Pathologic grooming (acne excoriee, trichotillomania, and nail biting) in 4 generations of a single family.

BFRBDs: body-focused repetitive behavior disorders DSM: Diagnostic and Statistical Manual of Mental Disorders INTRODUCTION Trichotillomania (hair pulling disorder), excoriation (skin-picking) disorder, and other body-focused repetitive behavior disorders (BFRBDs) have received increasing attention in the psychiatric nomenclature. Trichotillomania was introduced in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in DSM-III-R in 1987, whereas skin-picking disorder was introduced in the most recent edition of the manual, DSM-5. DSM-5 includes both disorders and also refers to other less well-studied BFRBDs, such as nail biting, in a new chapter on obsessive-compulsive and related disorders. A somewhat similar approach is likely to be taken in the next revision of the International Classification of Diseases. These disorders, which also represent pathologic grooming, may be particularly prevalent in dermatologic practice where they are sometimes precipitated by skin conditions such as acne (acne excoriee). Fortunately, there have been important advances in understanding the phenomenology and psychobiology of these conditions in recent decades. In particular, studies find that these are prevalent conditions that are associatedwith significant impairment and reduced quality of life and are responsive to specific pharmacotherapeutic and psychotherapeutic interventions. Studies emphasize that there is significant comorbidity between these conditions and that they may well share underlying psychobiological mechanisms, including familial and genetic risk factors, Further work is needed to understand the familial and genetic risk factors for the BFRBDs. Very few gene association studies have been undertaken, and