Body Focused Repetitive Disorders (Trichotillomania, Excoriation)

Question 1

What is Trichotillomania?

Answer 1

Hair pulling disorder

Question 2

What is the Diagnostic criteria for Trichotillomania?

Answer 2

A. Recurrent pulling out of one’s hair, resulting hair loss
B. Repeated attempts to decrease or stop pulling hair
C. The hiar pulling causes clinically signifant distress or impairment in social, occupational or other important areas of functioning
D. the hair pulling or hair loss is not attributable to another medical condition
E. The hair pulling is not better explained by the symptoms of another mental disorder

Question 3

What is the main difference between OCD and Body focused repetitive disorders?

Answer 3

• Less about obsessions and more about repetitive behaviour

- - Alleviating boredom or distress, not in response to an obsession

Question 4

What is the diagnostic criteria for excoriation disorder?

Answer 4

A. Recurrent Skin picking resulting in skin lesions
B. Repeated attempts to decrease or stop skin picking
C. The skin picking cause clinically significant impairment or distress
D. The skin picking is not attributable to the physiological effects of a substance or another medical condition
E. The skin picking is not better explained by symptoms of another mntal disorder (e.g., delusions or tactile hallucinations

Question 5

What is Excoriation Disorder?

Answer 5

Skin picking

Question 6

What is the etiology of body-focused repetitive disorders from a genetic/biological perspective?

Answer 6

• Genetics: trichotillomania and excoriation were found to be influenced by the same genetic factor, which was different than OCD, hoarding disorder, and BDD
• Excess cortical thickness in areas related to inhibitory control has been implicated in trichotillomania

Question 7

What is the possible biological etiology of excoriation vs. Trichotillomania?

Answer 7

• Excoriation - ↑ volume of the ventral striatum bilaterally, compared to patients with trichotillomania. ? Possible involvement of the reward system with skin picking disorder.
• Trichotillomania - ↓ thickness of the right parahippocampal gyrus ? Possible link to dissociative symptoms

Question 8

What is the emotional regulation model?

Answer 8

• Emotion regulation model states that hair-pulling and skin-picking behaviours are triggered by negative emotions.
• Hair-pulling and skin-picking behaviours serve to decrease the negative emotions, which in turn makes it more likely that the individual will engage in these behaviours (i.e., it is negatively reinforcing).

Question 9

What is the frustrated action model?

Answer 9

• Hair-pulling and skin-picking behaviours are triggered by frustration and boredom.
• Engaging in the behaviours alleviates these states, and so, similar to the emotion regulation model, the individual is more likely to engage in these behaviours.

Question 10

What is the therapy for Body focused repetitive behaviours?

Answer 10

Habit reversal training and other psychological treatments

• Habit reversal is the behavioral treatment most often used for body-focused repetitive behaviour disorders and other impulse control disorders, although it has since been simplified and is often combined with cognitive techniques
• One focus of habit reversal is awareness training,
• Involves the identification of triggers or high risk situations that often lead a person with one or both of these conditions to engage in hair-pulling and/or skin-picking.