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Prevalence of body-focused repetitive behaviors in a diverse population sample – rates across age, gender, race and education

Published online by Cambridge University Press:  13 December 2023

Steffen Moritz Open the ORCID record for Steffen Moritz [Opens in a new window] ,
Jakob Scheunemann Open the ORCID record for Jakob Scheunemann [Opens in a new window] ,
Lena Jelinek Open the ORCID record for Lena Jelinek [Opens in a new window] ,
Danielle Penney ,
Stella Schmotz Open the ORCID record for Stella Schmotz [Opens in a new window] ,
Luca Hoyer ,
Dominik Grudzień  and
Adrianna Aleksandrowicz
Steffen Moritz*
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Jakob Scheunemann
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Lena Jelinek
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Danielle Penney
Affiliation:
Centre Intégré Universitaire de Santé et de Services Sociaux de l'Ouest-de-l'Île-de-Montréal, Douglas Mental Health University Institute, Montréal, Canada
Stella Schmotz
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Luca Hoyer
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Dominik Grudzień
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Adrianna Aleksandrowicz
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
*
Corresponding author: Steffen Moritz; Email: moritz@uke.uni-hamburg.de
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Abstract

Background

Prevalence estimates for body-focused repetitive behaviors (BFRBs) such as trichotillomania differ greatly across studies owing to several confounding factors (e.g. different criteria). For the present study, we recruited a diverse online sample to provide estimates for nine subtypes of BFRBs and body-focused repetitive disorders (BFRDs).

Methods

The final sample comprised 1481 individuals from the general population. Several precautions were taken to recruit a diverse sample and to exclude participants with low reliability. We matched participants on gender, race, education and age range to allow unbiased interpretation.

Results

While almost all participants acknowledged at least one BFRB in their lifetime (97.1%), the rate for BFRDs was 24%. Nail biting (11.4%), dermatophagia (8.7%), skin picking (8.2%), and lip-cheek biting (7.9%) were the most frequent BFRDs. Whereas men showed more lifetime BFRBs, the rate of BFRDs was higher in women than in men. Rates of BFRDs were low in older participants, especially after the age of 40. Overall, BFRBs and BFRDs were more prevalent in White than in non-White individuals. Education did not show a strong association with BFRB/BFRDs.

Discussion

BFRBs are ubiquitous. More severe forms, BFRDs, manifest in approximately one out of four people. In view of the often-irreversible somatic sequelae (e.g. scars) BFRBs/BFRDs deserve greater diagnostic and therapeutic attention by clinicians working in both psychology/psychiatry and somatic medicine (especially dermatology and dentistry).

Keywords

body-focused repetitive behaviorsgendernail bitingprevalenceskin pickingtrichotillomania

Information

Type
Original Article
Information
Psychological Medicine , Volume 54 , Issue 8 , June 2024 , pp. 1552 - 1558
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Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

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Footnotes

*

Joint first authors

References

APA. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA, USA: American Psychiatric Association.Google Scholar
Bot, M., Middeldorp, C. M., de Geus, E. J. C., Lau, H. M., Sinke, M., van Nieuwenhuizen, B., … Penninx, B. W. J. H. (2017). Validity of LIDAS (LIfetime Depression Assessment Self-report): A self-report online assessment of lifetime major depressive disorder. Psychological Medicine, 47(2), 279–289. https://doi.org/10.1017/S0033291716002312CrossRefGoogle ScholarPubMed
Caragata, E. P., Rancès, E., O'Neill, S. L., & McGraw, E. A. (2014). Competition for amino acids between Wolbachia and the mosquito host, Aedes aegypti. Microbial Ecology, 67(1), 205–218. https://doi.org/10.1007/s00248-013-0339-4CrossRefGoogle ScholarPubMed
Cavallo, P., Carpinelli, L., & Savarese, G. (2016). Perceived stress and bruxism in university students. BMC Research Notes, 9(1), 514. https://doi.org/10.1186/s13104-016-2311-0CrossRefGoogle ScholarPubMed
Chandler, J., Rosenzweig, C., Moss, A. J., Robinson, J., & Litman, L. (2019). Online panels in social science research: Expanding sampling methods beyond Mechanical Turk. Behavior Research Methods, 51(5), 2022–2038. https://doi.org/10.3758/s13428-019-01273-7CrossRefGoogle ScholarPubMed
Charlson, F., van Ommeren, M., Flaxman, A., Cornett, J., Whiteford, H., & Saxena, S. (2019). New WHO prevalence estimates of mental disorders in conflict settings: A systematic review and meta-analysis. The Lancet, 394(10194), 240–248. https://doi.org/10.1016/S0140-6736(19)30934-1CrossRefGoogle ScholarPubMed
Christenson, G. A., Pyle, R. L., & Mitchell, J. E. (1991). Estimated lifetime prevalence of trichotillomania in college students. Journal of Clinical Psychiatry, 52(10), 415–417.Google ScholarPubMed
Erdogan, H. K., Arslantas, D., Atay, E., Eyuboglu, D., Unsal, A., Dagtekin, G., … Kilinc, A. (2021). Prevalence of onychophagia and its relation to stress and quality of life. Acta Dermatovenerologica, 30(1), 15–19. https://doi.org/10.15570/actaapa.2021.4Google ScholarPubMed
Fatima, R., Abid, K., Baig, N. N., & Ahsan, S. B. (2019). Association of cheek-biting and depression. Journal of the Pakistan Medical Association, 69(1), 49–52.Google ScholarPubMed
Franklin, M. E., Flessner, C. A., Woods, D. W., Keuthen, N. J., Piacentini, J. C., Moore, P., … Wilson, M. A. (2008). The child and adolescent trichotillomania impact project: Descriptive psychopathology, comorbidity, functional impairment, and treatment utilization. Journal of Developmental & Behavioral Pediatrics, 29(6), 493–500. https://doi.org/10.1097/DBP.0b013e31818d4328CrossRefGoogle ScholarPubMed
Grant, J. E., & Chamberlain, S. R. (2020). Prevalence of skin picking (excoriation) disorder. Journal of Psychiatric Research, 130, 57–60. https://doi.org/10.1016/j.jpsychires.2020.06.033CrossRefGoogle ScholarPubMed
Grant, J. E., Dougherty, D. D., & Chamberlain, S. R. (2020). Prevalence, gender correlates, and co-morbidity of trichotillomania. Psychiatry Research, 288, 112948. https://doi.org/10.1016/j.psychres.2020.112948CrossRefGoogle ScholarPubMed
Grant, J. E., Valle, S., Aslan, I. H., & Chamberlain, S. R. (2021). Clinical presentation of body-focused repetitive behaviors in minority ethnic groups. Comprehensive Psychiatry, 111, 152272. https://doi.org/10.1016/j.comppsych.2021.152272CrossRefGoogle ScholarPubMed
Greszki, R., Meyer, M., & Schoen, H. (2014). The impact of speeding on data quality in nonprobability and freshly recruited probability-based online panels. In Callegaro, M., Baker, R., Bethlehem, J., Göritz, A. S., Krosnick, J. A., & Lavrakas, P. L. (Eds.), Online panel research (pp. 238–262). Chichester, UK: Wiley. https://doi.org/10.1002/9781118763520.ch11CrossRefGoogle Scholar
Hasin, D. S., Sarvet, A. L., Meyers, J. L., Saha, T. D., Ruan, W. J., Stohl, M., & Grant, B. F. (2018). Epidemiology of adult DSM-5 major depressive disorder and its specifiers in the United States. JAMA Psychiatry, 75(4), 336. https://doi.org/10.1001/jamapsychiatry.2017.4602CrossRefGoogle ScholarPubMed
Houghton, D. C., Alexander, J. R., Bauer, C. C., & Woods, D. W. (2018). Body-focused repetitive behaviors: More prevalent than once thought? Psychiatry Research, 270, 389–393. https://doi.org/10.1016/j.psychres.2018.10.002CrossRefGoogle ScholarPubMed
Houghton, D. C., Maas, J., Twohig, M. P., Saunders, S. M., Compton, S. N., Neal-Barnett, A. M., … Woods, D. W. (2016). Comorbidity and quality of life in adults with hair pulling disorder. Psychiatry Research, 239, 12–19. https://doi.org/10.1016/j.psychres.2016.02.063CrossRefGoogle ScholarPubMed
Jafferany, M., Vander Stoep, A., Dumitrescu, A., & Hornung, R. L. (2010). The knowledge, awareness, and practice patterns of dermatologists toward psychocutaneous disorders: Results of a survey study. International Journal of Dermatology, 49(7), 784–789. https://doi.org/10.1111/j.1365-4632.2009.04372.xCrossRefGoogle ScholarPubMed
Kang, H. S., Lee, H. E., Ro, Y. S., & Lee, C. W. (2012). Three cases of Morsicatio labiorum. Annals of Dermatology, 24(4), 455–458. https://doi.org/10.5021/ad.2012.24.4.455CrossRefGoogle ScholarPubMed
Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21(3), 169–184. https://doi.org/10.1002/mpr.1359CrossRefGoogle ScholarPubMed
Keuthen, N. J., O'Sullivan, R. L., Ricciardi, J. N., Shera, D., Savage, C. R., Borgmann, A. S., … Baer, L. (1995). The Massachusetts General Hospital (MGH) hairpulling scale: 1. development and factor analyses. Psychotherapy and Psychosomatics, 64(3–4), 141–145.CrossRefGoogle ScholarPubMed
Khan, S. A., Khan, M. A., Khan, M., Sethi, M. R., & Irfan, M. (2018). Frequency of body-focused repetitive behaviours in medical students of Peshawar. Journal of Postgraduate Medical Institute, 32(3), 283–287.Google Scholar
Kruijshaar, M. E., Barendregt, J., Vos, T., de Graaf, R., Spijker, J., & Andrews, G. (2005). Lifetime prevalence estimates of major depression: An indirect estimation method and a quantification of recall bias. European Journal of Epidemiology, 20(1), 103–111. https://doi.org/10.1007/s10654-004-1009-0CrossRefGoogle Scholar
Lewin, A. B., Piacentini, J., Flessner, C. A., Woods, D. W., Franklin, M. E., Keuthen, N. J., … Stein, D. J. (2009). Depression, anxiety, and functional impairment in children with trichotillomania. Depression and Anxiety, 26(6), 521–527. https://doi.org/10.1002/da.20537Google ScholarPubMed
Lim, G. Y., Tam, W. W., Lu, Y., Ho, C. S., Zhang, M. W., & Ho, R. C. (2018). Prevalence of depression in the community from 30 countries between 1994 and 2014. Scientific Reports, 8(1), 2861. https://doi.org/10.1038/s41598-018-21243-xCrossRefGoogle ScholarPubMed
Lin, A., Farhat, L. C., Flores, J. M., Levine, J. L. S., Fernandez, T. V., Bloch, M. H., & Olfson, E. (2023). Characteristics of trichotillomania and excoriation disorder across the lifespan. Psychiatry Research, 322, 115120. https://doi.org/10.1016/j.psychres.2023.115120CrossRefGoogle ScholarPubMed
Modh, F. A. (2018). Rapunzel syndrome: A review of unusual case. International Surgery Journal, 5(11), 3764. https://doi.org/10.18203/2349-2902.isj20184661CrossRefGoogle Scholar
Moss, A. J., Hauser, D. J., Rosenzweig, C., Jaffe, S., Robinson, J., & Litman, L. (2023). Using market-research panels for behavioral science: An overview and tutorial. Advances in Methods and Practices in Psychological Science, 6(2), 4. https://doi.org/10.1177/25152459221140388CrossRefGoogle Scholar
Odlaug, B. L., & Grant, J. E. (2008). Clinical characteristics and medical complications of pathologic skin picking. General Hospital Psychiatry, 30(1), 61–66. https://doi.org/10.1016/j.genhosppsych.2007.07.009CrossRefGoogle ScholarPubMed
Odlaug, B. L., Lust, K., Schreiber, L. R. N., Christenson, G., Derbyshire, K., & Grant, J. E. (2013). Skin picking disorder in university students: Health correlates and gender differences. General Hospital Psychiatry, 35(2), 168–173. https://doi.org/10.1016/j.genhosppsych.2012.08.006CrossRefGoogle ScholarPubMed
Oppenheimer, D. M., Meyvis, T., & Davidenko, N. (2009). Instructional manipulation checks: Detecting satisficing to increase statistical power. Journal of Experimental Social Psychology, 45(4), 867–872. https://doi.org/10.1016/j.jesp.2009.03.009CrossRefGoogle Scholar
Pacan, P., Grzesiak, M., Reich, A., Kantorska-Janiec, M., & Szepietowski, J. (2014). Onychophagia and onychotillomania: Prevalence, clinical picture and comorbidities. Acta Dermato Venereologica, 94(1), 67–71. https://doi.org/10.2340/00015555-1616CrossRefGoogle ScholarPubMed
Randolph, J. J., Falbe, K., Manuel, A. K., & Balloun, J. L. (2014). A step-by-step guide to propensity score matching in R. Practical Assessment, Research and Evaluation, 19(18), 1–6.Google Scholar
Ricketts, E. J., Peris, T. S., Grant, J. E., Valle, S., Cavic, E., Lerner, J. E., … Piacentini, J. (2022). Clinical characteristics of youth with trichotillomania (hair-pulling disorder) and excoriation (skin-picking) disorder. Child Psychiatry & Human Development. https://doi.org/10.1007/s10578-022-01458-wCrossRefGoogle ScholarPubMed
Santomauro, D. F., Mantilla Herrera, A. M., Shadid, J., Zheng, P., Ashbaugh, C., Pigott, D. M., … Ferrari, A. J. (2021). Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. The Lancet, 398(10312), 1700–1712. https://doi.org/10.1016/S0140-6736(21)02143-7CrossRefGoogle Scholar
Scheunemann, J., Gawęda, L., Reininger, K.-M., Jelinek, L., Hildebrandt, H., & Moritz, S. (2020). Advice weighting as a novel measure for belief flexibility in people with psychotic-like experiences. Schizophrenia Research, 216, 129–137. https://doi.org/10.1016/j.schres.2019.12.016CrossRefGoogle ScholarPubMed
Shorey, S., Ng, E. D., & Wong, C. H. J. (2022). Global prevalence of depression and elevated depressive symptoms among adolescents: A systematic review and meta-analysis. British Journal of Clinical Psychology, 61(2), 287–305. https://doi.org/10.1111/bjc.12333CrossRefGoogle ScholarPubMed
Siddiqui, E. U., Naeem, S. S., Naqvi, H., & Ahmed, B. (2012). Prevalence of body-focused repetitive behaviors in three large medical colleges of Karachi: A cross-sectional study. BMC Research Notes, 5, 1–6. https://doi.org/10.1186/1756-0500-5-614CrossRefGoogle ScholarPubMed
Singh, S., Wetterneck, C. T., Williams, M. T., & Knott, L. E. (2016). The role of shame and symptom severity on quality of life in Obsessive-Compulsive and Related Disorders. Journal of Obsessive-Compulsive and Related Disorders, 11, 49–55. https://doi.org/10.1016/j.jocrd.2016.08.004CrossRefGoogle Scholar
Solley, K., & Turner, C. (2018). Prevalence and correlates of clinically significant body-focused repetitive behaviors in a non-clinical sample. Comprehensive Psychiatry, 86, 9–18. https://doi.org/10.1016/j.comppsych.2018.06.014CrossRefGoogle Scholar
Spitzer, C., Lübke, L., Lindstädt, T., Gallinat, C., Tietze, J. K., Emmert, S., & Thiem, A. (2022). Prevalence of pathological skin-picking in dermatological patients. Journal of Psychiatric Research, 147, 232–236. https://doi.org/10.1016/j.jpsychires.2022.01.035CrossRefGoogle ScholarPubMed
Tam, J., Mezuk, B., Zivin, K., & Meza, R. (2020). U.S. simulation of lifetime major depressive episode prevalence and recall error. American Journal of Preventive Medicine, 59(2), e39–e47. https://doi.org/10.1016/j.amepre.2020.03.021CrossRefGoogle ScholarPubMed
Thompson, G. (2013). A near fatal case of pathological skin picking. American Journal of Case Reports, 14, 284–287. https://doi.org/10.12659/AJCR.889357Google Scholar
Wetselaar, P., Vermaire, E. J. H., Lobbezoo, F., & Schuller, A. A. (2019). The prevalence of awake bruxism and sleep bruxism in the Dutch adult population. Journal of Oral Rehabilitation, 46(7), 12787. https://doi.org/10.1111/joor.12787CrossRefGoogle ScholarPubMed
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