Introduction
Nervous habits also identified as body focused repetitive behaviors (BFRBs) are behaviors that occur repeatedly across situations and consist of undesired repetitive, manipulative, problematic and or destructive behaviors directed toward the body such as hand-to-head (e.g., hair pulling, hair twirling), hand-to-mouth (e.g., nail biting, thumb sucking), hand-to-body (e.g., skin picking, skin scratching), and oral behaviors (e.g., teeth grinding, mouth biting) and are often seen to play a role in emotion regulation and can arise during periods of heightened tension (Miltenberger,2005 ; Roberts, O’Connor, Bélanger, 2013; Woods & Miltenberger, 1995). The Diagnostic and Statistical Manual of Mental Disorders, fifth edition, does identify body focused repetitive behaviors under Other Specified Obsessive Compulsive and Related Disorders as a behavior that can cause stress and impairment in areas of functioning however does not meet the full diagnostic criteria of specific obsessive compulsive and related disorders (American Psychiatric Association 2013, pp. 263-264). Roberts et al. (2013) states, “research into BFRBs has been limited in comparison to research into other psychiatric conditions”. One example given by Roberts et al. (2013) referred to the Psychlit database which between the 1975 and 2000 contained 2489 articles pertaining to bipolar disorder, 309 articles pertaining to trichotillomania and only fourteen pertaining to BFRBs. Robert et al. (2013) acknowledges there is a growing interest in BFRBs with hair pulling and skin picking receiving the most research attention (2013). The prevalence rate of BFRBs is hard to determine without more research and understanding.
Habit reversal therapy, developed by Natha...
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“Cognitive-behavior therapy refers to those approaches inspired by the work of Albert Ellis (1962) and Aaron Beck (1976) that emphasize the need for attitude change to promote and maintain behavior modification” (Nichols, 2013, p.185). A fictitious case study will next be presented in order to describe ways in which cognitive behavioral therapy can be used to treat the family members given their presenting problems.
It is rare to find one behavioral intervention that addresses the function of a problem behavior in each situation and setting. Positive behavioral support strategies should therefore include multicomponent intervention plans. Begin by developing a hypothesis regarding the undesirable behavior. The hypothesis statement is a summary of the evidence collected in the functional assessment.
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In the research study, “Relax and Try This Instead: Abbreviated Habit Reversal for Maladaptive Self-Biting” done by Jones, Swearer and Friman, they found that the most effective treatment for self-biting is habit reversal. To show the success of habit reversal treatment they conducted a study on a fifteen year old boy, named Sam, who had been diagnosed with overanxious disorder and was severely biting his lips when...
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My problem was that I often picked at my cuticles, such as peeling then skin or at the cuticle itself. After researching this, I have found that there is a disorder called Compulsive Skin Picking or Excoriation Disorder. I found that I am not the only one who was constantly looking at her cuticles and picking at the peelings. As I researched Excoriation Disorder, I have found it to be a serious problem where people suffered from constantly trying to “touch, rub, scratch, pick at, or dig into their skin, often in an attempt to remove small irregularities or perceived imperfections” (Trichotillomania Learning Center). This disorder occurs in kids and adults all over the world and in extreme cases, will cause severe scarring and distortion of the skin. Research has stated that there are at least 1 in 20 people who suffer from this disorder, and an “estimation of about 2% of dermatology clinic patients suffer from this condition” (Dell’Osso, B., Altamura, A. C., Allen, A., Marazziti, D., & Hollander, E. (2006). It is also suggested that though this disorder occurs both in male and female, it seems to manifest more in females (Fama, 2010.) The nature of this problem is that those who suffer are constantly feeling the need to pick at certain parts of the skin repetitively, which is why it is often classified as an OCD, or Obsessive Compulsive Disorder. Often times referred as “a body focuses repetitive behavior” or “obsessive compulsive spectrum disorder”, this disorder has features present that is also close to those in OCDs such as trichotillomania which is a repetitive hair pulling disorder (Fama, 2010.) However, there are a variety of reasons as to why one would pick at their skin. Some will pick at their skin because of boredom, w...
Relatives who suffer from TTM have shown higher rate of hair pulling behavior in other family members (Chatterjee 2012). Or, if the behavior is not hair-pulling, it is likely to be some similar behaviors such as nail biting, skin picking, and thumb sucking; these also show genetic association (Chatterjee 2012). And this might be a possible cause of the development of trichotillomania; however, it still need to be researched in the future (Chatterjee 2012). Also, childhood trauma might be another possible cause of developing trichotillomania; with the assistance of Childhood Trauma Questionnaire, which assesses physical, emotional, and sexual abuse as well as physical and emotional neglect, Lochner found out that data showed that childhood trauma was significantly higher in patients who suffer from OCD and/or TTM than in healthy people (Lochner 2002). Both OCD and TTM sufferers scored higher than healthy people on emotional neglect; and the data did show an association between anxiety disorders such as OCD and/or TTM and childhood trauma (Lochner 2002). However, this association may not be generalizable to males; variables such as age and socio-economic status may also influence the results; thus, further studies are needed (Lochner
Developmental Analytic Behavior Therapy (DABT), one of the newest forms of behavior therapy, is “the first behavioral analytical therapy that incorporates behavioral developmental stage and value of the outcome of a behavior into its working. It is quite different from conventional therapies as it focuses on altering problem behaviors directly to help individuals live satisfying lives despite their existing behavioral problems. Moreover, the behavioral developmental stage also seems to affect the kind of defense mechanism one uses, in the psychoanalytic sense, which in turn affects one’s behavior (Semrad, 1969a, b, c).” (Commons & Tuladhar, 2014, p.