Zusammenfassung
In der 11. Version der Internationalen statistischen Klassifikation der Krankheiten und verwandter Gesundheitsprobleme (ICD-11) findet sich erstmals die Kategorie der Körperbezogenen repetitiven Verhaltensstörungen (engl. „body-focused repetitive behavior disorders“, BFRBDs), die u. a. die Trichotillomanie (TTM) sowie die Skin-Picking-Störung (SPS) enthält und dem Zwangsspektrum zugeordnet ist. Diese Neuerung umfasst sowohl die Neukategorisierung der TTM, die in der ICD-10 noch bei den „abnormen Gewohnheiten und Störungen der Impulskontrolle“ verortet war, als auch die erstmalige Einführung einer eigenständigen Diagnose für die SPS. Trotz beachtlicher Prävalenzen (TTM: 1–2 %; SPS: 1,4–3,1 %) wurden die TTM und die SPS bislang in Fachkreisen wenig beachtet, was sich neben einem hohen Forschungsbedarf – auch in Bezug auf die nosologische Verortung – insbesondere in mangelhaften Versorgungsangeboten widerspiegelt. Bezüglich der Einordnung im Zwangsspektrum ist kritisch anzumerken, dass die Störungsbilder zwar Ähnlichkeiten mit der Zwangsstörung zeigen, aber dennoch fundamentale Unterschiede in Symptomatik, Ätiologie und Behandlung zu beachten sind. In diesem Kontext sollte davon abgesehen werden, TTM und SPS pauschal als Zwangsstörungen zu bezeichnen. Vielmehr sollten die individuellen Besonderheiten der BFRBD, die sich bei Betroffenen durch eine impulshafte, zwanghafte oder auch suchtartige Phänomenologie äußern können, individuell und differenziert analysiert und behandelt werden, um die bestmögliche Versorgung zu gewährleisten. Insgesamt bietet die Einführung der BFRBD-Kategorie mit einer eigenständigen Diagnose für die SPS in der ICD-11 wichtige Chancen zur Verbesserung der Forschungs- und Versorgungslage.
Abstract
The 11th version of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) includes for the first time the category of body-focused repetitive behavior disorders (BFRBDs), which includes trichotillomania (TTM) and skin-picking disorder (SPD) and is subsumed in the obsessive-compulsive spectrum. This innovation thus includes both the recategorization of TTM, which was located in the category of habit and impulse disorders in the ICD-10, and also the first-time introduction of a discrete diagnosis for SPD. Despite considerable prevalences (TTM 1–2%, SPD 1.4–3.1%) TTM and SPD have so far received little attention among researchers and therapists, which is reflected not only in a high need for research, also with respect to the nosological categorization, but also particularly in insufficient specific treatment options. Regarding the classification in the obsessive-compulsive spectrum, it should be critically noted that although the disorders show similarities to obsessive-compulsive disorder, fundamental differences in symptomatology, etiology and treatment must be considered. In this context, it should be refrained from calling TTM and SPD obsessive-compulsive disorders in a generalized way. Instead, the individual characteristics of BFRBDs, which can manifest in affected individuals as an impulsive, obsessive or even addictive-like phenomenology, should be differentially analyzed and treated individually to ensure the best possible care. Overall, the introduction of the BFRBD category with a separate diagnosis for SPD in ICD-11 provides important opportunities to improve the research and treatment situation.
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Gallinat, C., Schmidt, J. Trichotillomanie, Skin-Picking-Störung und andere körperbezogene repetitive Verhaltensstörungen in der ICD-11. Psychotherapie (2024). https://doi.org/10.1007/s00278-024-00718-5
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DOI: https://doi.org/10.1007/s00278-024-00718-5