Examining Self-Guided Interventions for Body-Focused Repetitive Behaviors in Dermatology: A Literature Review

Abstract

Body-focused repetitive behaviors (BFRBs) present a unique challenge for dermatologists, characterized by recurrent self-grooming behaviors, such as skin-picking or hair-pulling. While individuals may find temporary relief or gratification, BFRBs can have significant consequences, including social stigma, impaired quality of life, and physical injury. Effective behavioral treatments like habit reversal therapy (HRT) exist, but time constraints may limit the utilization of HRT techniques in dermatology visits. Internet-based self-help interventions may help improve access to care by empowering patients with self-guided treatment options. This review examines the impact of internet-based self-help interventions on adults with BFRBs. We conducted a literature review of peer-reviewed articles in PubMed using these search terms: (body-focused repetitive behaviors OR BFRB* OR trichotillomania OR skin picking disorder* OR dermatillomania OR excoriation disorder* OR nail-biting* OR onychotillomania OR onychophagia OR compulsive grooming* OR lip biting* OR cheek biting*) AND (self* OR online* OR internet* OR computer* OR web OR digital* OR manual* OR video*). The search returned 1,033 results and 13 randomized controlled trials were selected for analysis upon title, abstract, and full-text screening based on our eligibility criteria. The outcomes of the studies included BFRB severity, quality of life, and depression severity, and the control groups varied, from comparative interventions to waitlist control groups. The internet-based self-help interventions were found to be acceptable and feasible for adult patients, suggesting their potential as accessible treatment options. The studies also demonstrated important areas for further research, from increasing racial and ethnic representation in BFRB research to considering patient-user experience.