Trichotillomania, skin picking disorder and other body-focused repetitive behavior disorders in the ICD-11

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.