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Body-focused repetitive behaviors are a relatively common group of
manifestations of underlying psychiatric pathology. The severities of
the pathologies vary as these behaviors are sometimes expressed as a
comorbid condition to a higher profile psychiatric diagnosis such as
schizophrenia. However, it is increasingly becoming evident in the
clinic that behaviors such as skin picking, trichotillomania, etc…often
are seen as stand-alone findings without any other overt conditions.
The editors of Trichotillomania, Skin Picking, & Other Body-Focused
Repetitive Behaviors have set out to provide a comprehensive guide
for healthcare professionals to aid in the recognition and management of
patients displaying these behaviors. Many mental health professionals
and even more primary care practitioners miss the diagnosis of
trichotillomania. Some of these aren’t even fully aware of the
existence of a diagnosis for these conditions which are not noticed, not
inquired about, or are mistakenly referred out to neurology under the
guise of movement disorders.
Trichotillomania, Skin Picking, & Other Body-Focused Repetitive
Behaviors thus will serve as eye-opener to many professionals who
are on the frontlines of patient encounter. The 13 chapters are divided
into 3 parts which contain balanced coverage of information on clinical
presentation, diagnosis, and treatment. An impressive amount of
research has been incorporated into the chapters of this book.
Reference sections at the end of the chapters serve in many cases are
nearly a complete list of the existing literature on a topic. This
speaks to the lack of literature in general in this area and the need
for this book. For those topics such as repetitive body picking that
have a moderate amount of research from several different fronts, care
is taken to at least outline some of the more promising findings from
each camp. Therefore, the psychological literature heavily influenced
by motivation theory is represented as well as more bench top science
theories involving neurotransmitters. Much effort is also placed on the
description of distinctive presentations that will cue the clinician
that a problem may exist which requires further investigation. Gender
differences and situational circumstances under which problem behavior
occurs is emphasized in an effort to improve diagnosis. Finally,
treatment strategies are discussed in the context of a series of
chapters which each focus on different approaches such as cognitive
behavioral therapy, alternative therapies and pharmacotherapy.
Despite the multitude of studies that are referenced within the
text, readers will still find that the chapters flow well and are easy
to read. This mainly applies to those readers who are professionals in
the field of mental health or medicine. Although one of the intentions
of this book was to provide patients and their families with expert
information about their conditions, it falls somewhat short of that
level of accessibility. This is not to say that a lay readership could
not gain valuable information by consulting this volume, but they will
need to work harder to work through the large number of research
articles discussed. Readers may have some trouble discerning between
those studies that have findings essential to an understanding of these
behaviors versus those that are of less clinical importance.
This volume will have most benefit in the hands of primary care
physicians with a special interest in the recognition of psychiatric
conditions and behaviors which are suggestive of such pathology. Keen
observation of their patients and a focused inquiry when necessary will
likely uncover many cases of these stereotypical behaviors which will
require referral to behavioral specialists. Those more familiar with
this area of psychiatric practice will refer to this book often as each
patient will require a unique approach based on the many options
discussed in its pages.
Ratings (1-10 , 10 being the highest):
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Underestimated, under-researched, and often
poorly understood, the body-focused repetitive disorders nevertheless
cause human suffering that is serious, persistent, and pervasive. These
disorders can occur in both adults and children and manifest themselves
as hair pulling (trichotillomania), pathologic skin picking, thumb
sucking, and nail biting. Although these disorders are common, very few
medical students and residents hear them addressed in lectures or know
where to begin when confronted with a patient presenting with these
behaviors. Trichotillomania, Skin Picking, and Other Body-Focused
Repetitive Behaviors seeks to remedy this situation by synthesizing
the latest research on body-focused repetitive disorders and presenting
it in a systematic, easy-to-grasp manner.
Much has changed in the more than a decade
since the last book on this topic was published. This new volume
reflects the most current and substantive research into the etiology and
symptoms of body-focused repetitive disorders and therapeutic options.
Organized in logical fashion, it begins with a review of the clinical
characteristics, moves on to diagnosis and evaluation, and concludes
with a full review of treatment options. Special features include:
- Extensive material to help
clinicians and patients understand the underlying purpose of
engaging in these behaviors, which include, reducing tension,
regulating strong emotion, and alleviating boredom.
- Separate chapters on adults and
children, who may have a different presentation and a different set
of treatment options. An additional chapter focuses on the role of
the child patient’s family in the diagnosis and treatment of the
- Thorough coverage of the full range
of treatments—including psychotherapy, medication, and alternative
treatments—which provides the clinician with an evidence-based
approach to treating patients.
- Discussion of the psychobiology of
hair pulling and skin picking, which allows the reader to understand
and contextualize the disorder from a neurological perspective and
offers clues that may assist in optimizing treatment.
- A presentation style that is
detailed enough for clinicians, yet accessible enough for a lay
audience, including patients with the disorder and the families who
seek to understand and support them.
Trichotillomania, Skin Picking, and
Other Body-Focused Repetitive Behaviors fills a critical gap in the
literature by addressing this common and frequently debilitating
disorder in an utterly current, highly practical, and wholly
Part 1: Clinical Characteristics.
Trichotillomania: epidemiology and clinical
Pathologic skin picking.
Habitual stereotypic movements: a descriptive analysis
of four common types.
Psychobiology of hair pulling disorder (trichotillomania)
and skin picking disorder.
Part 2: Diagnosis and Evaluation.
Diagnosis and comorbidity.
Dermatological assessment of hair pulling, skin picking,
and nail biting.
Diagnosis and evaluation: trichotillomania, skin
picking, and other stereotypic behaviors in children.
Assessment of trichotillomania, pathological skin
picking, and stereotypic movement disorder.
Part 3: Treatment.
Cognitive-behavioral therapy for pediatric
Cognitive-behavioral therapy in adults.
Family involvement in the treatment of children with
body-focused repetitive behaviors.
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