Body-Focused Repetitive Behaviors: Trichotillomania, Dermatillomania, and Onychophagia

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In the realm of mental health, there are various conditions that affect individuals differently. Body-focused repetitive behaviors (BFRBs) are a group of disorders characterized by the repetitive and compulsive engagement in self-directed actions that cause physical damage to one’s body. Three common BFRBs are Trichotillomania, Dermatillomania, and Onychophagia. This article aims to provide a comprehensive understanding of these conditions and their impact on individuals’ lives.

Trichotillomania: The Hair-Pulling Disorder

Trichotillomania is an impulse control disorder that involves recurrent pulling out of one’s hair, leading to noticeable hair loss. It can affect any area of the body where hair grows, but most commonly involves the scalp, eyebrows, and eyelashes. People with trichotillomania experience an irresistible urge to pull their hair, often as a way to cope with stress, anxiety, or boredom.

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Symptoms and Consequences

Trichotillomania is typically accompanied by a sense of tension or anxiety before pulling the hair and a feeling of relief or gratification afterward. However, this relief is often followed by guilt, shame, or embarrassment due to the noticeable hair loss. Constant hair pulling can result in significant distress, social withdrawal, and impairment in daily functioning.

Treatment Options

Treatment for trichotillomania usually involves a multidisciplinary approach, including therapy and medication. Cognitive-behavioral therapy (CBT) is commonly used to help individuals identify and modify the thoughts and behaviors associated with hair pulling. Medications such as selective serotonin reuptake inhibitors (SSRIs) may be prescribed to reduce the urges and symptoms associated with trichotillomania.

Dermatillomania: The Skin-Picking Disorder

Dermatillomania, also known as excoriation disorder, refers to the compulsive picking or scratching of the skin, leading to tissue damage. Individuals with dermatillomania often engage in repetitive skin picking, causing lesions, scabs, or scars. The urge to pick is driven by various emotional factors such as anxiety, stress, or a desire for smooth skin.

Symptoms and Consequences

The symptoms of dermatillomania include persistent skin picking, unsuccessful attempts to stop, and significant distress or impairment caused by the behavior. Skin picking can result in infections, tissue damage, and disfigurement. Individuals may experience difficulties in interpersonal relationships and suffer from low self-esteem and emotional distress due to the visible skin lesions.

Treatment Options

Like trichotillomania, dermatillomania can be treated with a combination of therapy and medication. Cognitive-behavioral therapy (CBT) is often used to address the underlying psychological factors associated with skin picking and to develop coping mechanisms. Antidepressants or other medications may be prescribed to manage any co-occurring conditions such as anxiety or depression.

Onychophagia: The Nail-Biting Habit

Onychophagia, commonly known as nail-biting, is a repetitive behavior characterized by biting, chewing, or picking at the nails. This behavior can extend to the cuticles and surrounding skin as well. Nail-biting is often a subconscious habit that individuals engage in during periods of stress, anxiety, boredom, or as a response to certain triggers.

Symptoms and Consequences

Onychophagia can lead to various physical and psychological consequences. Persistent nail-biting can cause damage to the nail bed, infections, and dental problems if the habit involves biting the nails with the teeth. Socially, individuals with onychophagia may experience embarrassment or shame due to the appearance of their nails, and it may also affect their self-confidence.

Treatment Options

Treatment for onychophagia primarily focuses on behavior modification techniques. Habit reversal training and cognitive-behavioral therapy (CBT) can help individuals become more aware of their nail-biting triggers and develop alternative coping mechanisms. In some cases, bitter-tasting nail polishes or other deterrents may be used to discourage nail-biting behavior.


Body-focused repetitive behaviors such as trichotillomania, dermatillomania, and onychophagia can significantly impact individuals’ lives, affecting their emotional well-being, social interactions, and daily functioning. Understanding these conditions and seeking appropriate treatment is crucial for individuals struggling with BFRBs.

If you or someone you know is experiencing symptoms related to these disorders, it is important to consult with a qualified healthcare professional. They can provide a proper diagnosis and develop an individualized treatment plan to address the specific needs of each person. With proper support and intervention, individuals with BFRBs can lead fulfilling lives and manage their symptoms effectively.

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