Body-Focused Repetative Disorders/Body-Focused Compulsive Disorders

Ever since I was about 10 years old, I have been biting my nails and fingers. I was really self-conscious about it, but I could never seem to stop. My Dad does it too, so after a while, I just sort of came to accept it as a nervous habit. I still bite, to this day.

    Why do people have “nervous habits”? What are these habits? Why are some of these habits, albeit to a minimal degree, destructive? I’m talking about the compulsive hair-pulling disorder Trichotillomania, and the related disorder Dermatillomania (also known as CSP, or Chronic Skin Picking). Although these disorders can be painful, and although they can be the source of a great amount of embarrassment and self-consciousness, people who have them cannot seem to stop. Why?
    Trichotillomania is a hair-pulling disorder. A Google search for Trichotillomania leads me straight to the Trichotillomania Learning Center, or TLC, where I find a wealth of information. According to the site, sufferers “pull out the hair from their scalp, eyelashes, eyebrows, pubic area, underarms, beard, chest, legs or other parts of the body, resulting in noticeable bald patches.” (TLC website). For people with Trich (as it is sometimes shortened to), hair pulling can be focused on one area of the body, or can be widespread. Trichotillomania, it seems, occurs in everyone who has it slightly differently. Some people have severe cases, while others have mild cases. The symptoms, as described on the TLC website, also seem to vary from case to case. Some people feel relaxed while pulling or after pulling. Some feel a sense of gratification. Some feel a sort of relief after pulling. But one thing that seems to categorize all cases is the inability to stop (without treatment).
    The TLC website also has a section about Skin Picking. Interestingly, the term “Dermatillomania” is nowhere to be found on the site. Instead, it refers to the disorder as chronic skin picking (CSP). People who have CSP, according to the site, “repetitively touch, rub, scratch, pick at, or dig into their skin, often in an attempt to remove small irregularities or perceived imperfections. This behavior may result in skin discoloration or scarring.” Some of the symptoms are similar to Trich, in that some people with CSP feel gratification, relief, or relaxed while picking or after picking. Also like Trich, CSP varies from case to case in terms of severity, location, etc.
    Not much is known about the causes of these disorders. They are now thought of as related, and are classifies by the umbrella term Body-Focused Repetitive Behaviors (or BFRB), of which skin picking and hair pulling are only two. Other BFRBs include compulsive nail and cuticle biting (also known as Onychophagia), compulsive blemish picking, compulsive skin biting (Dermatophagia), and compulsive biting of the inside of the cheek. These disorders often begin in the early teenage years, however they may begin earlier. The common denominator here seems to be the inability to resist urges to engage in these behaviors. This is also the difference between people who engage in these on occasion (most people do), and those who have a disorder.
    Are these behaviors, some of which seem to cause physical pain, similar to things like cutting? A couple of sources I looked at said no. People who cut themselves do so with the intention of causing pain, while people with body-focused repetitive disorders do not. Is BFRD related to OCD (obsessive compulsive disorder)? Most believe that, while these are both disorders related to anxiety, they are not the same.
    So why do people engage in these behaviors? As previously stated, the exact causes are unknown. It has been expressed that a certain amount of relief, relaxation, or gratification is gained from these behaviors. However, sufferers also often feel badly after engaging in them. Despite this, they cannot resist the urge to continue to pick, pull, or bite the next time. In my research, I found a number of possible factors as to why people have body-focused repetitive disorders. One very prevalent explanation is that it is related to anxiety or stress. Indeed, some report an increase in their repetitive behavior when they are anxious or stressed. Another is genetics, as body-focused repetitive behaviors can run in families. A third explanation I came across is some sort of traumatic experience. A fourth is brain chemistry. My inclination is to believe that it is not just one of these causes, but perhaps many of them; that they are related in some way.
    Anxiety in itself may be diagnosed as a disorder, called generalized anxiety disorder (or GAD). It is characterized by excessive worrying. Interestingly, the potential causes cited for anxiety bore resemblance to the potential causes for body-focused repetitive disorders. The potential causes for GAD are genetics, outside factors (such as a traumatic experience), and brain chemistry. It is interesting that anxiety, which may be a cause of body-focused repetitive disorder, has its roots in the same causes.
    From what I have read, and from my own experiences, I believe that brain chemistry, heredity, anxiety, and outside factors, like trauma, all play a role in causing these disorders. I think that brain chemistry can be inherited. This means that anxiety can be inherited, and it is my belief that body-focused repetitive behaviors is an expression of anxiety. For people who began experiencing symptoms after a traumatic experience, I might guess that the traumatic experience would alter their brain chemistry somewhat, inciting anxiety and then BFRD. But I also believe that these two “paths” if you will are two extremes. As in my last paper, funnily enough, I shall argue that a combination of internal and external factors cause BFRDs. While I think the two “paths” I mentioned are likely enough, I think that people who are genetically inclined to have anxiety and a BFRD are also affected by outside factors that may set off anxiety or make them stressed out, and that people who began after an outside experience may also have been genetically inclined to a certain degree.

My research has shed light on my own situation. The genetic explanation makes sense for me, as I said, because my father also has a BFRD. Anxiety or stress as causes also makes sense to me, as I feel that I bite more when I am stressed or anxious. I know now that what I do is not a “nervous habit,” but a disorder.

Sources:
Information on Trichotillomania:
The Trichotillomania Learning Center (TLC): http://www.trich.org/

Information on Dermatillomania (or CSP):
The Trichotillomania Learning Center (also has info on skin picking): http://www.trich.org/
More info: http://www.skinpick.com/

Information on Body-Focused Repetitive Disorders (or Body-Focused Repetitive Behaviors):
http://www.aamft.org/families/Consumer_Updates/Body-focusedRepetitiveDisorders.asp
http://www.nbiweston.com/conditions.php?id=11

Information on Anxiety:
http://www.medicinenet.com/anxiety/article.htm
http://www.allaboutlifechallenges.org/cause-of-anxiety-faq.htm
http://www.healthyplace.com/anxiety-panic/main/what-causes-anxiety-disorders-to-develop/menu-id-69/

General Information:
http://en.wikipedia.org/wiki/Body-focused_repetitive_behavior
http://en.wikipedia.org/wiki/Trichotillomania
http://en.wikipedia.org/wiki/Dermatillomania
http://en.wikipedia.org/wiki/Anxiety