According to Angela Hartlin's support website, Body- Focused Repetitive Behaviours (BFRB’s) “is an umbrella term for any chronic behaviour that causes a person to consistently cause physical damage to oneself unintentionally through a compulsive act in order to relieve anxiety.” BFRBs are characterised by direct body-to-body contact, and is collectively grouped among Obsessive Compulsive and Related Disorders in the Diagnostic and Statistical Manual 5 (DSM5). These behaviours can manifest in a variety of ways, with the overarching similarity between the different disorders being the regulatory effect experienced by the person engaging in this behaviour, on overwhelming emotions or cognitive thought patterns such as intense anxiety. There is very little awareness about the various BFRBs and as such it often goes undiagnosed, with sufferers feeling too ashamed to seek help for what they perceive as a ‘bad habit’. Awareness is slowly on the rise though, with compulsive hair-pulling disorder, (trichotillomania) being at the forefront of awareness raising campaigns, research, and worldwide support.
N-acetyl cysteine comes from the amino acid L-cysteine. Amino acids are the building blocks of protein, which plays an important role in almost all biological processes. N-acetylcysteine is a pharmaceutical drug and nutritional supplement that can be found at nutrition and health food stores, commonly claiming antioxidant and liver protecting effects. It has primarily been used as a mucolytic because it breaks disulfide bonds in mucous, thinning abnormally thick mucous in cystic and pulmonary fibrosis patients. It is also used in the management of paracetamol and for sulphate repletion in conditions as autism, where amino acids such as cysteine are believed to be depleted. So then how is this relevant to skin picking disorder?
Group therapy is a shared therapeutic experience which can be engaged in on its own, or as a means of additional support to supplement primary therapy. Group therapy is usually offered to people challenged by similar issues, with the objective to increase self awareness, increase social comfort, provide support, develop skills and promote positive social interaction. Participants in group sessions find discussing their problems with those who can offer genuine empathy gives them a sense of belonging and encouragement. In contrast to individual therapy, group therapy fosters the development of multiple relationships to harness the healing power the sense of belonging has on an individual.
Liz Atkin is a London-based visual artist who has been challenged by skin picking disorder for more than 20 years. She spoke to BBC radio’s Felicity Finch (interview starts at 35:15 into the recording) about her disorder and the impact her art has had on her journey to recovery. Liz grew up in an alcoholic home. She describes a childhood characterized by fear and anxiety and recalls hearing violent arguments between her parents. This may have been when the picking behaviour started to manifest itself.
Liz has discovered the healing power of expression through art, dance and theatre, which she refers to as “harnessing a creative recovery”. Through intimate artworks, photographs and performances, Liz has become an active advocate for Body-Focussed Repetitive Behaviours (BFRBs). Liz is open and outspoken about the distressing impact skin picking has had on her life. On her website, she talks about the intense guilt and shame people with skin picking feel about the harm they are causing to their bodies, and describes the secrecy and isolation that occurs from trying to hide the condition from family and friends.
Body-Focussed Repetitive Behaviours (BFRBs) such as dermatillomania (skin-picking) and trichotillomania (hair-pulling) are common disorders, but are largely undiagnosed. As a result people who have these conditions suffer alone, ashamed, and in silence. The greatest travesty of this is that the loneliness and isolation can be prevented if there was greater awareness and acceptance of these disorders. In an age of social media and the accessibility of digital technology, raising awareness and accessing support is possible and available to more people.
Join the awareness raising revolution, help make a positive change for all affected by BFRBs by getting involved in the campaign, which runs from the 1 to 7 October 2014. One way to raise awareness is to get a BFRB awareness ribbon and wear it proudly. The green and blue ribbon has been adopted to represent this community and help us to connect to each other “in the real world”.
Filmed at the Trichotillomania Learning Center Annual Conference, April 2014 Featuring Jon Grant, JD, MD, MPH Chair, TLC Scientific Advisory Board
Where are we in terms of treatment and understanding of Body-Focused Repetitive Behaviors (BFRBs, or behaviors like trichotillomania, skin picking, nail biting, etc.), where do we need to go and how will we get there? TLC Scientific Advisory Board Chair, Dr. Jon Grant provides an overview of BFRB research to date and the implications for treatment and recovery moving forward.
We took the liberty to transcribe this fascinating lecture:
"So, this is a very exciting year I think for TLC, and you probably have already seen these buttons, right, that some people are wearing that say BPM, and asked about it. So you’re gonna see more of these, and, and so, what’s happening this year is, TLC is launching a much sort of bigger, I think much more impressive research agenda for the forthcoming years.
As with any condition of the body or mind, dermatillomania does not discriminate. Celebrities are often heralded by fans as being perfect and untouchable. Yet, celebrities also experience the trials and tribulations of human emotion, and are also vulnerable to stress and anxiety. Unfortunately conditions like dermatillomania evoke feelings of shame and embarrassment in the person challenged by it, and is therefore not a condition that is publicized, especially by those in the limelight. However, in 2012, a well known singer-songwriter became one of the first celebrities to publicly admit to having dermatillomania.
One of the first and greatest hurdles to overcome to successfully be skin-pick free is to open up to someone who cares and to seek help and support. So imagine the courage it must take to stand up in from of hundreds of people, in front of a camera, and admit that you are a skin-picker.
In this video clip, a brave woman named Caroline does just that. Not only does she admit to being a skin-picker, but she also describes her skin-picking habits in detail and gives an emotional account of how skin-picking has impacted her life socially and academically. She describes the journey that so many with dermatillomania can relate to, in which the shame and guilt of her skin-picking habits drove her to engage in other destructive behaviours such as drug abuse. She describes a life spiraling out of control and failed attempts at managing her condition with therapy and support groups.
Dermatillomania or excoriation (skin picking) disorder is not a very well known condition, primarily because the behaviours that manifests in this disorder are not often shared by people who engage in them. As a skin-picker you are often riddled with shame and guilt about your behaviour, covering up the ‘evidence’ to protect your closely guarded humiliating secret. Ironically the secrecy often isolates you from those you care about and, ironically, prevents you from receiving the much needed support and help you need to overcome it.
This short film (by Rhiannon Harris) called “She’s lost control” portrays just how lonely the shame of dermatillomania can be. In the film, a young beautiful girl is shown picking at sores (most likely created by her in the first place) until they bleed. She is disturbed by her mother knocking at the bathroom door asking her why she was taking so long.
Onychophagia is a behavioral disorder characterized by compulsive nail biting. It is categorized with other disorders such as skin picking disorder (aka dermatillomania or excoriation disorder) and hair pulling disorder (trichotillomania) under the umbrella term body-focused repetitive behaviors (BFRB). These are compulsive habits that are automatic in nature and in its mildest forms are not perceived as socially unacceptable and therefore often not recognized by the individual as a clinical problem. Of the BFRBs, compulsive nail biting is the most socially accepted habits, viewed as simply a ‘nervous habit’. It is also commonly occurring in childhood with frequency tending to decrease by adulthood. However, the behaviour is known to intensify or persist through adulthood, and the severity of onychophagia can range from a very mild presentation to behaviours that are so severe that physiological complications occur.