Study Reveals Somatic and Habitual Predisposing Factors Topographically-Related to Body-Focused Repetitive Behaviors

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Body-focused repetitive behaviors (BFRBs) such as dermatillomania and trichotillomania are characterized by an urge to picking, pull, or bite the skin, nails, and hair. Various factors contribute to the development of BFRBs, including parental care patterns, family history, genetic predisposition, and sensory abnormalities.¹

A recent study published in The Journal of the European Academy of Dermatology and Venereology delved into premorbid somatic and habitual factors that might act as risk and maintenance factors in BFRBs.²

BFRBs often lead to distress and a diminished quality of life, with skin picking even associated with increased suicidality. Despite this, individuals with BFRBs often exhibit ambivalence toward their habits, reporting feelings of gratification and reward while engaging in these behaviors.³

The study aimed to explore the ambivalence toward BFRBs and investigate whether certain preferences, preoccupations, or habits precede the onset of these behaviors, especially in topographically related areas.

The study began with an online survey involving 201 participants with BFRBs who participated in a 2-year follow-up assessment of a treatment trial. Participants were asked about their experiences with BFRBs, which were rated on a Likert scale to gauge ambivalence toward these behaviors. Additionally, a new scale was developed to assess somatic and habitual predispositions toward BFRBs.

The majority of participants were female, with skin picking and nail biting being the most prevalent BFRBs. Most participants reported more than one BFRB, and females were especially likely to be attributed to skin picking and trichotillomania cases. Ambivalence toward repetitive habits was common among participants, suggesting a nuanced relationship with these behaviors.

"Most individuals reported premorbid somatic factors, preoccupations, habits, or preferences related to their body, which were topographically related to their BFRBs (e.g., dislike of their skin in skin picking, dislike of their nails and brittle nails in nail biting, playing with their hair in trichotillomania, a tendency to scarring in lip-cheek biting)," study authors wrote. "These factors may worsen under certain conditions (e.g., stress) and lead to a BFRB. Of note, trichotillomania showed the weakest association with a somatic disposition."

Potential study limitations included potential biases inherent in self-reporting and the recruitment of a help-seeking sample, which may not be fully representative of the broader population. Additionally, no formal diagnoses were determined, and the study relied on self-reported assessments.

"Our study highlights the role of premorbid somatic and habitual dispositions that may act as predisposing factors to BFRBs," according to Moritz et al. "Future studies should adopt a longitudinal design to examine the causal role of these factors in a prospective fashion and investigate whether early treatment of habitual or somatic risk factors may mitigate or prevent the exacerbation of BFRBs."

References

1. Redden SA, Leppink EW, Grant JE. Body focused repetitive behavior disorders: significance of family history. Compr Psychiatry. 2016; 66: 187–192. Accessed March 21, 2024. https://doi.org/10.1016/j.comppsych.2016.02.00
2. Moritz S, Penney D, Hoyer L, Schmotz S. Risk and maintenance factors in body-focused repetitive behaviours. J Eur Acad Dermatol Venereol. March 15, 2024. Accessed March 21, 2024. https://doi.org/10.1002/jvc2.405
3. Odlaug BL, Grant JE. Pathologic skin picking. Am J Drug Alcohol Abuse. 2010; 36(5): 296–303. Accessed March 21, 2024. https://doi.org/10.3109/00952991003747543