Question
Which BFRBs can be diagnosed using distinct DSM criteria, and how are others classified?
Answer
Only trichotillomania (hair-pulling disorder) and excoriation disorder (skin-picking disorder) have distinct diagnostic criteria in the DSM. Other body-focused repetitive behaviors (BFRBs), such as nail-biting or cheek-biting, need to be coded under "Other Specified Obsessive-Compulsive and Related Disorders."
BFRBs have been documented in medical literature long before their formal recognition. For instance, cases of skin-picking and hair-pulling were documented as early as 1920 and the late 1800s, respectively.
The 2013 DSM reclassification of trichotillomania and excoriation disorder under OCD and related disorders was based on research that also influenced the ICD-11 in 2018. This reclassification was supported by findings such as familial links to OCD, neurocircuitry anomalies, and similar treatment responses.
This Ask the Expert is an edited excerpt from the course, Introduction to Body-Focused Repetitive Behaviors, presented by Mandy Simmons, PsyD
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