-Compulsive and Related Disorders.”4 On the other hand, according to the International Classification of Diseases and Health Related Problems – 11th Revision (ICD-11), these are classified under emotional and behavioral problems.6,7Secondary Psycho-cutaneous Disorders: In secondary psycho-cutaneous disorders, patients have psychiatric symptoms as a result of the skin disease. These include alopecia areata, vitiligo, chronic eczema, ichthyosiform syndromes, severe acne, rhinophyma, neurofibroma, and albinism.2
Body-focused repetitive behaviors in youth with mental health conditions: A preliminary study on their prevalence and clinical correlates
Published in International Journal of Mental Health, 2021
Valérie La Buissonnière-Ariza, Jeffrey Alvaro, Mark Cavitt, Brittany M. Rudy, Sandra L. Cepeda, Sophie C. Schneider, Elizabeth McIngvale, Wayne K. Goodman, Eric A. Storch
Body-focused repetitive behaviors (BFRBs) are recurrent behaviors that target one or more body regions (McGuire et al., 2012). Among the most commonly investigated BFRBs are nail biting, skin picking, and hair pulling. Although at times considered as benign “nervous habits” (McGuire et al., 2012), it is now acknowledged that BFRBs can be associated with negative outcomes including medical and esthetical problems and a range of socio-emotional difficulties (Franklin et al., 2008; Ghanizadeh, 2011; Odlaug et al., 2010).
Wide range of age of onset and low referral rates to psychiatry in a large cohort of acne excoriée at a Swiss tertiary hospital
Published in Journal of Dermatological Treatment, 2018
Florian Anzengruber, Katrin Ruhwinkel, Adhideb Ghosh, Richard Klaghofer, Undine E. Lang, Alexander A. Navarini
The lifetime prevalence is estimated to be around 1–7.7% (5–11). Even though one study claims acne excoriée de jeunes filles is gender-neutral (12), the majority of reports have demonstrated an increased female-to-male ratio of approximately 8:1 (5,6,13,14). Mostly younger people in their twenties or thirties are affected (9). Patients with SPD are known to suffer from a decreased quality of life compared to healthy people (15), but no correlation with the intensity of disease was found. SPD, a body-focused repetitive behavior (BFRB), functions as a regulator of emotions. It has been shown that the majority of patients suffered from negative affective states as being bored, depressed or anxious before the manipulation. After manipulation, nonetheless, these emotions tended to decline and guilt arose (6,16). Pathological occupational or social functioning can be the root of BFRBs (17–19). While the ICD-10 and the forth diagnostic and statistical manual of mental disorders (DSM-5) characterized SPD as an impulse control disorder, the latest DSM-V edition places SPD in the group of the obsessive–compulsive and related disorders and establishes the diagnostic criteria for SPD (Table 1) (20). However, if the treatment of SPD should focus either on impulse control regulation e.g. in the context of a personality disorder with self-mutilating behavior or if an isolated treatment of obsessive compulsive behavior might be more useful depends on the underlying psychiatric disorder and comorbidity in the context of SPD. Indeed in psychiatric practice, a symptom or a set of symptoms is best explained, classified and treated when a well-identified mental disorder is diagnosed, i.e. the diagnosis and treatment should than be related to the main psychiatric disorder. Moreover, possibly underlying and comorbid psychiatric disorders, i.e. personality disorders with other self-destructive behaviors (21) or other obsessive compulsive disorders and behaviors or factitious disorder has to be clarified to understand the SPD behavior in the context of a psychiatric condition. Self-mutilations occur in a broad range of psychiatric disorders, e.g. in schizophrenia, Prader Willi or Lesch Nyhan syndrome, mental retardation, tic-disorders or autistic spectrum disorders (22). In particular, SPD is classified in the new DSM-5 as an individual disorder, which includes ‘skin picking’ within the spectrum of obsessive–compulsive disorders (OCD), however, this does not belong to the same diagnostic class when it is based on impulsive behavior or a behavior in the context of other psychiatric disorders, e.g. borderline personality disorder or factitious disorder (22).