Four of us from CBSN were able to make it to the 2nd Annual Frederick W. Thompson Centre Anxiety and Related Disorders Centre conference at Sunnybrook Hospital in Toronto on Monday, March 10. As it was a full day of information we just want to share some pertinent information that we learned specifically about BFRB treatments. Other topics that were covered were, hoarding disorder, OCD treatment, pharmacology for OCD and related disorders, and mindfulness. If you want any information on these other things, let us know and we can send you what we have.
Dr. Mark Sinyor did a wonderful presentation about BFRB treatment, I have summarized important points from his lecture. I have also added a couple of points at the end from another lecture by Dr. Peggy Richter.
- It’s important to recognize that though there are a lot of similarities between people with BFRBs, there is no one-size-fits-all cure or treatment.
- Treatment: The best option seems to be a modification of Cognitive Behavioural Therapy that takes into account SCAMP:
Sensation (What does it feel like for you?)
Cognition (What are you thinking about when you do it?)
Affect (What kind of purpose does it serve?)
Motor (What are you doing specifically, with what arm?)
Place (Where are you most likely to do it?)These are very crucial things that someone with BFRBs should try to become more aware of.
- The cognitive part of BFRBs is in fact a cognitive distortion. For example, often skin-pickers will feel as though they need to remove something from under the skin (because it’s going to be a pimple or it feels weird, etc).) Though we may have very real feelings that tell us we have to do it, these thoughts are not reality. In fact, it is counterproductive to maintaining a healthy body. These thoughts will be very hard to challenge but we should always try to challenge them sometimes.
- Motivation: The motivation for people to do these behaviours varies between times and individuals. It could either be a need for stimulation (in times of boredom), or it could be anxiety-reducing (in times of high stress). OCD therapies often work with anxiety-reducing behaviours and thus will not work for our BFRB self-stimulating behaviours.
- Medication: There have been moderate successes with different medications, specifically clomipramine (an OCD treatment) and n-acetyl cysteine, but overall the conference emphasized that medication is not the best long-term treatment.
- Finding a therapist: It is so important to find a therapist that makes you feel comfortable discussing the particulars of your BFRBs without the confusion or excessive concern that these behaviours normally provoke. Unfortunately, it’s very hard to find a therapist like this because of the lack of research and resources.
[Peer support groups are the next best thing].
- Self-help: Do not underestimate self-help. Apparently, self-help works completely for milder cases of disorders on the OCD spectrum and 30% of OCD cases don’t even need to go into more intensive therapies. This statistic is unfortunately not specific to BFRBs but it just goes to show you that your mind is capable of helping itself!
- The BFRB brain: Research has shown that there is a slight abnormality in the basal ganglia and the cerebellum [These are motor and habit learning areas].
- Comorbidity: 22% of BFRBs are comorbid with [happen at the same time as] an OCD diagnosis. There is also higher comorbity with Body Dysmorphic Disorder but the percentage was not specified.
Summarized by Rebecca