Evidence-Based Psychosocial Treatments for Pediatric Body-Focused Repetitive Behavior Disorders

Abstract

Habits, such as hair pulling and thumb sucking, have recently been grouped into a category of clinical conditions called body-focused repetitive behavior disorders (BFRBDs). These behaviors are common in children and, at extreme levels, can cause physical and psychological damage. This article reviews the evidence base for psychosocial treatment of pediatric BFRBDs. A review of academic databases and published reviews revealed 60 studies on psychosocial treatments for pediatric BFRBDs, 23 of which were deemed suitable for review. Based on stringent methodological and evidence base criteria, we provided recommendations for each specific BFRBD. Individual behavior therapy proved probably efficacious for thumb sucking, possibly efficacious for several conditions, and experimental for nail biting. Individual and multicomponent cognitive-behavioral therapy was named experimental for trichotillomania and nail biting, respectively. No treatment met criteria for well-established status in the treatment of any BFRBD. Recommendations for clinicians are discussed. Reasons for the limitations of existing research in children and adolescents are explored. Several recommendations are presented for future pediatric treatment research on BFRBDs.

Abnormal perceptual sensitivity in body-focused repetitive behaviors

“…Cognitive-behavior therapy has the highest level of empirical support for BFRBs [4,5]. Although effect sizes are high for such treatments [4,71], complete remission is infrequent [6,72] and long-term relapse is common [ [73], [74], [75], [76], [77]]. This may not be surprising in light of the current findings.…”

“…Despite involving different areas of the body, BFRBs are thought to share functional similarities and may represent different behavioral manifestations of a single latent obsessive-compulsive related disorder. Indeed, BFRBs have similar symptom presentations, phenomenology, age of onset, and courses; co-occur at a high rate [2,3]; and respond to similar treatments [ [4], [5], [6]].…”

The Impact of a Cognitive–Behavioral Therapy on Event-Related Potentials in Patients with Tic Disorders or Body-Focused Repetitive Behaviors

“…Another good reason to characterize TD and BFRB is mainly related to their response to treatment. Currently, cognitive–behavioral therapy (CBT) constitutes an effective line of treatment for adults with both TD ( 19 , 20 ) and BFRB ( 21 – 24 ), but the cognitive–behavioral and physiological outcomes are not well understood. The therapy proposed by our group is based on the cognitive–psychophysiological (CoPs) model and aims at regulating the high level of sensorimotor activation present in these populations and preventing the build-up of tension that leads to tic bursts or to the compulsive habit related to BFRB ( 12 , 25 , 26 ).…”

Oral Myofunctional and Articulation Disorders in Children with Malocclusions: A Systematic Review

“…In a caudal resting tongue position, the tongue is directed to the lower anterior teeth rather than being sucked up to the palate [2,3]. Lastly, biting habits, which can be defined as biting on the nails, lips, or objects [7], and has been considered behavior similar to sucking habits [8], will be considered. A causal relationship between these OMD and malocclusions, a group of developmental disorders that result in an irregular position of the teeth or an abnormal relationship of the dental arches [9][10][11], is theorized in the literature.…”