BFRBs like nail biting, hair pulling, and skin picking are common co-morbid diagnoses with ADHD.
Trichotillomania involves compulsive hair pulling with consequences like bald spots and social isolation.
Dermatillomania entails compulsively removing skin imperfections leading to scarring and isolation, especially in acne-prone individuals.
Nail biting, a prevalent BFRB, can lead to sore nails, cuts, and negative social perceptions, impacting dexterity.
Deep dives
Body Focus Repetitive Behaviors: Symptoms and Impact
Body focus repetitive behaviors (BFRBs) like nail biting, hair pulling, cheek biting, and skin picking are common yet rarely discussed co-morbid diagnoses related to ADHD. These behaviors, often chronic and providing pleasure or pain, are compulsive actions despite individuals' wishes to stop. Examples include trichotillomania (hair pulling), dermatillomania (skin picking), nail biting, and knuckle cracking. The impact includes physical damage, feelings of pleasure and pain, and the compulsive nature of the behaviors.
Trichotillomania: Hair Pulling Behavior
Trichotillomania involves impulsively or compulsively pulling hair, usually triggered by the desire to remove unwarranted hairs for various reasons. Individuals may engage in manual manipulation before and after pulling, resulting in consequences like bald spots and social isolation.
Dermatillomania: Skin Picking Behavior
Dermatillomania, akin to trichotillomania, entails identifying and removing skin imperfections compulsively, often triggered by mirror checking and sensory experiences. It may involve tools and result in scarring, blood loss, and social isolation, particularly affecting those with acne.
Nail Biting Behavior
Nail biting, a prevalent BFRB, can be chronic, impacting dexterity and oral health. The behavior may involve biting nails, chewing them, and inspecting the nail post-biting. Consequences include sore nails, cuts, abrasions, and potential negative social perceptions.
ADHD and BFRBs: Intersection and Implications
The relationship between ADHD and BFRBs highlights poor impulse control, hyperfocus, and stress relief as contributing factors. Individuals with ADHD often seek stimulation and grounding through BFRBs, leading to potential reinforcing effects and challenges in treatment, where habit reversal training, mindfulness, and cognitive-behavioral therapy play vital roles.
Seeking Help for BFRBs
Seeking specialized help for BFRBs may involve contacting organizations like the TLC Foundation or the International OCD Foundation for resources and treatment providers. While family physicians may lack specific knowledge, finding specialists in BFRBs or related areas is crucial for tailored and effective interventions. Genetic predispositions and environmental factors play a role in BFRBs, necessitating comprehensive assessment and treatment approaches.
Parental Guidance and Support for BFRBs
Parents observing BFRBs in children should adopt a non-judgmental and understanding approach, exploring the behavior's soothing aspects and suggesting alternative coping mechanisms. Encouraging open dialogue, addressing shame, and acknowledging the genetic and psychological aspects of BFRBs can support children's well-being and treatment journeys.
Treatment Approaches for BFRBs
Effective treatment for BFRBs involves habit reversal training, competing response strategies, cognitive-behavioral therapy, and dialectical behavior therapy. Genetic influences, sensory rewards, and underpinning disorders like OCD and ADHD necessitate tailored interventions, often with a multidisciplinary approach and consideration of individual needs.
Body-focused repetitive behavior (BFRB) is a common (but rarely discussed) comorbid diagnosis related to ADHD. Roberto Olivardia, Ph.D., talks about how to recognize BFRB, the physical and emotional consequences, and recommended treatments.
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