Same but different? Phenomenological differences among various types of body-focused repetitive behaviors

BACKGROUND: Body-focused repetitive behaviors (BFRBs) are highly prevalent conditions at the border of psychiatry and dermatology. Using a newly developed scale, the Generic BFRB scale (GBS-36), we aimed to compare 4 prominent BFRBs in terms of phenomenology, age at onset, and other illness-related aspects.

METHODS: A sample of 391 individuals with different forms of BFRBs completed the GBS-36, the Patient Health Questionnaire-9 (depression), and the World Health Organization Quality of Life-BREF global item (quality of life).

RESULTS: Most individuals showed multiple BFRBs (73.9%). Skin picking and nail biting were reported most frequently (nail biting: 68.3%; skin picking: 60.9%; trichotillomania: 52.4%; lip-cheek biting: 31.7%). Nail biting was most common in childhood; the other BFRBs began mainly in adolescence. Both trichotillomania and skin picking were associated with the greatest impairment and urge to perform the behavior. The 2 conditions also showed a higher association with obsessive-compulsive disorder. Overall symptom severity was correlated with earlier age of onset, number of concurrent BFRBs, and severity of depression as well as suicidality.

CONCLUSIONS: BFRBs are a heterogeneous group of conditions, with trichotillomania and skin picking showing the largest similarities. Whether the observed differences reflect specific etiological factors awaits further testing.