Hintergrund: Die körperbezogenen repetitiven Verhaltensweisen (body focused repetitive behaviors; BFRBs) subsumieren eine Gruppe von Störungsbildern an der Schnittstelle von klinischer Psychologie/Psychiatrie, Dermatologie und Zahnheilkunde. Ohne entsprechende Behandlung neigen BFRBs zur Chronizität und können zu gravierenden körperlichen und psychischen Folgeproblemen führen. Ungeachtet der hohen Prävalenz (ca. 24 % der Erwachsenen in der allgemeinen Bevölkerung berichten Fälle mit Leidensdruck und/oder sichtbaren körperlichen Folgen im Laufe ihres Lebens) gibt es weiter große Wissenslücken aufseiten Behandelnder. Zusammenfassung: Aufgrund der körperlichen Folgeerscheinungen sind überwiegend Allgemeinmediziner:innen und Dermatolog:innen die erste Anlaufstelle für Betroffene. In den aktuellen Klassifikationssystemen sind Trichotillomanie (pathologisches Ausreißen der Haare) und Dermatillomanie (pathologisches Manipulieren der Haut) als eigenständige Diagnosen gelistet und werden entweder als zwangsverwandte Störungen (DSM-5) oder als Störungen der Impulskontrolle (ICD-10) klassifiziert. Weitere Verhaltensweisen, die zu den BFRBs gerechnet werden, sind Cavitadaxia (Lippen-Wangen-Beißen), Nägelkauen, Wach-Bruxismus sowie Daumenlutschen im Erwachsenenalter. Verhaltenstherapeutische Maßnahmen sind aktuell die Behandlung der Wahl. Den Goldstandard stellt das Habit-Reversal-Training (HRT) dar, dessen Wirksamkeit mehrfach empirisch nachgewiesen wurde. Effektive Selbsthilfeverfahren sind neben der Selbsthilfeadaption des HRT, die Entkopplung, die Entkopplung in sensu und das Habit Replacement. Kernaussage: Der Artikel vermittelt einen Überblick über die einzelnen Störungsbilder von BFRBs, differenzialdiagnostische Schwierigkeiten sowie Behandlungsmöglichkeiten.

1.
American Psychiatric Association
.
Diagnostisches und Statistisches Manual Psychischer Störungen DSM-5. 2. Auflage
.
Göttingen
:
Hogrefe
;
2018
.
2.
Asplund
M
,
Rück
C
,
Lenhard
F
,
Gunnarsson
T
,
Bellander
M
,
Delby
H
, et al
.
ACT-enhanced group behavior therapy for trichotillomania and skin-picking disorder: a feasibility study
.
J Clin Psychol
.
2021
;
77
(
7
):
1537
1555
.
3.
Azrin
NH
,
Nunn
RG
.
Habit-reversal: a method of eliminating nervous habits and tics
.
Behav Res Ther
.
1973
;
11
(
4
):
619
628
.
4.
Badenoch
J
,
Searle
T
,
Watson
I
,
Cavanna
AE
.
Sensory symptoms in body-focused repetitive behaviors, restless legs syndrome, and tourette syndrome: An overlap
.
Neurosci Biobehav Rev
.
2020
;
119
:
320
332
.
5.
Barber
KE
,
Capel
LK
,
Merl
N
,
Twohig
MP
,
Saunders
SM
,
Compton
SN
, et al
.
Pulling sites in trichotillomania: exploring differences in characteristics, phenomenology, and contextual variables
.
Cognit Ther Res
.
2023
;
48
(
1
):
164
176
.
6.
World Health Organization
.
International statistical classification of diseases and related health problems
. 11th ed.
2021
. https://icd.who.int/.
7.
Bundesinstitut für Arzneimittel und Medizinprodukte
: ICD-11 in Deutsch – Entwurffassung [Internet]. Verfügbar unter: https://www.bfarm.de/DE/Kodiersysteme/Klassifikationen/ICD/ICD-11/uebersetzung/_node.html
8.
Browne
HA
,
Gair
SL
,
Scharf
JM
,
Grice
DE
.
Genetics of obsessive-compulsive disorder and related disorders
.
Psychiatr Clin North Am
.
2014
;
37
(
3
):
319
335
.
9.
Capel
LK
,
Petersen
JM
,
Woods
DW
,
Marcks
BA
,
Twohig
MP
.
Mental health providers’ knowledge of trichotillomania and skin picking disorder, and their treatment
.
Cognit Ther Res
.
2023
;
48
(
1
):
30
38
.
10.
Carlson
EJ
,
Malloy
EJ
,
Brauer
L
,
Golomb
RG
,
Grant
JE
,
Mansueto
CS
,
et al
.
Comprehensive behavioral (ComB) treatment of trichotillomania: a randomized clinical trial
.
Behav Ther
.
2021
;
52
(
6
):
1543
1557
.
11.
Carr
JR
,
Sholevar
EH
,
Baron
DA
.
Trichotillomania and trichobezoar: a clinical practice insight with report of illustrative case
.
J Osteopath Med
.
2006
;
106
(
11
):
647
652
.
12.
Ekore
RI
,
Ekore
JO
.
Excoriation (skin-picking) disorder among adolescents and young adults with acne-induced postinflammatory hyperpigmentation and scars
.
Int J Dermatol
.
2021
;
60
(
12
):
1488
1493
.
13.
Erdogan
HK
,
Arslantas
D
,
Atay
E
,
Eyuboglu
D
,
Unsal
A
,
Dagtekin
G
, et al
:
Prevalence of onychophagia and its relation to stress and quality of life
.
Acta Dermatovenerol
.
2021
;
30
;(
1
):
15
19
.
14.
Eskeland
SO
,
Moen
E
,
Meland
KJ
,
Andersen
A
,
Hummelen
B
.
Skin picking disorder
.
Tidsskr Nor Laegeforen
.
2021
;
141
(
18
). https://doi.org/10.4045/tidsskr.21.0128.
15.
Farhat
LC
,
Olfson
E
,
Nasir
M
,
Levine
JLS
,
Li
F
,
Miguel
EC
, et al
.
Pharmacological and behavioral treatment for trichotillomania: an updated systematic review with meta-analysis
.
Depress Anxiety
.
2020
;
37
(
8
):
715
727
.
16.
Flaitz
CM
,
Felefli
S
.
Complications of an unrecognized cheek biting habit following a dental visit
.
Pediatr Dent
.
2000
;
22
(
6
):
511
512
.
17.
Ghisi
M
,
Chiri
L
,
Marchetti
I
,
Sanavio
E
,
Sica
C
.
In search of specificity: "not just right experiences" and obsessive-compulsive symptoms in non-clinical and clinical Italian individuals
.
J Anxiety Disord
.
2010
;
24
(
8
):
879
886
.
18.
Golomb
R
,
Franklin
M
,
Grant
JE
,
Keuthen
NJ
,
Mansueto
CS
,
Mouton-Odum
S
, et al
.
Expert consensus treatment guidelines: body-focused repetitive behaviors
.
2016
. p.
1
24
. Verfügbar unter: http://www.bfrb.org/storage/documents/Expert_Consensus_Treatment_Guidelines_2016w.pdf.
19.
Okumuş
HG
,
Akdemir
D
.
Body focused repetitive behavior disorders: behavioral models and neurobiological mechanisms
.
Turkish J Psychiatry
.
2023
;
34
(
1
):
50
59
.
20.
Henkel
ED
,
Jaquez
SD
,
Diaz
LZ
.
Pediatric trichotillomania: review of management
.
Pediatr Dermatol
.
2019
;
36
(
6
):
803
807
.
21.
Houghton
DC
,
Alexander
JR
,
Bauer
CC
,
Woods
DW
.
Body-focused repetitive behaviors: more prevalent than once thought
.
Psychiatry Res
.
2018
;
270
:
389
393
.
22.
ICD-10-GM Version 2021, Systematisches Verzeichnis, Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, 10. Revision, Stand: 18
. September 2020 [Internet]. Köln: Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM) im Auftrag des Bundesministeriums für Gesundheit (BMG) unter Beteiligung der Arbeitsgruppe ICD des Kuratoriums für Fragen der Klassifikation im Gesundheitswesen (KKG); 2020. Verfügbar unter: www.bfarm.de – Kodiersysteme – Services – Downloads – ICD-10-GM – Version 2021.
23.
Jafferany
M
,
Vander Stoep
A
,
Dumitrescu
A
,
Hornung
RL
.
The knowledge, awareness, and practice patterns of dermatologists toward psychocutaneous disorders: results of a survey study
.
Int J Dermatol
.
2010
;
49
(
7
):
784
789
.
24.
Jurska
J
,
Corcoran
V
,
Andover
M
:
Nonsuicidal self-injury and compulsive disorders
. In:
Washburn
JJ
, Hrsg.
Nonsuicidal Self-Injury: Advances in Research and Practice
.
New York
:
Routledge
;
2019
. p.
88
108
.
25.
Keuthen
NJ
,
Deckersbach
T
,
Wilhelm
S
,
Engelhard
I
,
Forker
A
,
O’Sullivan
RL
, et al
.
The Skin Picking Impact Scale (SPIS): scale development and psychometric analyses
.
Psychosomatics
.
2001
;
42
(
5
):
397
403
.
26.
Keuthen
NJ
,
O’Sullivan
RL
,
Ricciardi
JN
,
Shera
D
,
Savage
CR
,
Borgmann
AS
, et al
.
The Massachusetts General Hospital (MGH) Hairpulling Scale: 1. development and factor analyses
.
Psychother Psychosom
.
1995
;
64
(
3–4
):
141
145
.
27.
Keuthen
NJ
,
Rothbaum
BO
,
Fama
J
,
Altenburger
E
,
Falkenstein
MJ
,
Sprich
SE
, et al
.
DBT-enhanced cognitive-behavioral treatment for trichotillomania: a randomized controlled trial
.
J Behav Addict
.
2012
;
1
(
3
):
106
114
.
28.
Lee
DK
,
Lipner
SR
:
The potential of N-acetylcysteine for treatment of trichotillomania, excoriation disorder, onychophagia, and onychotillomania: an updated literature review
.
Int J Environ Res Public Health
.
2022a
;
19
(
11
):
6370
.
29.
Lee
DK
,
Lipner
SR
.
Update on diagnosis and management of onychophagia and onychotillomania
.
Int J Environ Res Public Health
.
2022b
;
19
(
6
):
3392
.
30.
Lee
MT
,
Mpavaenda
DN
,
Fineberg
NA
.
Habit reversal therapy in obsessive compulsive related disorders: a systematic review of the evidence and consort evaluation of randomized controlled trials
.
Front Behav Neurosci
.
2019
;
13
:
79
.
31.
Lochner
C
,
Roos
A
,
Stein
D
.
Excoriation (skin-picking) disorder: a systematic review of treatment options
.
Neuropsychiatr Dis Treat
.
2017
;
13
:
1867
1872
.
32.
Mansueto
CS
,
Mansfield Vavrichek
S
,
Goldfinger Golomb
R
.
Overcoming body-focused repetitive behaviors: a comprehensive behavioral treatment for hair pulling and skin picking
.
New Harbinger Publications
;
2020
.
33.
Mathew
AS
,
Davine
TP
,
Snorrason
I
,
Houghton
DC
,
Woods
DW
,
Lee
H-J
.
Body-focused repetitive behaviors and non-suicidal self-injury: a comparison of clinical characteristics and symptom features
.
J Psychiatr Res
.
2020
;
124
:
115
122
.
34.
McDonald
KA
,
Jafferany
M
,
Rohani
K
.
Excoriation disorder vs skin-centered body dysmorphic disorder: a clinical and therapeutic update
.
Dermatol Ther
.
2020
;
33
(
6
):
e13994
.
35.
Mehrmann
L.M.
,
Gerlach
A.L
.
The challenge for successful self-help: side effects of discontinuing an internet-based program for skin picking disorder
.
Cogn Ther Res
.
2024
;
48
(
1
):
39
51
.
36.
Mehrmann
LM
,
Hunger
A
,
Gerlach
AL
.
Pathologisches Hautzupfen/-quetschen (Skin Picking): Erste Ergebnisse zur Psychometrie störungsspezifischer Messinstrumente [Excoriation disorder (Skin Picking): an initial analysis of disorder-specific assessment instruments]
.
Z Klin Psychol Psychother
.
2017
;
46
(
1
):
23
31
.
37.
Melo
DF
,
Lima
C
,
Piraccini
B M
,
Tosti
A
,
Tosti
A
.
Trichotillomania: what do we know so far
.
Skin Appendage Disord
.
2022
;
8
:
1
7
.
38.
Moritz
S
,
Gallinat
C
,
Weidinger
S
,
Bruhns
A
,
Lion
D
,
Snorrason
I
, et al
.
The Generic BFRB Scale-8 (GBS-8): a transdiagnostic scale to measure the severity of body-focused repetitive behaviours
.
Behav Cogn Psychother
.
2022a
;
50
(
6
):
620
628
.
39.
Moritz
S
,
Penney
D
,
Ahmed
K
,
Schmotz
S
.
A head-to-head comparison of three self-help techniques to reduce body-focused repetitive behaviors
.
Behav Modif
.
2022b
;
46
(
4
):
894
912
.
40.
Moritz
S
,
Penney
D
,
Bruhns
A
,
Weidinger
S
,
Schmotz
S
.
Habit reversal training and variants of decoupling for use in body-focused repetitive behaviors. а randomized controlled trial
.
Cognit Ther Res
.
2023a
;
47
(
1
):
109
122
.
41.
Moritz
S
,
Penney
D
,
Mißmann
F
,
Snorrason
I
,
Schmotz
S
.
Same same but different? Phenomenological differences among different types of body-focused repetitive behaviors
.
Ann Clin Psychiatry
.
2023b
;
35
(
4
):
252
259
.
42.
Moritz
S
,
Penney
D
,
Weidinger
S
,
Gabbert
T
,
Schmotz
S
.
A randomized controlled trial on a novel behavioral treatment for individuals with skin picking and other body-focused repetitive behaviors
.
J Dermatol
.
2022c
;
15
. https://onlinelibrary.wiley.com/doi/10.1111/1346-8138.16435.
43.
Moritz
S
,
Rufer
M
,
Schmotz
S
.
Recovery from pathological skin picking and dermatodaxia using a revised decoupling protocol
.
J Cosmet Dermatol
.
2020
;
19
(
11
):
3038
3040
.
44.
Moritz
S
,
Rufer
M
.
Movement decoupling: a self-help intervention for the treatment of trichotillomania
.
J Behav Ther Exp Psychiatry
.
2011
;
42
(
1
):
74
80
.
45.
Moritz
S
,
Scheunemann
J
,
Jelinek
L
,
Penney
D
,
Schmotz
S
,
Hoyer
L
, et al
.
Prevalence of body-focused repetitive behaviors in a diverse population sample – rates across age, gender, race and education
.
Psychol Med
.
2024a
;
54
(
8
):
1552
1558
.
46.
Moritz
,
S
,
Penney
,
D
,
Hoyer
,
L
,
Schmotz
,
S
:
Risk and maintenance factors in body-focused repetitive behaviours
.
JEADV Clin Pract
.
2024b
. https://doi.org/10.1002/jvc2.405.
47.
Moritz
S
,
Treszl
A
,
Rufer
M
.
A randomized controlled trial of a novel self-help technique for impulse control disorders: a study on nail-biting
.
Behav Modif
.
2011
;
35
(
5
):
468
485
.
48.
Ravipati
P
,
Conti
B
,
Chiesa
E
,
Andrieux
K
.
Dermatillomania: strategies for developing protective biomaterials/cloth
.
Pharmaceutics
.
2021
;
13
(
3
):
341
.
49.
Schmotz
S
,
Weidinger
S
,
Markov
V
,
Penney
D.
,
Moritz
S
.
Self-help for body-focused repetitive behaviors: a randomized controlled trial
.
J Obsessive Compuls Relat Disord
.
2023
;
38
:
100810
.
50.
Siddiqui
J
,
Quershi
SF
.
Onychophagia (nail biting): an overview
.
Indian J Ment Health
.
2020
;
7
(
2
):
97
104
.
51.
Skurya
J
,
Jafferany
M
,
Everett
GJ
.
Habit reversal therapy in the management of body focused repetitive behavior disorders
.
Dermatol Ther
.
2020
;
33
(
6
):
e13811
.
52.
Snorrason
I
,
Beard
C
,
Peckham
AD
,
Björgvinsson
T
.
Transdiagnostic dimensions in obsessive-compulsive and related disorders: associations with internalizing and externalizing symptoms
.
Psychol Med
.
2021
;
51
(
10
):
1657
1665
.
53.
Snorrason
I
,
Ólafsson
RP
,
Flessner
CA
,
Keuthen
NJ
,
Franklin
ME
,
Woods
DW
.
The Skin Picking Scale-Revised: Factor structure and psychometric properties
.
J Obsessive Compuls Relat Disord
.
2012
;
1
(
2
):
133
137
.
54.
Snorrason
I
,
Ricketts
EJ
,
Stein
AT
,
Björgvinsson
T
.
Trichophagia and trichobezoar in trichotillomania: a narrative mini-review with clinical recommendations
.
J Obsessive Compuls Relat Disord
.
2021
;
31
:
100680
.
55.
Solley
K
,
Turner
C
.
Prevalence and correlates of clinically significant body-focused repetitive behaviors in a non-clinical sample
.
Compr Psychiatry
.
2018
;
86
:
9
18
.
56.
Stamu-O’Brien
C
,
Jafferany
M
,
Carniciu
S
,
Abdelmaksoud
A
.
Psychodermatology of acne: psychological aspects and effects of acne vulgaris
.
J Cosmet Dermatol
.
2021
;
20
(
4
):
1080
1083
.
57.
Torales
J
,
Díaz
NR
,
Barrios
I
,
Navarro
R
,
García
O
,
O’Higgins
M
, et al
.
Psychodermatology of skin picking (excoriation disorder): a comprehensive review
.
Dermatol Ther
.
2020
;
33
(
4
):
e13661
.
You do not currently have access to this content.