(PS5-70) The Co-Occurrence of Body-Focused Repetitive Behaviors and Eating Disorders: Insights from a Residential Treatment Sample

Abstract Text:

Introduction: Both body-focused repetitive behaviors (BFRBs) and eating disorders (EDs) involve recurrent, body-related behaviors that cause distress and functional impairment. Notably, both conditions are associated with impulsivity and compulsivity, and frequently co-occur with obsessive-compulsive disorder (OCD). Despite these shared features, the relationship between BFRBs and EDs has received limited research attention.

Methods: This study investigated the prevalence of both subclinical and clinical BFRBs (hair pulling, skin picking, nail biting, and mouth chewing) within a sample of 97 female adolescents and adults receiving residential treatment for EDs. The sample included 85 individuals with anorexia nervosa (n=49 restricting and n=36 binge-eating/purging subtypes), 9 with bulimia nervosa, and 1 with other specified feeding or ED. The Habit Questionnaire was used to identify BFRBs. We tested ED symptom severity (Eating Disorder Examination Questionnaire) and OCD symptom severity (Dimensional Obsessive-Compulsive Scale) as predictors of BFRB presence.

Results: A significant proportion of the sample exhibited BFRBs: 37% met criteria for clinically significant BFRBs, and 31% displayed subclinical behaviors. The most prevalent clinical BFRBs were skin picking, mouth chewing, and hair pulling. Subclinical BFRBs were most commonly nail biting, mouth chewing, and skin picking. Higher ED and OCD symptom severity predicted having a BFRB, with OCD symptoms demonstrating a stronger predictive relationship.

Discussion: These findings suggest BFRBs may be common in clinical ED samples. The predictive power of ED and, particularly, OCD symptoms suggests that shared underlying mechanisms, such as impulsivity, compulsivity, and emotion dysregulation, may contribute to the co-occurrence of these conditions. The prevalence of BFRBs in this residential ED sample underscores the importance of assessing for BFRBs within ED treatment settings, which could inform tailored interventions to target BFRBs. Future research should focus on elucidating the underlying mechanisms and risk factors that explain the overlap between EDs and BFRBs.