WHAT WE TREAT: Behavorial Disorders

BEHAVIORAL DISORDERS IN CHILDREN & TEENS

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BDD - Body Dysmorphic Disorder

Description: AS they develop and grow our children experience tremendous changes in their bodies. It is normal for a child to experience some anxiety and concerns about their bodies at times. However an excessive focus on body appearance can be a sign of the Obsessive Compulsive related disorder of Body Dysmorphic Disorder (BDD).

BDD consists of obsessions (repetitive thoughts or images) related to body or appearance and compulsions (physical or mental behaviors or avoidance of situations), which function to reduce the anxiety, your child experiences as a result of his or her body-focused obsessions.

Symptoms:

Symptoms of Body Dysmorphic Disorder include:

  • being preoccupied and distressed with a perceived appearance-related defect or flaw
  • frequently and negatively comparing their own appearance with peers or celebrities
  • getting “stuck” in front of mirrors or reflective surfaces
  • repeatedly asking for reassurance about their appearance
  • extreme difficulty deciding which clothes to wear
  • wearing the same clothes repeatedly and refusing to wear different clothing
  • exercising excessively
  • engaging in excessive grooming routines

Treatment & Parental Involvement: Along with the treatment provided for Obsessive Compulsive Disorder, treatment for BDD may include “perception retraining”. This involves retraining your child’s self-perception through viewing themselves in the mirror during structured exposure exercises while also narrating their appearance with neutral terms. Your child’s experienced therapist at the Anxiety and Depression Center will identify the appropriate treatment components that will help them to minimize anxiety and reduce their BDD symptoms.

Hair Pulling (Trichotillomania)

Description: Trichotillomania (also referred to as “Trich”) is an Obsessive Compulsive related disorder that involves the pulling of hair from the scalp, eyebrows, eyelashes, or from other body parts. Children who experience trichotillomania are often able to hide this disorder from family and friends until the pulling behaviors result in bald spots on the head, eye area or other parts of the body.

Trichotillomania consists of obsessions (repetitive thoughts and images) and compulsions (repetitive behaviors) typically related to desire for symmetry, perception that the hair strand “doesn’t feel right” in texture, attempts to pull the hair in a certain manner, sensation of “itchiness or tingling” in the area of the hair-pulling or examining/manipulating the hair strand extensively after it is pulled, which may include rolling it into a ball or pulling it between one’s teeth. Your child may feel extreme anxiety and distress if you attempt to prevent them from engaging in these hair-pulling actions.

Symptoms:

Your child may suffer from Trichotillomania if you notice that your child:

  • spends extensive amounts of time alone in their bedroom or bathroom
  • leaves unexpected loose hairs on furniture, the floor, in the wastebasket
  • has bald spots on his or her scalp, eye area, or other body parts
  • complains of stomachaches or nausea (possibly due to swallowing excessive hair strands)

Treatment: Exposure therapy for Trichotillomania may include having your child spend time in the area that typically triggers hair pulling while systematically and purposely not engaging in hair pulling behavior. Treatment may also involve having your child learn and engage in alternative benign strategies (to replace the stimulating sensorial sensations they receive from hair-pulling and to provide alternative activities for the hands and fingers), such as playing with silly putty, “fidget” toys such as fidget spinner, “koosh balls”, etc. Your child may also learn a number of anxiety management coping strategies that will enable them to engage in these exposure exercises.

Skin Picking (Excoriation/Dermatillomania)

Description: Excoriation (Skin-Picking) Disorder is an Obsessive-Compulsive related disorder. Excoriation Disorder, sometimes referred to as Dermotillomania, involves recurrent skin-picking behavior and typically is focused on acne, scabs, or perceived imperfection in skin such as around the nail area. The recurrent picking behavior typically results in lesions (which may also result in infections and scarring).

Many children and adolescents engage in skin-picking due to boredom, anxiety, or a perception that the area of focus “isn’t right”. Your child may use his or her fingernail or an instrument such as tweezers or a pin to engage in the skin picking behavior.

Symptoms:

Your child may be struggling with Excoriation Disorder if he or she:

  • spends excessive amounts of time alone in their bedroom, in the bathroom, or in front of mirrors
  • experiences significant distress related to acne or skin imperfections
  • has repeatedly attempted to cease skin-picking, but is unable to stop the behavior
  • suffers lesions, infections, or scarring related to their picking
  • refuses to attend events due to the condition of their skin
  • attempts to cover up the perceived skin imperfections and feels shame related to their perceived skin imperfections

Treatment: Exposures for Excoriation may include limiting time spent in front of mirrors, along with other exposures your child’s experienced therapist will identify. Treatment may also involve having your child learn and engage in alternative benign strategies (to replace the stimulating sensations they receive from skin-picking or to provide alternative activities to engage the hands and fingers), such as playing with silly putty, “fidget” toys such as fidget spinner, “koosh balls”, etc. Your child may also learn a number of anxiety management coping strategies that will enable them to engage in these exposure exercises.

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