An Examination of Impulsivity and Metacognitions in Adolescents with Body-Focused Repetitive Behavior Disorders

Trichotillomania (TTM), skin-picking disorder (SPD), and nail-biting (NB) are classified as Body-Focused Repetitive Disorders (BFRBDs), which share characteristics with both obsessive-compulsive and impulse control disorders. This study aimed to compare impulsivity, metacognitions, and clinical characteristics across BFRBDs. Ninety adolescents (aged 10-18 years) with BFRBDs and 40 healthy controls (HC) completed the Revised Children's Anxiety and Depression Scale-Child Version (RCADS-CV), the Metacognitions Questionnaire for Children and Adolescents (MCQ-CA), the Barratt Impulsiveness Scale-Brief (BIS-Brief), and the Pediatric Quality of Life Inventory (PedsQL). Symptom severity was assessed using disorder-specific measures. There were no significant age differences between the BFRBDs and HC groups. However, within the BFRBDs subgroups, adolescents with TTM and SPD were significantly older than those with NB (p = .028). Notably, despite being younger, the NB group exhibited the longest duration of BFRBDs symptoms (p < .001). The TTM group showed higher MCQ-CA total, positive beliefs about worry, and cognitive monitoring. In contrast, the SPD group had higher poor self-regulation scores (all p < .05). Symptom severity across BFRBDs was negatively associated with PedsQL total scores and positively associated with MCQ-CA total and RCADS-CV total scores (all p < .05). These findings suggest that while metacognitions are more prominent in TTM, impulsivity plays a greater role in SPD. Understanding the distinct contributions of impulsivity and metacognitions in BFRBDs may facilitate the development of targeted treatment approaches tailored to each behavior.