Körperbezogene repetitive Verhaltensstörungen

Körperbezogene repetitive Verhaltensstörungen wie Trichotillomanie und Skin Picking sind Störungsbilder an der Schnittstelle von Psychiatrie/Psychologie und psychosomatischer Medizin zu Dermatologie und Zahnheilkunde. Kognitiv-verhaltenstherapeutische Maßnahmen stellen aktuell die Therapiemethode der Wahl dar. Idealerweise adressiert die Behandlung auch auslösende Faktoren wie mangelnde Stress- und Emotionsregulation sowie sensorische Trigger.

Kernaussagen

• Unter körperbezogenen repetitiven Verhaltensweisen versteht man ein sich wiederholendes, stereotypes und exzessives Selbstpflegeverhalten, welches nur schwer von der betroffenen Person unterlassen werden kann.

• Starke Ausprägungen des Verhaltens haben negative Auswirkungen auf das psychische und körperliche Wohlbefinden und führen zu sozialen Beeinträchtigungen; in diesen Fällen spricht man von einer Verhaltensstörung.

• Für die Diagnose einer BFRBD sind die mangelnde Fähigkeit, dem Impuls zu widerstehen und ein signifikanter Leidensdruck ausschlaggebend.

• Betroffene Personen berichten häufig von prädisponierenden körperlichen Faktoren, die die Wahrscheinlichkeit des Auftretens einer BFRB erhöhen; aufrechterhalten wird das Verhalten durch einen Teufelskreis aus negativer und (kurzfristiger) positiver Verstärkung.

• Das Habit-Reversal-Training stellt die Behandlungsmöglichkeit 1. Wahl für BFRBs dar, wobei zusätzlich auf individuelle Trigger und eine mangelnde Stress- bzw. Emotionsregulationsfähigkeit geachtet werden sollte.

Schlüsselwörter

BFRB - negative Verstärkung - Habit-Reversal-Training - Entkopplung - Behandlungslücke

Publication History

Article published online:
26 September 2025

• Literatur

• 1 Moritz S, Hoyer L, Sarna N. et al. Quo vadis DSM-6? An expert survey on the classification, diagnosis, and differential diagnosis of body-focused repetitive behaviors.
• 2 American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 5th. Arlington, VA, USA: American Psychiatric Association; 2013
• 3 Moritz S, Penney D, Mißmann F. et al. Same but different? Phenomenological differences among various types of body-focused repetitive behaviors. Ann Clin Psychiatry 2023; 35: 252-259
• 4 Moritz S, Scheunemann J, Jelinek L. et al. Prevalence of body-focused repetitive behaviors and disorders in a diverse population sample – rates across age, gender, race and education. Psychol Med 2024; 54: 1552-1558
• 5 Günal Okumuş H, Akdemir D. Body focused repetitive behavior disorders: behavioral models and neurobiological mechanisms. Turk Psikiyatri Derg 2023; 34: 50-59
• 6 Browne HA, Gair SL, Scharf JM. et al. Genetics of obsessivecompulsive disorder and related disorders. Psychiatr Clin North Am 2014; 37: 319-335
• 7 Monzani B, Rijsdijk F, Cherkas L. et al. Prevalence and heritability of skin picking in an adult community sample: A twin study. Am J Med Genet Part B Neuropsychiatr Genet 2012;
• 8 Monzani B, Rijsdijk F, Harris J. et al. The structure of genetic and environmental risk factors for dimensional representations of DSM-5 obsessive-compulsive spectrum disorders. JAMA Psychiatry 2014; 71: 182-189
• 9 Halteh P, Scher RK, Lipner SR. Onychophagia: A nail-biting conundrum for physicians. J Dermatolog Treat 2017; 28: 166-172
• 10 Mansueto C. Trichotillomania: A comprehensive behavioral model. Clin Psychol Rev 1997; 17: 567-577
• 11 Mansueto CS, Vavrichek SM, Golomb R. Overcoming body-focused repetitive behaviors. A comprehensive behavioral treatment for hair pulling and skin picking. Oakland, CA: New Harbinger; 2019
• 12 Moritz S, Penney D, Hoyer L. et al. Risk and maintenance factors in body-focused repetitive behaviours. JEADV Clin Pract 2024;
• 13 Bottesi G, Cerea S, Ouimet AJ. et al. Affective correlates of trichotillomania across the pulling cycle: Findings from an Italian sample of self-identified hair pullers. Psychiatry Res 2016; 246: 606-611
• 14 Roberts S, O’Connor K, Bélanger C. Emotion regulation and other psychological models for body-focused repetitive behaviors. Clin Psychol Rev 2013; 33: 745-762
• 15 Houazene S, Aardema F, Leclerc JB. et al. The role of self-criticism and shame in body-focused repetitive behaviour symptoms. Behav Chang 2021; 38: 10-24
• 16 Chesivoir EK, Collins M, Grant JE. Emotional dysregulation in skin picking disorder. Cognit Ther Res 2024; 48: 156-163
• 17 Houazene S, Leclerc JB, O’Connor K. et al. “Shame on you”: The impact of shame in body-focused repetitive behaviors and binge eating. Behav Res Ther 2021; 138: 103804
• 18 Houghton DC, Alexander JR, Bauer CC. et al. Abnormal perceptual sensitivity in body-focused repetitive behaviors. Compr Psychiatry 2018; 82: 45-52
• 19 Nakell SK. Treatment for body-focused repetitive behaviors. An integrative psychodynamic approach. New York: Routledge; 2022
• 20 Obermayer M. Cheekbiting (morsicatio buccarum). Arch Dermatol 1964; 90: 185
• 21 Spitzer C, Lübke L, Lindstädt T. et al. Prevalence of pathological skin-picking in dermatological patients. J Psychiatr Res 2022; 147: 232-236
• 22 Henkel ED, Jaquez SD, Diaz LZ. Pediatric trichotillomania: Review of management. Pediatr Dermatol 2019; 36: 803-807
• 23 Ravipati P, Conti B, Chiesa E. et al. Dermatillomania: strategies for developing protective biomaterials/cloth. Pharmaceutics 2021; 13: 341
• 24 Solley K, Turner C. Prevalence and correlates of clinically significant body-focused repetitive behaviors in a nonclinical sample. Compr Psychiatry 2018; 86: 9-18
• 25 Torales J, Díaz NR, Barrios I. et al. Psychodermatology of skin picking (excoriation disorder): A comprehensive review. Dermatol Ther 2020; 33: e13661
• 26 Lee DK, Lipner SR. Update on diagnosis and management of onychophagia and onychotillomania. Int J Environ Res Public Health 2022; 19: 3392
• 27 Snorrason I, Ricketts EJ, Stein AT. et al. Trichophagia and trichobezoar in trichotillomania: A narrative mini-review with clinical recommendations. J Obsessive Compuls Relat Disord 2021; 31
• 28 Snorrason I, Ólafsson RP, Flessner CA. et al. The Skin Picking Scale-Revised: Factor structure and psychometric properties. J Obsessive Compuls Relat Disord 2012; 1: 133-137
• 29 Mehrmann LM, Hunger A, Gerlach AL. Pathologisches Hautzupfen/-quetschen (Skin Picking): Erste Ergebnisse zur Psychometrie störungsspezifischer Messinstrumente [Excoriation disorder (Skin Picking): An initial analysis of disorder-specific assessment instruments]. Z Klin Psychol Psychother 2017; 46: 23-31
• 30 Keuthen NJ, O’Sullivan RL, Ricciardi JN. et al. The Massachusetts General Hospital (MGH) Hairpulling Scale: 1. development and factor analyses. Psychother Psychosom 1995; 64: 141-145
• 31 Moritz S, Gallinat C, Weidinger S. et al. The Generic BFRB Scale-8 (GBS-8): a transdiagnostic scale to measure the severity of body-focused repetitive behaviours. Behav Cogn Psychother 2022; 50: 620-628
• 32 Schmotz S, Weidinger S, Markov V. et al. Self-help for body-focused repetitive behaviors: A randomized controlled trial. J Obsessive Compuls Relat Disord 2024; 48: 94-106
• 33 Moritz S, Hoyer L, Abramowitsch A. Motives for performing body-focused repetitive behaviors (BFRBs): Similarities and differences compared to non-suicidal self-injurious and stereotypic movement behaviors. Cognit Ther Res 2024; 48: 1248-1254
• 34 Grant JE, Chamberlain SR. Characteristics of 262 adults with skin picking disorder. Compr Psychiatry 2022; 117: 152338
• 35 Farhat LC, Olfson E, Nasir M. et al. Pharmacological and behavioral treatment for trichotillomania: An updated systematic review with meta-analysis. Depress Anxiety 2020; 37: 715-727
• 36 Skurya J, Jafferany M, Everett GJ. Habit reversal therapy in the management of body focused repetitive behavior disorders. Dermatol Ther 2020; 33: e13811
• 37 Lee MT, Mpavaenda DN, Fineberg NA. Habit reversal therapy in obsessive compulsive related disorders: A systematic review of the evidence and consort evaluation of randomized controlled trials. Front Behav Neurosci 2019; 13: 79
• 38 Mansueto CS, Golomb RG, Thomas AM. et al. A comprehensive model for behavioral treatment of trichotillomania. Cogn Behav Pract 1999; 6: 23-43
• 39 Carlson EJ, Malloy EJ, Brauer L. et al. Comprehensive behavioral (ComB) treatment of trichotillomania: A randomized clinical trial. Behav Ther 2021; 52: 1543-1557
• 40 Golomb R, Franklin M, Grant JE. et al. Expert consensus treatment guidelines: Body-focused repetitive behaviors. Santa Cruz, CA. 2016
• 41 Capel LK, Petersen JM, Woods DW. et al. Mental health providers’ knowledge of trichotillomania and skin picking disorder, and their treatment. Cognit Ther Res 2023; 48: 1-9
• 42 Moritz S, Penney D, Weidinger S. et al. A randomized controlled trial on a novel behavioral treatment for individuals with skin picking and other body-focused repetitive behaviors. J Dermatol 2022; 49: 933-934
• 43 Schmotz S, Dilekoglu E, Hoyer L. et al. Self-help to reduce body-focused repetitive behaviors via video or website? A randomized controlled trial. Cognit Ther Res 2024; 48: 94-106
• 44 Moritz S, Hoyer L, Schmotz S. Two-year follow-up of habit reversal training and decoupling in a sample with bodyfocused repetitive behaviors. Cognit Ther Res 2024; 48: 75-81