Finding Better Treatments for BFRBs
Why customized approaches have the best chances of success.
Posted January 30, 2019
Over the past year, this blog has focused on understanding the phenomenology of body-focused repetitive behavior disorders (BFRBs) and what makes them a “disorder.” We’ve explored what governs how we learn to engage in these behaviors and whether they are best conceptualized as impulsive or compulsive. We’ve described their onset in childhood and what pediatricians should know when screening for these common and potentially debilitating conditions. With guest posts by experts affiliated with The TLC Foundation for Body-Focused Repetitive Behaviors, we’ve tried to provide education on an overlooked and poorly understood set of conditions that scientists suspect are much more common than previously thought (Grant & Chamberlain, 2016).
On balance, we’ve devoted much less time to understanding the treatment of these conditions. We’ll start to address this topic as we head into the new year, focusing on evidence-based approaches to managing BFRBs. We’ll approach treatment from several perspectives, covering behavioral interventions, medications, family-based approaches, and nutritional supplements. As usual, we will draw on experts in these areas, emphasizing treatments that have empirical support (and specifying just how much) or scientific plausibility (i.e., those promising leads rooted in sound theory but not yet evaluated).
As we turn in this direction, it’s important to note that while evidence-based treatments exist, and while they are helpful to many people, large numbers of people don’t see the responses for which they hope. Relapse is, unfortunately, quite common. This landscape speaks to the need for new and better treatments, and with that in mind, we will also be including additional topics related to how translational and animal research methods can inform the next generation of BFRB treatments. Much of this work is rooted in the precision medicine framework already enshrined in other areas of medicine.
What is precision medicine? It’s an approach to treatment that uses our understanding of the underlying biology of illness—often a genetic or neural marker—to match a treatment more precisely to factor(s) underlying disease. It’s often compared to matching a person’s blood type during a transfusion or to taking a throat culture that can tell you whether you need a specific antibiotic for strep throat. Precision medicine approaches consider individual biology, lifestyle, and environmental factors that can be used to match patients to the treatments most likely to work for them.
With promising advances in treating cancer and other diseases, there is growing emphasis on how these personalized approaches can transform mental health intervention. For individuals with BFRBs, this is big news. These conditions vary considerably among affected individuals and there is unlikely to be a one-size-fits-all treatment. With prominent distinctions between focused/unfocused presentations, the role of reward, sensory processes, and self-soothing, different groups of people are likely to need different intervention approaches.
As the mechanisms underlying various aspects of disorder are clarified, the hope is that they pave the way to not one—but many—new treatments for BFRBs.
Grant, J.E., & Chamberlain, S.R. (2016). Trichotillomania. American Journal of Psychiatry, 173:9, 868-874.