Motives for Performing Body-Focused Repetitive Behaviors (BFRBs): Similarities to and Differences from Non-Suicidal Self-Injurious and Stereotypic Movement Behaviors

Abstract

Abstract Background In the DSM-5, body-focused repetitive behaviors (BFRBs) are now classified in the obsessive-compulsive and related disorders section. Differential diagnosis is complicated by the overlap of BFRBs with other disorders, especially non-suicidal self-injurious behavior (NSSI) and stereotypic movement behavior (SMB). The present study examined participants’ motives for performing BFRBs to provide a better understanding of how BFRBs may differ from NSSI and SMB and to determine whether BFRB is best characterized as an obsessive-compulsive spectrum disorder. Methods A total of 268 individuals with various BFRBs were assessed with respect to their motives for performing BFRBs, comorbid diagnoses, emotions accompanying their BFRBs, and whether they felt an urge to perform the behavior on others as well as themselves. Results The main motives for performing BFRBs were release of stress (84.7%), boredom (51.5%), and gratification/pleasure (34.7%). Approximately one third of the sample were unable to provide a clear motive. The majority were ambivalent about their behavior. Participants rarely engaged in cutting; 16.4% performed a BFRB on someone else’s body or wanted to do so. OCD was self-reported by only 7.5% of the participants. Discussion Ambivalence towards symptoms is high in individuals with BFRBs; the main motive for performing the behavior was emotion regulation, particularly of stress. Limitations of the study are the self-reported assessment and the high attrition during the assessment. Further research is needed to clarify whether BFRBs, NSSI, and SMB should be kept separate or should be combined into one category, perhaps with specifiers. The current classification of BFRBs as an OCD-related disorder should be reconsidered.