Does Trauma Cause Body-Focused Repetitive Behaviors? Not Quite

"When the causes of body-focused repetitive behaviors (BFRBs), such as hair pulling (trichotillomania), skin picking (excoriation disorder), or nail biting, are discussed, the question often arises: Are these behaviors caused by trauma? It's a fair question. The assumption makes intuitive sense. Many behaviors that cause physical harm or distress are linked to emotional pain or traumatic experiences. However, the science paints a more nuanced picture."

"Empirical studies exploring trauma histories among individuals with body-focused repetitive behaviors (BFRBs) have produced mixed, but generally nonsupportive, findings regarding a causal link. Early work by Christenson and Crow (1996) found childhood trauma rates among people with trichotillomania to be similar to those observed in the general population. In contrast, Özten et al. (2015) reported somewhat higher trauma exposure among individuals with trichotillomania and skin-picking disorder compared to controls, yet trauma history was not predictive of symptom severity, suggesting correlation rather than causation."

"Similarly, Houghton et al. (2016) conducted a large-scale analysis and concluded that the association between trauma and trichotillomania is "tenuous at best." A broader review by Roberts, O'Connor, and Bélanger (2013) emphasized that habit-based and neurobehavioral mechanisms, rather than trauma pathways, best explain BFRB development and maintenance. Collectively, these findings indicate that while trauma may be present in some individuals with BFRBs, it is neither necessary nor sufficient for their emergence."

Empirical research into trauma histories among people with body-focused repetitive behaviors (BFRBs) has produced mixed results and generally does not support trauma as a causal factor. Some studies report trauma rates similar to the general population while others find higher exposure without links to symptom severity. Large-scale analyses describe the trauma association as tenuous. Reviews emphasize habit-based and neurobehavioral mechanisms as primary explanations for BFRB development and maintenance. Trauma can be present in some individuals with BFRBs, but it is neither necessary nor sufficient for occurrence. Treatment centers on building healthy self-regulation and self-care strategies to manage symptoms.

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