Objective: Interest on body-focused repetitive behaviors (BFRB) such as hair pulling and skin picking has been increasing recently. DSM-5 classifies Trichotillomania and Skin Picking disorder among Obsessive Compulsive and Related Disorders. Onychophagia, on the other hand is not listed separately within DSM-5. The prevalence of pathological skin picking may vary between 0.2-5.4% while that of trichotillomania may be 0.5-3.5%. The prevalence of onychophagia is not known. As far as we are aware, there is no study conducted on body-focused repetitive behaviors in our country. In this study, it was aimed to investigate the prevalence of body-focused body-focused repetitive behaviors in a clinical sample evaluated at a tertiary Child and Adolescent Psychiatry outpatient department, determine treatments chosen and to clarify the changes in behaviors and functionality during 2 months.
Methods: The study was conducted at the outpatient department in between March and June 2013. Patients who were between 9-17 years old at the time of application, who complained for onychophagia, skin picking, trichotillomania, obsessions/ compulsions and who did not have Body Dysmorphic Disorder, Psychotic Disorders or Mental Retardation were enrolled in the study. The complaints should not have started after a drug or substance use for enrollment. Mental Retardation was ruled out with WISC-R while comorbidities were evaluated with interviews according to DSM-IV-TR. Clinical Global Impressions, Childhood Global Assessment Scale, Children's Depression Inventory, Screen for Anxiety and Related Disorders and Maudsley Obsessive-Compulsive Checklist were used for evaluations. Treatment choices were naturalistic after baseline evaluations and involved Habit Reversal, SSRIs, Antipsychotics and their combinations. Follow-up visits were conducted on the 4th and 8th weeks. Evaluations at follow-up visits also involved CGI, CDI, SCARED and MOCCL.
Results: Sixty seven patients (56.9% male) with a mean age of 12.5 years (S.D. 2.3) were enrolled in the study. Mean duration of body-focused behaviors was 44.7 months (S.D. 23.0). The prevalence of body-focused behaviors in the sample was 3.8% while prevalences for Trichotillomania and Skin Picking Disorder as defined by DSM-5 were 0.6% and 1.2%, respectively. 30.9% of the patients had at least 1 comorbid disorder (ADHD being most common, 30.9%). Subjective distress, dysfunction, social avoidance and change in appearance due to behavior were most commonly reported for onychophagia. The most common treatment choice in our sample was antipsychotics (50.0%) with SSRIs being the second (32.4%). 14.7% of the patients received a combination of both while 2.9% were managed with habit reversal. Patients using combinations of SSRIs and antipsychotics had significantly higher levels of anxiety (p=0.03, Mann-Whitney U test). A multivariable variance analysis for repeated measures showed that psychometric evaluations at 4th and 8th weeks did not differ in terms of treatment choices.
Conclusion: The prevalence of body-focused repetitive behaviors in our clinical sample was similar to those reported for community while differing treatments seemed not to have an effect on symptoms. Our results should be replicated with further studies.