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Body-Focused Repetitive Behaviours (BFRBs). Risk Factors, Prevention, Treatment

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (22 March 2023) | Viewed by 20324

Special Issue Editors


E-Mail Website
Guest Editor
Institute of Psychology, Jagiellonian University, ul. Ingardena 6, 30-060 Krakow, Poland
Interests: early risk states of psychopathology; psychotic spectrum disorders; body focused repetitive disorders

E-Mail Website
Guest Editor
Institute of Psychology, Jagiellonian University, ul. Ingardena 6, 30-060 Krakow, Poland
Interests: early risk states of psychopathology; body focused repetitive behaviours; behavioral addictions

Special Issue Information

Dear Colleagues,

The term body-focused repetitive behaviors (BFRBs) refers to a group of recurrent and problematic behaviors directed toward the body. Although studies on BFRBs had been limited in comparison to research on other psychiatric conditions, the number of studies in this field is recently growing systematically. This current interest in BFRBs is related to the new approach to BFRB classification as obsessive-compulsive and related disorders, as well as to the introduction of excoriation (skin picking) disorder into the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) as a separate diagnostic category.

These recent changes in classification not only organize the so far poorly systematized knowledge about BFRB disorders, but also open up new research directions within the contexts of obsessive-compulsive and related disorders.

The increase of studies on BFRBs is also related to results of recent epidemiological studies showing that BFRBs are more widespread than previously thought.

While extremely severe BFRBs do not occur more often in the population than other mental disorders, the mild, non-clinical forms of BFRBs are relatively common in the general population. Notwithstanding, although they affect a large part of the population, they are rarely effectively treated. Considering BFRB symptoms as harmless habits, feeling of shame and unwillingness to report these behaviours by affected individuals, ignoring symptoms by physicians or physicians' reluctance to refer patients reporting BFRBs to mental health specialists - all of these limit the possibility of getting help.

This issue of IJERPH focuses on research and experiences related to BFRBs, such as trichotillomania, skin picking, onychophagia, cheek and lip biting, nail picking, scab picking/eating, knuckle cracking, and teeth grinding. This may include a description of risk factors (including biological, psychological, environmental), prevalence, mechanisms, subjective experiences of sufferers, assessment tools and treatment options.

We invite all specialists in the fields of medicine, psychology, pedagogy, public health and epidemiology to submit high quality empirical papers or systematic reviews related to the issues in this research area.

Dr. Katarzyna Prochwicz
Dr. Joanna Kłosowska
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Body Focused Repetitive Behaviours (BFRBs)
  • BFRBs risk factors
  • BFRBs course and symptoms
  • Subjective experiences
  • Treatment
  • Prevention
  • Comorbidity
  • Quality of life

Published Papers (4 papers)

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Research

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13 pages, 360 KiB  
Article
Assessing Excoriation (Skin-Picking) Disorder: Clinical Recommendations and Preliminary Examination of a Comprehensive Interview
by Ivar Snorrason and Han-Joo Lee
Int. J. Environ. Res. Public Health 2022, 19(11), 6717; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19116717 - 31 May 2022
Cited by 3 | Viewed by 2005
Abstract
Excoriation (skin-picking) disorder (SPD) is a psychiatric condition with variable clinical presentation. We developed the Diagnostic Interview for Skin Picking Problems (DISP), a semi-structured interview designed to assess (1) DSM-5 criteria for SPD and (2) several clinical features of SPD, including the frequency [...] Read more.
Excoriation (skin-picking) disorder (SPD) is a psychiatric condition with variable clinical presentation. We developed the Diagnostic Interview for Skin Picking Problems (DISP), a semi-structured interview designed to assess (1) DSM-5 criteria for SPD and (2) several clinical features of SPD, including the frequency and duration of picking episodes, and the proportion of time devoted to picking at different body areas. The DISP was administered along with other measures to 120 college students (88% women, average age = 22 years) with suspected skin picking problems (based on their responses to a screening survey). The results showed that the DISP had good inter-rater reliability, test–retest reliability over 1–5 months, and convergent/divergent validity. We also found that participants displayed divergent clinical characteristics depending on the pattern of frequency, duration, and body location of picking episodes (e.g., those who primarily picked at the fingers had a unique clinical presentation). Overall, the findings provide preliminary support for the psychometric properties and clinical utility of DISP. The results also underscore the importance of accurately assessing frequency, duration, and body location of picking episodes. Full article
12 pages, 1121 KiB  
Article
Validation and Psychometric Properties of the Polish Version of the Skin Picking Scale-Revised
by Joanna Kłosowska, Katarzyna Prochwicz, Dominika Sznajder, Rachela Antosz-Rekucka, Aleksandra Tuleja, Aleksandra Dembińska and Ivar Snorrason
Int. J. Environ. Res. Public Health 2022, 19(5), 2578; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19052578 - 23 Feb 2022
Cited by 2 | Viewed by 1905
Abstract
The Skin Picking Scale-Revised (SPS-R) is an 8-item self-report measure of skin picking behaviors. It includes two subscales related to skin picking symptom severity and picking-related impairments. The study aimed to assess the psychometric properties of the Polish version of the SPS-R in [...] Read more.
The Skin Picking Scale-Revised (SPS-R) is an 8-item self-report measure of skin picking behaviors. It includes two subscales related to skin picking symptom severity and picking-related impairments. The study aimed to assess the psychometric properties of the Polish version of the SPS-R in a sample of adults reporting skin picking. The sample of 764 participants was recruited from the general population through an online survey. Among them, 159 meet the criteria of pathological skin picking applied in the original SPS-R validation study, and 57 endorsed all of the DSM-5 criteria for excoriation disorder. The SPS-R was back-translated into Polish. Factor structure, reliability, convergent and divergent validity, and diagnostic accuracy were assessed. Confirmatory factor analyses revealed a two-factor structure of the scale. High internal consistency and convergent and divergent validity were confirmed for the total score as well as for the subscales. High prognostic ability of the SPS-R total score was also demonstrated using ROC analysis: ≥5 was accepted as an optimal cut-off point for distinguishing skin picking sufferers from healthy controls. The Polish version of the SPS-R shows good psychometric properties and appears to be a reliable measure of skin picking symptoms and picking-related impairment. Full article
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Review

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15 pages, 500 KiB  
Review
The Potential of N-Acetylcysteine for Treatment of Trichotillomania, Excoriation Disorder, Onychophagia, and Onychotillomania: An Updated Literature Review
by Debra K. Lee and Shari R. Lipner
Int. J. Environ. Res. Public Health 2022, 19(11), 6370; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19116370 - 24 May 2022
Cited by 11 | Viewed by 6310
Abstract
Background: Trichotillomania (TTM), excoriation disorder, onychophagia, and onychotillomania are categorized as body focused repetitive behavior (BFRB) disorders, causing damage to the skin, hair, and/or nails with clinically significant psychosocial consequences. Currently, there are no standardized treatments for these compulsive, self-induced disorders. Studies on [...] Read more.
Background: Trichotillomania (TTM), excoriation disorder, onychophagia, and onychotillomania are categorized as body focused repetitive behavior (BFRB) disorders, causing damage to the skin, hair, and/or nails with clinically significant psychosocial consequences. Currently, there are no standardized treatments for these compulsive, self-induced disorders. Studies on treatment of these disorders using psychotropic drugs (i.e., selective serotonin reuptake inhibitors, tricyclic antidepressants, anticonvulsants) have shown variable efficacy. Recently, there is a growing interest in N-acetylcysteine (NAC) for treating BFRBs. NAC is a glutamate modulator that has shown promise in successfully reducing the compulsive behaviors in BFRB disorders. This article provides an updated review of the literature on the use of NAC in TTM, excoriation disorder, onychophagia, and onychotillomania. Methods: Relevant articles were searched in the PubMed/MEDLINE database. Results: Twenty-four clinical trials, retrospective cohort studies, and case reports assessing the efficacy of NAC in TTM, excoriation disorder, and onychophagia were included. No studies for onychotillomania were found in our search. Conclusions: Although NAC has proven successful for treatment of BFRB disorders, data is derived from few clinical trials and case reports assessing small numbers of patients. Larger studies with longer durations are needed to fully establish the efficacy of NAC in these disorders. Full article
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17 pages, 973 KiB  
Review
Update on Diagnosis and Management of Onychophagia and Onychotillomania
by Debra K. Lee and Shari R. Lipner
Int. J. Environ. Res. Public Health 2022, 19(6), 3392; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19063392 - 13 Mar 2022
Cited by 8 | Viewed by 8988
Abstract
Onychophagia (nail biting) and onychotillomania (nail picking) are chronic nail conditions categorized as body-focused repetitive behavior (BFRB) disorders. Due to a limited awareness of their clinical presentations, embarrassment on the part of patients, and/or comorbid psychiatric conditions, these conditions are frequently underrecognized and [...] Read more.
Onychophagia (nail biting) and onychotillomania (nail picking) are chronic nail conditions categorized as body-focused repetitive behavior (BFRB) disorders. Due to a limited awareness of their clinical presentations, embarrassment on the part of patients, and/or comorbid psychiatric conditions, these conditions are frequently underrecognized and misdiagnosed. This article reviews the prevalence, etiology, diagnostic criteria, historical and physical exam findings, and treatment options for these conditions. The PubMed/MEDLINE database was searched for relevant articles. Onychophagia and onychotillomania are complex disorders necessitating a detailed patient history and physical examination and a multidisciplinary treatment approach for successful diagnosis and management. Due to the dearth of clinical trials for treatment of nail biting and nail picking, large clinical trials are necessary to establish standardized therapies. Full article
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