Clinical Aspects of Hair Pulling, Skin Picking, and Nail Biting

Opinion StatementBody-focused repetitive behaviors (BFRBs) include conditions such as hair pulling, skin picking, nail biting, lip or cheek chewing/biting, thumb or finger sucking, and nose picking. Hair pulling, skin picking, and nail biting have received the most attention in the empirical literature. BFRBs are believed to reduce emotional states such as anxiety, tension, or boredom, through negative reinforcement (e.g., [1]), or to satisfy a need for sensory stimulation, through positive reinforcement (e.g., [2]). For individuals with these disorders who have impaired functioning from these behaviors, cognitive behavioral therapy (CBT) and pharmacotherapy are to be considered. The results for CBT interventions are generally favorable, whereas pharmacology interventions have shown mixed results. Habit reversal training (HRT) in particular, and interventions that have been used to enhance HRT, including acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and the comprehensive behavioral model (ComB), appear to show the most promise for BFRBs, especially for individuals who use these behaviors to control unwanted thoughts, urges, and emotions. Research on predictors of maintenance of treatment gains in hair pulling suggests that abstinence from pulling is an important factor in maintaining gains and preventing relapse. Thus, it is recommended that therapists continue treatment with patients until they are abstinent from hair pulling, which may general...
Source: Current Treatment Options in Psychiatry - Category: Psychiatry Source Type: research