Emotion regulation and other psychological models for body-focused repetitive behaviors

The term body-focused repetitive behaviors (BFRBs) refers to a group of recurrent, problematic, destructive behaviors directed toward the body, including hair-pulling, skin-picking, and nail-biting. Individuals with BFRBs report diminished control over the behavior and a range of physical and psychological sequelae. Recent research on psychological models for BRFBs has investigated the role of emotion regulation (ER), and many authors in this area have conceptualized problematic body-focused behavior as a maladaptive ER mechanism. This article organizes and reviews the empirical research on the ER model for BRFBs. First, the three most common BFRBs are described, as are the conceptualization, phenomenological similarities and covariation, and psychological and physical impact of BFRBs. Next, psychodynamic models and several cognitive-behavioral (CB) models are described. The article focuses on the ER model, including a review of studies of comorbidity in BFRBs, naturalistic and experimental studies, studies of subtypes of BFRBs, and treatment trials. The implications of the findings are discussed and the authors make recommendations for future research. The article concludes with a discussion of the limitations of psychological models for BFRBs and the limitations of the review.