Is there an underlying factor common to BFRBs?

According to diagnostic categories, compulsive skin picking is considered to be on the spectrum of obsessive-compulsive disorders, yet it is not OCD. Sometimes, it co-occurs with OCD or other body-focused repetitive behaviors such as compulsive hair pulling, and researchers sought to determine whether the body-focused repetitive behaviors were one disorder. Secondarily, if body-focused repetitive behaviors were separate disorders, the researchers wanted to know if there was an underlying factor they all had in common to determine whether these behaviors could be predicted.

Over 2,700 participants agreed to answer questions in an online survey regarding their grooming habits. Of those, 36% intentionally pulled hair, 85% bit their nails, and 44% picked at their skin. Not only were their self-grooming habits evaluated, but the survey also assessed self-control, impulsive behavior, impatience, the presence of mental health and personality disorders, as well as contingent self-esteem which is self-esteem derived from outside sources.     

The researchers found that differentiating the type of body-focused repetitive behavior is useful. Second, each of the behaviors related positively to impulsivity, psychiatric distress, and low self-esteem. What does this mean? Well, previous research suggests self-directed behavior can indicate stress and anxiety in primates, and this study supports the notion that humans do it too. People with high levels of impulsivity demonstrated more body-focused behaviors than those with high levels of psychiatric distress, but the research did not establish a cause and effect relationship.

Essentially, this study confirmed other research but in a community sample. The participants in this study stated they intentionally pulled hair, bit nails, or picked skin, but the survey did not differentiate those who do so compulsively. That difference indicates that even people without diagnoses who engage in body-focused repetitive behaviors have trouble with impulsivity, psychiatric distress, and self-esteem.

While this research does not add much new information to the knowledge base about skin picking disorder, it does highlight the role of impulsivity, psychiatric distress, and self-esteem. Even though scientists still do not fully understand the cause of the disorder or have a definitive evidence-based treatment, this kind of research shows that interventions targeting impulsivity, distress, and self-esteem may help people with excoriation disorder manage behaviors better.