Body-Focused Repetitive Behaviors: The Proximal and Distal Effects of Affective Variables on Behavioral Expression

  • Ellen J. Teng
  • Douglas W. Woods
  • Brook A. Marcks
  • Michael P. Twohig


This paper reports on 2 studies designed to examine the contribution of affective variables on the expression of body-focused repetitive behaviors (BFRBs; e.g., skin picking, nail biting). The first study revealed that persons engaging in a BFRB experienced significantly higher levels of anxiety and depression than those without BFRBs. The second study was conducted to determine if repetitive behaviors were differentially affected across various emotional states and across those persons with and without BFRBs. Participants were randomly exposed to anxiety, depression, boredom, and control conditions. Results showed no differential effects on the occurrence of repetitive behaviors within the no-BFRB group; however, the BFRB group engaged in more repetitive behaviors in the Bored condition than in the Control condition. This study offers the first experimental evidence that emotional variables can have a differential impact on the expression of BFRBs.

body-focused behaviors habits emotional regulation anxiety nail biting skin picking 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders-Text Revision (4th ed.). Washington, DC: Author.Google Scholar
  2. Beck, A. T. (1961). Beck Depression Inventory. San Antonio, TX: The Psychological Corporation.Google Scholar
  3. Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: The Guilford Press.Google Scholar
  4. Bohne, A., Wilhelm, S., Keuthen, N. J., Florin, I., Baer, L., & Jenike, M. A. (2002). Skin-picking in German students: Prevalence, phenomenology, and associated characteristics. Behavior Modification, 26 320–339.Google Scholar
  5. Castellanos, F. X., Ritchie, G. F., Marsh, W. L., & Rapoport, J. L. (1996). DSM-IV stereotypic movement disorder: Persistence of stereotypies of infancy in intellectually normal adolescents and adults. Journal of Clinical Psychiatry, 57 116–122.Google Scholar
  6. Christenson, G. A., Ristvedt, S. L., & Mackenzie, T. B. (1993). Identification of trichotillomania cue profiles. Behaviour Research and Therapy, 31 315–320.Google Scholar
  7. Coleman, J. C., & McCalley, J. E. (1948). Nail-biting among college students. Journal of Abnormal and Social Psychology, 43 517–525.Google Scholar
  8. Deardorff, P. A., Finch, A. J., Jr., & Royall, L. R. (1974). Manifest anxiety and nail biting. Journal of Clinical Psychology, 30 378.Google Scholar
  9. Deckersbach, T., Wilhelm, S., Keuthen, N. J., Baer, L., & Jenike, M. A. (2002). Cognitive behavior therapy for self-injurious skin picking: A case series. Behavior Modification, 26 361–377.Google Scholar
  10. Diefenbach, G. J., Mouton-Odum, S., & Stanley, M. A. (2002). Affective correlates of trichotillomania. Behaviour Research and Therapy, 40 1305–1315.Google Scholar
  11. Glaros, A. G., & Rao, S. M. (1990). Bruxism: A critical review. Psychological Bulletin, 84 767–781.Google Scholar
  12. Hansen, D. J., Tishelman, A. C., Hawkins, R. P., & Doepke, K. J. (1990). Habits with potential as disorders. Behavior Modification, 14 66–80.Google Scholar
  13. Iwata, B., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1982). Toward a functional analysis of self-injury. Analysis and Interventions in Developmental Disabilities, 2 3–20.Google Scholar
  14. Keuthen, N. J., Deckersbach, T., Wilhelm, S., Hale, E., Fraim, C., Baer, L., et al. (2000). Repetitive skin picking in a student population and comparison with a sample of self-injurious skin-pickers. Psychosomatics, 41 210–215.Google Scholar
  15. Klatte, K. M., & Deardorff, P. A. (1981). Nail-biting and manifest anxiety of adults. Psychological Reports, 48 82.Google Scholar
  16. Mansueto, C. S., Stemberger, R. M. T., Thomas, A. M., & Golomb, R. G. (1997). Trichotillomania: A comprehensive behavioral model. Clinical Psychology Review, 17 567–577.Google Scholar
  17. O'Sullivan, R. L., Phillips, K. A., Keuthen, N. J., & Wilhelm, S. (1999). Near-fatal skin picking from delusional body dysmorphic disorder responsive to fluvoxamine. Psychosomatics, 40 79–81.Google Scholar
  18. Southam-Gerow, M. A., & Kendall, P. C. (2002). Emotion regulation and understanding: Implications for child psychopathology and therapy. Clinical Psychology Review, 22 189–222.Google Scholar
  19. Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs G. A. (1983). State-Trait Anxiety Inventory for adults. Redwood City, CA: Mind Garden, Inc.Google Scholar
  20. Stanley, M. A., Borden, J. W., Mouton, S. G., & Breckenridge, J. K. (1995). Nonclinical hair-pulling: Affective correlates and comparison with clinical samples. Behaviour Research and Therapy, 33(2), 179–186.Google Scholar
  21. Stehouwer, R. S. (1985). Beck Depression Inventory. In D. J. Keyser & R. C. Sweetland (Eds.), Test critiques (pp. 83–87). Kansas City, MO: Westport.Google Scholar
  22. Stein, D. J., Dana, J. H., Niehaus, D., Seedat, S., & Emsley, R. A. (1998). Phenomenology of stereotypic movement disorder. Psychiatric Annals, 28 307–312.Google Scholar
  23. Tamaka-Matsumi, J., & Kameoka, V. A. (1986). Reliabilities and concurrent validities of popular self-report measures of depression, anxiety, and social desirability. Journal of Consulting and Clinical Psychology, 54 328–333.Google Scholar
  24. Teng, E. J., Woods, D. W., Twohig, M. P., & Marcks, B. A. (2002). Body focused repetitive behavior problems: Prevalence in a nonreferred population and differences in perceived somatic activity. Behavior Modification, 26 340–360.Google Scholar
  25. Twohig, M. P., & Woods, D. W. (2001). Habit reversal as a treatment for chronic skin picking in typically developing adult male siblings. Journal of Applied Behavior Analysis, 34 217–220.Google Scholar
  26. Twohig, M. P., Woods, D. W., Marcks B. A., & Teng, E. J. (2003). Evaluating the efficacy of habit reversal: Comparison with a placebo control. Journal of Clinical Psychiatry, 64 40–48.Google Scholar
  27. Wilhelm, S., Keuthen, N. J., Deckersbach, T., Engelhard, I. M., Forker, A. E., Baer, L., O'Sullivan, R. L., & Jenike, M. A. (1999). Self-injurious skin picking: Clinical characteristics and comorbidity. Journal of Clinical Psychiatry, 60 454–459.Google Scholar
  28. Woods, D. W., Friman, P. C., & Teng, E. (2001). Physical and social functioning in persons with repetitive behavior disorders. In D. W. Woods & R. G. Miltenberger (Eds.), Tic disorders, trichotillomania, and other repetitive behavior disorders: Behavioral approaches to analysis and treatment (pp. 33–52). Norwell, MA: Kluwer Academic.Google Scholar
  29. Woods, D. W., Fuqua, R. W., Siah, A., Murray, L. K., Welch, M., Blackman, E., et al. (2001). Understanding habits: A preliminary investigation of nail biting function in children. Education and Treatment of Children, 24 199–216.Google Scholar
  30. Woods, D. W., & Miltenberger, R. G. (1995). Habit reversal: A review of applications and variations. Journal of Behavior Therapy and Experimental Psychiatry, 26 123–131.Google Scholar
  31. Woods, D. W., & Miltenberger, R. G. (1996). Are persons with nervous habits nervous? A preliminary examination of habit function in a nonreferred population. Journal of Applied Behavior Analysis, 29 259–261.Google Scholar
  32. Woods, D. W., Miltenberger, R. G., & Flach, A. D. (1996). Habits, tics, and stuttering: Prevalence and relation to anxiety and somatic awareness. Behavior Modification, 20 216–225Google Scholar

Copyright information

© Plenum Publishing Corporation 2004

Authors and Affiliations

  • Ellen J. Teng
    • 1
    • 2
  • Douglas W. Woods
    • 1
  • Brook A. Marcks
    • 1
  • Michael P. Twohig
    • 1
    • 3
  1. 1.Department of PsychologyUniversity of Wisconsin – MilwaukeeMilwaukee
  2. 2.The Veterans Affairs Medical Center/Baylor College of Medicine in HoustonHouston
  3. 3.University of Nevada –Reno, RenoNevada

Personalised recommendations