Repetitive Behaviors

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Providing exceptional treatment for repetitive behaviors.

Trichotillomania is relatively common (.5%) and usually first noticed in late childhood/puberty and involves hair twirling and pulling/plucking that results in noticeable hair loss. “Trich”, considered an Obsessive Compulsive Related Disorder, often happens when the sufferer is stressed or bored, and frequently results in considerable shame/embarrassment for the individual.

Excoriation is a skin-picking disorder that is relatively common occurring in 2-5% of the population and involves picking at skin tags, pimples, cuticles, bug bites, and scabs often resulting in bleeding. Like Trich, skin-picking occurs predominantly in females.

Onychophagia or nail-biting involves habitual biting and tearing of finger nails to the point of bleeding and soreness. Nail-biting is very common, affecting 20-30% of the population, and typically appears in school-aged children.

Treatment

Cognitive Behavioral Therapy (CBT)

There is little research regarding effective treatments for Body-Focused Repetitive Behaviors, and Cognitive Behavioral Therapies (CBT) are considered the front-line treatment.

CBTs include:

  • Habit reversal training (HRT)
  • Comprehensive behavioral treatment (ComB)
  • Acceptance and commitment therapy (ACT)
  • Dialectical behavior therapy (DBT)

CBT that is more comprehensive and focuses on building more adaptive coping mechanisms has been shown to be more effective than those that focus solely on reducing the behavior.

No one medication has been shown to be effective for treating hair-pulling or skin-picking, and often medications are prescribed for co-occurring psychiatric conditions. For hair pulling and skin-picking, an over the counter amino acid (N-acetylcysteine or NAC for short) has shown some promise.

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Co-Occurring Disorders

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