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Trichotillomania, Skin Picking, & Other Body-Focused Repetative Behaviors
Authors:Jon E. Grant, M.D., M.P.H., J.D., Dan J. Stein, M.D., Ph.D., Douglas W. Woods, Ph.D., and Nancy J. Keuthen, Ph
ISBN 13: 978-1-58562-398-3
American Psychiatric Publishing
List Price: $57.00  Members: $47.20  Members-In-Training $44.95    268 Pages  Soft Cover 
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   MedicalScienceBooks.com Medical Book Review:

     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):

Overall Rating:


Author’s objectives met:



Organization of information: 9
Significant number of illustrations: 3
Suitable for intended audience: 9
Overall presentation: 8
Quality of illustrations: na
Usefulness of book:   8
Value: 9
Writing style: 9


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 disorder.
  • 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 compassionate manner.

Table of Contents:

Part 1: Clinical Characteristics.

Trichotillomania: epidemiology and clinical characteristics.
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 trichotillomania.
Cognitive-behavioral therapy in adults.
Alternative treatments.
Family involvement in the treatment of children with body-focused repetitive behaviors.

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