Evidence-Based Psychosocial Treatments for Pediatric Body-Focused Repetitive Behavior Disorders

Habits, such as hair pulling and thumb sucking, have recently been grouped into a category of clinical conditions called body-focused repetitive behavior disorders (BFRBDs). These behaviors are common in children and, at extreme levels, can cause physical and psychological damage. This article reviews the evidence base for psychosocial treatment of pediatric BFRBDs. A review of academic databases and published reviews revealed 60 studies on psychosocial treatments for pediatric BFRBDs, 23 of which were deemed suitable for review. Based on stringent methodological and evidence base criteria, we provided recommendations for each specific BFRBD. Individual behavior therapy proved probably efficacious for thumb sucking, possibly efficacious for several conditions, and experimental for nail biting. Individual and multicomponent cognitive-behavioral therapy was named experimental for trichotillomania and nail biting, respectively. No treatment met criteria for well-established status in the treatment of any BFRBD. Recommendations for clinicians are discussed. Reasons for the limitations of existing research in children and adolescents are explored. Several recommendations are presented for future pediatric treatment research on BFRBDs.