Body-focused
Repetitive Behaviors (BFRBs), a group of disorders that includes hair pullingdisorder, excoriation disorder
(compulsive skin picking), and nail-biting, represent a group of problems not well
recognized or understood by health professionals. Even psychologists,
psychiatrists, and dermatologists may not always get it right, and so it should
come as no surprise that pediatricians are not as well educated about them as
they could be. As a psychologist, over the years I have seen countless examples
of how these child specialists, when faced with a BFRB, would brush it off with such statements as, “It’s
just a phase,” “Give it time—they’ll grow out of it,” “They must be really
stressed out,” or “It’s just a bad habit.” Their suggestions can include
punishing the child for the behavior, rewarding the child for not doing the
behavior, putting bandages on their fingers, or having them wear hats.
I recently
saw a case of a young adolescent girl taken to a dermatologist who examined the
patient and simply sent her home with a prescription for a topical steroid
cream. In another case, a pediatrician called a child’s hair-pulling "a
bad habit" and recommended that the mother punish her child whenever she
was spotted pulling her hair. No attempt was made to understand what was going
on or to make a real diagnosis.This is, unfortunately, all too typical.
My
suggestions for medical professionals would be as follows:
1.
When you see a child with hair loss, do not neglect to ask if they pulled it out themselves. If
there are scabs or skin wounds, ask if they did this to their own skin. Do not
be surprised if you are met with excuses or denial, as many children and adults
with BFRBs feel extremely stigmatized and may be reluctant to admit to doing
it.
2.
These disorders have a great deal of emotional fallout and can be great sources
of shame and isolation. Watch your own reactions when
encountering people with BFRBs. Things like tone of voice, body language, facial expressions, and the way you
examine them can have a very powerful impact. Try to be more reassuring that
many other children and young people do these types of things also, and that
this doesn’t make them abnormal or "bad" people.
3.
As far as we know, females with BFRBs may outnumber males at a ratio of 9 to 1.
4.
If necessary, also try to reassure parents that the pulling or picking is not a sign
of some serious underlying disturbance, and can be effectively treated with the
right type of therapy. Also, try to discourage parents from blaming
themselves.
5.
Don’t simply assume that hair pulling and skin picking are due to stress, are a sign of some other deep underlying
problem, or are some kind of developmental phase. These behaviors are much more
complex than that and need to be understood. Aside from a minority of very
early onset cases seen in toddlers that eventually resolve themselves, they are
not simply developmental and can be lifelong.
6.
Don’t assume the pulling or picking behaviors are a reaction to some kind of
hardship or trauma, like abuse. These behaviors are largely due to
sensory issues, and are most often done when a child is either understimulated
(bored or sedentary) or overstimulated (stressed or even happily excited).
7.
In the case of hair pulling, be sure to inquire about whether or not the child
is swallowing the hairs. Such behavior can lead to the formation of
Trichobezoars. which then have to be removed surgically and can be
life-threatening.
8.
Try to educate yourself about BFRBs. As a group, they involve around 5 percent
of the population, so you will undoubtedly encounter them in your practice. The
information is out there. The TLC Foundation for Body-Focused Repetitive
Behaviors provides an excellent source at bfrb.org.
9.
BFRBs can be effectively treated via a type of comprehensive behavioral
therapy, but only as practiced by those who have specialized training and
experience with these disorders. Ordinary talk or play therapy, or such approaches as relaxation training
or hypnosis have never been shown to be effective
interventions.
10.
Develop a list of referral sources in your region of specialized behavioral
therapists who treat BFRBs, and don’t hesitate to send people to them for
treatment. Effective treatment is out there if you take the time to look. You
can get names from the TLC Foundation and also the Association
for Behavioral and Cognitive Therapy.
Source: Medical News Today
No comments:
Post a Comment