Body-focused repetitive behaviors (BFRBs) have recently gained attention in the psychiatric literature given their prevalence, considerable associated impairment (Bohne, Wilhelm, Keuthen, Baer, & Jenike, 2002;Teng, Woods, Twohig, & Marcks, 2002), and possible link to other obsessive-compulsive spectrum disorders (Bienvenu et al., 2000;Hollander, 1993;Hollander & Wong, 1995;Jaisoorya, Reddy, & Srinath, 2003). ''Nervous habits'' such as nailbiting, hair pulling, and skin picking are often seen by healthcare practitioners as common and benign, but awareness of the impairment linked to these behaviors is limited (Arnold, Auchenbach, & McElroy, 2001;Bohne, Keuthen, & Wilhelm, 2005). Due to the variance in criteria defining the BFRBs and under-reporting of symptoms, prevalence rates have been difficult to determine. At least one BFRB was reported by 13.7% of 105 college students, nailbiting being the most common (Teng et al., 2002). While suspected to regulate negative affective states (Christenson, Ristvedt, & Mackenzie, 1993;Diefenbach, Mouton-Odum, & Stanley, 2002;Keuthen et al., 2000), BFRBs often directly result in significant distress and impaired social or occupational functioning as a result of their wounds or attempts to conceal them (Christenson, Mackenzie, & Mitchell, 1991;Flessner & Woods, 2006;O'Sullivan et al., 1997;Wilhelm et al., 1999). Further, many people report that their BFRB causes such shame and embarrassment that they withdraw from social activities (Keuthen et al., 2000;Stemberger, Thomas, Mansueto, & Carter, 2000;Wilhelm et al., 1999;Woods, Fuqua, & Outman, 1999). Together, BFRBs have been unofficially grouped under the obsessive-compulsive spectrum (Arnold et al., 1998;Hollander, 1993;Hollander & Wong, 1995;Stein et al., 1995), which includes conditions associated with OCD on one anchor point to behaviors characteristic of impulse-control disorders (ICDs), such as pathological gambling.Of the BFRBs discussed, trichotillomania is the only condition given distinct classification in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-R; American Psychiatric Association, 2000). Trichotillomania, affecting an estimated 1-3% of the general population, is listed as an ICD and characterized by repetitive hair pulling which results in noticeable hair loss most commonly from the scalp, eyebrows, and eyelashes (Christenson et al., 1991). The behavior can result in serious physical consequences. For example, irreversible damage to hair roots due to repetitive pulling can cause permanent baldness, and the chewing and eating of pulled hair can lead to dental complications and gastrointestinal blockage (O'Sullivan et al., 1997). Like other disorders marked by impulsivity, individuals with trichotillomania typically experience an increase in Body-focused repetitive behaviors such as skin picking have gained recent attention in the psychiatric literature. Prevalence of skin picking has not been well researched and is difficult to estimate; however, consequences of such behaviors can include seve...

CTO placement may have helped patients with a greater need for treatment to experience shorter hospital stays. Whether the CTO directly enabled the fulfillment of unsought but required treatment needs that protected patient health and safety is a question that needs to be addressed in future research.

Objective Mental health peer-run organizations are nonprofits providing venues for support and advocacy among people diagnosed as having mental disorders. It has been proposed that consumer involvement is essential to their operations. This study reported organizational characteristics of peer-run organizations nationwide and how these organizations differ by degree of consumer control. Methods Data were from the 2012 National Survey of Peer-Run Organizations. The analyses described the characteristics of the organizations (N = 380) on five domains of nonprofit research, comparing results for organizations grouped by degree of involvement by consumers in the board of directors. Results Peer-run organizations provided a range of supports and educational and advocacy activities and varied in their capacity and resources. Some variation was explained by the degree of consumer control. Conclusions These organizations seemed to be operating consistently with evidence on peer-run models. The reach of peer-run organizations, and the need for in-depth research, continues to grow.

Mental health system involvement and CTO supervision appeared to facilitate access to physical health care in acute care settings for patients with severe mental illness, a group that has, in the past, been subject to excess morbidity and mortality.

Mental health consumers/survivors developed consumer-run services (CRSs) as alternatives to disempowering professionally run services that limited participant self-determination. The objective of the CRS is to promote recovery outcomes, not to cure or prevent mental illness. Recovery outcomes pave the way to a satisfying life as defined by the individual consumer despite repetitive episodes of disorder. Recovery is a way of life, which through empowerment, hope, self-efficacy, minimisation of self-stigma, and improved social integration, may offer a path to functional improvement that may lead to a better way to manage distress and minimise the impact of illness episodes. ‘Nothing about us without us’ is the defining objective of the process activity that defines self-help. It is the giving of agency to participants. Without such process there is a real question as to whether an organisation is a legitimate CRS or simply a non-governmental organisation run by a person who claims lived experience. In considering the effectiveness of CRSs, fidelity should be defined by the extent to which the organisation's process conveys agency. Unidirectional helping often does for people what they can do for themselves, stealing agency. The consequence of the lack of fidelity in CRSs to the origins of the self-help movement has been a general finding in multisite studies of no or little difference in outcomes attributable to the consumer service. This, from the perspective of the research summarised herein, results in the mixing of programmatic efforts, some of which enhance outcomes as they are true mutual assistance programmes and some of which degrade outcomes as they are unidirectional, hierarchical, staff-directed helping efforts making false claims to providing agency. The later CRS interventions may provoke disappointment and additional failure. The indiscriminate combining of studies produces the average: no effect.