Diagnosing Body-Focused Repetitive Behaviors

The Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5, American Psychiatric Association, 2013) defines body-focused repetitive behavior disorder as follows:

This is characterized by recurrent body-focused repetitive behaviors (e.g., nail biting, lip biting, cheek chewing) and repeated attempts to decrease or stop the behaviors. These symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning and are not better explained by trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder, stereotypic movement disorder, or nonsuicidal self-injury.

The most common type of BFRBs are defined as follows:

Excoriation (Skin-Picking) Disorder

  1. Recurrent skin picking resulting in skin lesions.
  2. Repeated attempts to decrease or stop skin picking.
  3. The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  4. The skin picking is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., scabies).
  5. The skin picking is not better explained by symptoms of another mental disorder (e.g., delusions or tactile hallucinations in a psychotic disorder, attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder, stereotypies in stereotypic movement disorder, or intention to harm oneself in nonsuicidal self-injury).

 

Trichotillomania (Hair-Pulling) Disorder:

  1. Recurrent pulling out of one’s hair, resulting in hair loss.
  2. Repeated attempts to decrease or stop hair pulling.
  3. The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  4. The hair pulling or hair loss is not attributable to another medical condition (e.g., a dermatological condition).
  5. The hair pulling is not better explained by the symptoms of another mental disorder (e.g., attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder).