Body Focused Repetitive Behavior Disorders: Behavioral Models and Neurobiological Mechanisms

2023 34(1): 50-59
DOI: 10.5080/u26213
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Objective: Body Focused Repetitive Behaviors (BFRB) is an umbrella
term for undesirable, repetitive motor activities such as Trichotillomania
(TTM), Skin Picking Disorder (SPD), nail biting, cheek chewing,
lip biting, finger sucking, finger cracking and teeth grinding. Such
behaviors are engaged in to eliminate a part of the body and may result
in impaired functionality.
The frequency of presentation to clinicians is low since BFRB are defined
as harmless, although the number of studies on this condition has
increased rapidly recently, including those making a clear determination
of epidemiological data, those investigating the etiopathogenesis and
those providing treatment guidelines, although they remain inadequate.
The present study provides a review of studies investigating the etiology
of BFRB to date.
Method: Articles published between 1992 and 2021 stored in the
Pubmed, Medline, Scopus and Web of Science databases were reviewed,
and the prominent research studies of the condition identified were
included in the evaluation.
Results: Studies investigating the etiopathogenesis of BFRB were found
in most cases to investigate adult populations, and were hampered
by such confounding factors as clinical heterogeneity, high rates of
comorbid psychiatric diseases and small sample sizes. The identified
studies reveal that attempts have been made to explain BFRB based
on behavioral models, and that the condition is inherited at a high
rate. Treatment planning is mostly associated with monoamine systems
(especially glutamate and dopamine) and interventions were directed
to addiction elements. Furthermore, cognitive flexibility and motor
inhibition defects in neurocognitive area and cortico-striato-thalamocortical
cycle abnormalities in neuroimaging studies have been reported.
Conclusion: Studies investigating the clinical features, incidence,
etiopathogenesis and treatment of BFRB, which holds a controversial
place in psychiatric classification systems, would contribute to a better
understanding of the disease and a more appropriate definition of the
Keywords: Body focused repetitive behavior disorders, trichotillomania,
skin picking disorder, behavior models, neurobiology, neuroimaging