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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).
This chapter discusses the cumulative effect of oral parafunctions (OPFs) on the health of a patient's natural dentition, dental restorations, oral soft structures, and temporomandibular joints (TMJs). Nail biting and other OPFs are common in young children. Consequently, unmanaged parafunctional habits may contribute to the etiology of trauma in the stomatognathic systems of adolescents and adults. Prevention, early detection, and intervention are important clinical activities to diminish the influences of chronic OPFs on the teeth, muscles, and temporomandibular joints. The dentist can assist in detecting OPFs, protecting vulnerable oral and TMJ structures, and making appropriate referrals. Although occlusal splints can protect the oral structures from wear, they have little effect on parafunctional habits. Growing evidence suggests that psychological interventions to address factors contributing to the maintenance of these adverse habits can assist patients in overcoming them.
This chapter uses the phrase nail biting rather than onychophagia because nail biting is more easily understood. Although most nail biters bite only their fingernails, some people bite their toenails as well or overclip their toenails. Occasionally, people may bite their nails as part of a behavioral disorder occasioned by intense pain. Nail biting can be reliably and simply measured by using calipers. For older teenagers and adults, the data from Malone and Massler's study indicate that fewer girls and women than boys and men bite their nails. Studies of obsessive-compulsive spectrum disorders have often revealed quite high levels of nail biting, among other habits. Only one trial of pharmacological agents has been described, in which clomipramine and desimipramine were compared in a double-blind, randomized study. A number of interventions have been proposed, but none has shown clear superiority in adequately designed trials.
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