Insights into recurrent body-focused repetitive behaviors: evidenced by New York Times commenters
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ORIGINAL PAPER
Insights into recurrent body‑focused repetitive behaviors: evidenced by New York Times commenters Claire Stewart1 · Shari R. Lipner2 Received: 19 December 2019 / Revised: 18 January 2020 / Accepted: 8 February 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract In September 2019, the New York Times (NYT) published the article “Fighting the Shame of Skin Picking,” which discussed the cosmetic, social and emotional impacts of body-focused repetitive behaviors (BFRBs). BFRBs, including excoriation disorder, trichotillomania, onychotillomania, and onychophagia, are recurring actions that damage one’s physical appearance. The aim of this study is to characterize the demographic information provided and themes raised in the 166 comments posted in response to the article. The most commonly reported condition was skin picking (38.2%), followed by trichotillomania and/ or trichophagia (30.3%), onychotillomania (24.7%), and onychophagia (23.6%). All conditions had a female predominance. Treatment of body-focused repetitive behaviors was the most common topic of discussion, followed by shame and impact on appearance. Since commenters described significant impairments to quality of life, larger randomized controlled trials on skin picking, trichotillomania, onychophagia, and onychotillomania are necessary to provide evidence-based management to patients. Keywords Body-focused repetitive behaviors · Skin picking · Trichotillomania · Onychophagia · Onychotillomania Abbreviations BFRB Body-focused repetitive behaviors CI Confidence interval NAC N-Acetylcysteine NYT The New York Times OR Odds ratio SNRI Serotonin–norepinephrine reuptake inhibitors SSRI Selective serotonin reuptake inhibitors
Introduction Body-focused repetitive behaviors (BFRBs) are chronic, recurring actions that damage one’s physical appearance or cause physical injury [1]. They include skin picking or excoriation disorder, trichotillomania or hair pulling, onychophagia or nail biting, and onychotillomania or nail picking, among others. While occasionally biting fingernails, picking
* Shari R. Lipner [email protected] 1
Weill Cornell Medical College, New York, NY, USA
Department of Dermatology, Weill Cornell Medical College, 1305 York Ave, 9th Floor, New York, NY 10021, USA
2
at the cuticles, scratching skin or twirling a piece of hair are within the range of normal behaviors, they are considered pathologic when they occur with such frequency and repetition that they cause significant distress and negatively impact quality of life. BFRBs are relatively common medical conditions. In 2002, Teng et al. found that 13.7% of undergraduate college students reported at least one BFRB, defined as a behavior that was “performed at least five times per day and caused functional impairment” [2]. More recently, Houghton et al. found that, in a sample of 4335 college students, 12.3% met criteria for a BFRB [3]. Yet despite their ubiquity, dermatologists need further education on clinical signs and symptoms a
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