Body-focused repetitive behaviors in youth with mental health conditions: A preliminary study on their prevalence and clinical correlates

Abstract

Body-focused repetitive behaviors (BFRBs) are recurrent behaviors targeting one or more body regions that may associate with negative outcomes. Little is known on their prevalence and correlates in psychiatric populations. This study examined the preliminary prevalence and correlates of BFRBs in 67 youth aged 9–17 years with primary anxiety-related disorders, mood disorders, or attention deficit and hyperactivity disorder (ADHD), using the Repetitive Body-focused Behavior Scale (RBBS), the Clinical Global Impressions scale, and the Behavior Assessment System for Children—2nd Edition, Behavioral & Emotional Screening System (BASC-2-BESS). Nearly half of the youth and parents reported significant child BFRBs on the RBBS. Additionally, 15% of the youth and 4.5% of the parents reported significant child distress/impairment related to BFRBs. A primary diagnosis of ADHD associated with greater parent-reported BFRB rates, number, and severity. An increased proportion of girls vs. boys presented with child-reported BFRBs and associated distress/impairment. The presence of BFRBs across the sample was associated with increased internalizing and externalizing symptom severity as measured with the BASC-2-BESS. In addition, internalizing and externalizing symptom severity positively correlated with BFRB severity. Our results suggest youth with psychiatric conditions, especially ADHD, who present with elevated symptom severity, may be particularly at-risk for concomitant BFRBs.

Keywords:

• Hair pulling
• skin picking
• nail biting
• children
• adolescents

Acknowledgments

The authors thank each family who participated. The authors also acknowledge the contributions of Dr. Adam Lewin, Brittney Dane, Morgan King, Amanda Collier, Nicole McBride, Teresa Goff, and Zachary Tidler. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Disclosure statement

Dr. Storch is a consultant for Levo Therapeutics. He has received royalties from Elsevier Publications, Springer Publications, American Psychological Association, Wiley, Inc, Kingsley, Oxford University Press, and Lawrence Erlbaum. Dr. Goodman discloses consultations to Biohaven Pharmaceuticals and Neurocrine Bioscience. No other potential conflicts of interest are reported.

Data availability

Data will be made available on demand.

Additional information

Funding

Dr. La Buissonniere-Ariza has received a postdoctoral research scholarship from the Canadian Institutes of Health Research. Dr. Schneider has received funding from the American Red Cross, and the Texas Higher Education Coordinating Board. Dr. Storch has received research funding from National Institute of Health, Red Cross, ReBuild TX, TX Higher Education Coordinating Board, Houston Community Foundation, and All Children's Hospital Research Foundation.