Body focused repetitive disorders (trichotillomania & excoriation) - Body-focused repetitive disorders is an umbrella term in the DSM-5 or Diagnostic and Statistical Manual, the 5th edition, for disorders where individuals compulsively damage their physical appearance. In fact, these used to be classified as impulse-control disorders, but now belong in the family of obsessive-compulsive disorders. Two of the well known ones are trichotillomania which is a hair pulling disorder and excoriation which is a skin-picking disorder. Obsessive-compulsive disorders are usually defined by psychological obsessions which are thoughts, urges, and images, that are unwanted, intrusive, and recurrent. as well as behavioral compulsions like repetitive behaviors that are in response to the obsessions. For body focused repetitive disorders, though, the self-damaging behavior is typically not related to a conscious psychological obsession, but instead it happens when a person feels stressed, anxious, or even bored. And once a person starts the self-damaging behavior, there is usually a strong urge to keep doing it over and over again. This can happen in multiple short episodes throughout the day, or during single long sessions that can last hours at a time. People with body focused repetitive disorders aren't always fully aware of their behavior while they are doing it, and this makes it difficult to stop the behavior. Also, these behaviors are distinct from behaviors to improve physical appearance like plucking the eyebrows, and are not attributable to other underlying causes like substance abuse, for example, skin picking which is a side effect of amphetamine or cocaine use. Also behaviors from other mental disorders, for example skin picking as a result of a tactile hallucination, which could be like seeing or thinking there are bugs under your skin, also behaviors from other medical conditions, for example scratching at the skin due to a scabies infection, or finally as a side effect of a medication. Trichotillomania is one type of body focused repetitive disorder where people feel an irresistible urge to pull out their hair, resulting in hair loss, which comes as no surprise. Now here he name defines the condition. "Trich" derives from the greek word for hair, "tillo" is related to the greek phrase "to pull" and "mania" refers to frenzy. This hair pulling can happen in any part of the body, but the most common sites are the scalp, the eyebrows, and the eyelids. Because the hair pulling sites can vary slightly each time, trichotillomania is not always as visible as you might this it is. Having said that, the most common area for hair pulling is the scalp, especially the hair around the crown of the head, which can result in a very distinctive pattern of hair loss referred to as a "friar tuck" appearance. People with trichotillomania generally feel embarrassed by their behavior, and often make repeated attempts to stop or hide it. Sometimes this hair pulling can be associated with specific ritual behaviors like only pulling out hairs in a specific way, like with with tweezers or with the root still intact. Regardless of how it's done, as the behavior continues, it can lead to permanent damage of the underlying skin and future hair growth. Excoriation disorder is another type of body focused repetitive disorder, which used to go by the name "dermatillomania." "Derma" referring to the greek word for skin, and the same greek roots that relate to the term "to pull" and "frenzy", so these people feel an irresistible urge to pick at their skin, often resulting in skin lesions, most commonly on the face, the hands, and the arms. Some people pick at healthy skin, whereas others pick at minor skin irregularities such as damaged nail cuticles, pimples, dry skin, and often scabs from previous picking. Picking is generally done with the fingernails, although some individuals even use their teeth or tweezers. These behaviors often lead to embarrassment and like trichotillomania people often try to stop the behavior or do it privately. Unfortunately, chronic damage to the skin can cause scarring and infection. Now there are a number of other body-focused repetitive behavior disorders that are less common, like trichophagia and dermatophagia, which is where people compulsively eat their hair and skin, respectively. Often these disorders happen alongside trichotillomania and excoriation, where people eat the hair or skin that they pull and pick. Dermatophagia might involve picking or biting the inside of the mouth, the cheeks, and the lips, which can lead to sores in the mouth and and an increased risk of infection. Often dermatophagia appears along with onychophagia, which is chronic nail biting, where people bite their nails and the skin around their fingers, as well as onychotillomania, nail picking, which can lead to bleeding and scarring. The common features shared among all of these disorders is that the symptoms cause significant distress and impairment in social functioning, and that people often make numerous unsuccessful attempts to stop the behavior. Typically, these behaviors start around puberty, and can be associated with conditions that often develop around that time as well, like acne. Body focused repetitive disorders are chronic conditions, although people can sometimes go into remission for months or even years. That said, there are treatment options available, for example medications like tricyclic antidepressants and selective serotonin reuptake inhibitors, have both been useful in reducing these behaviors, and those medications are most successful when they are paired with some sort of therapy, like habit-reversal therapy and cognitive behavioral therapy. In both these cases, people are trained to identify and differentially react to the impulse that leads to the repetitive behavior. Alright, as a quick recap, body focused repetitive disorders are part of the family of obsessive compulsive disorders, and are where people compulsively damage their physical appearance, two of the most common ones are trichotillomania or hair pulling, and excoriation or skin picking. 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