Should there be a category: “grooming disorders?”

Abstract

Summary Grooming disorders, such as trichotillomania (TTM), nail biting, and skin picking, are receiving increasing attention from researchers and clinicians. This is in part due to their possible link to obsessive–compulsive disorder (OCD). It is imperative that these disorders are categorized correctly in order to facilitate research and aid diagnosis and treatment. However, within current psychiatric classification systems TTM is currently conceptualized as an impulse control disorder and nail biting, lip biting, and skin picking are not yet included in the official nomenclature. It is therefore unclear whether these grooming disorders should form a category on their own (i.e., “grooming disorders” or “pathological grooming behaviors”), or whether they should be classified as obsessive–compulsive spectrum disorders (OCSD), impulse control disorders, or as body-focused repetitive behaviors. This chapter will discuss these diagnostic and taxonomic issues particularly as they pertain to clinical practice, fostering further discussion on the psychopathology of aberrant grooming behaviors. Introduction The positioning of TTM and other conditions characterized by self-directed repetitive behaviors (e.g., nail biting and pathological skin picking [PSP]) within existing psychiatric classification systems has recently been debated (e.g., Stein et al . 2007). Trichotillomania is classified in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; APA, 2000) as an impulse control disorder. However, some researchers suggest that TTM is an OCSD (Swedo and Leonard 1992).