Body Focused Repetitive Behaviors (BFRBs) are a usual occurrence in routine dermatology clinic. It commonly presents in the forms of onychotillomania, trichotillomania, dermatillomania, lip biting etc. While the field of psychodermatology helps in identifying such behaviours and managing them, body-focused behavior disorders still remain a huge challenge for the clinicians.

Treatment for Body Focused Repetitive Behaviors – An integrative Psychodynamic Approach, by Stacy Nakell, is divided into two parts. The first part is about the understanding of BFRBs and the second part introduces the reader to her integrative psychodynamic treatment approach. The book provides a concise, yet complete overview of the BFRBs and their management.

Stacy very effectively explains the etiology of body-focused repetitive behaviors. She shifts the perspective on BFRBs to capture how normal it is for us to soothe and groom our own selves by touching our skin. She explains that grooming behaviors serve important functions including comfort, hygiene, self-expression and social connection. They are the means of relieving the emotional burden that is stored in the body. The effect of this shift in perspective is to understand body-focused behaviors as coping mechanisms and thus to decrease the shame that coats the behaviors.

The author goes on to describe the psychological basis of developing BFRBs, focusing on the concepts of psychic skin, attachment theory, soft and hard comforts and perfectionism; and how all of these can play a role in development and maintenance of reliance on body-focused behaviors.

The author talks about the history of treating BFRBs in the fields of dermatology, psychiatry and mental health. Currently, the most widely used approaches to the management of these disorders include habit reversal therapy (HRT) and cognitive behaviour therapy (CBT). However, BFRBs treated with these approaches tend to recur frequently and don’t usually lead to long-term remission. The author proposes that an integrated psychodynamic approach can be really useful in providing an effective care and management to these patients.

The second part of the book focuses on the management aspect of the BFRBs. Nakell effectively describes the rationale of using the integrative psychodynamic approach quoting ample scientific evidence. She outlines the phases of this treatment approach: the safety phase, exploration and intervention phase, and adjournment phase. She has dedicated different chapters for each of these phases which makes the book a very informative read. Chapters about family therapy and group therapy as adjuncts to individual therapy open new possibilities for deepening the healing process.

Case examples bring the material to life and the reading experience is lively and interesting. The appendices attached at the end of the book provide a very useful guidance for the day to day practice.

As we move into the world that is becoming faster and faster with each passing day, the traditional psychodynamic approach of therapy has been replaced by newer schools of therapies like cognitive therapies, behaviour therapies, mindfulness-based therapies etc., since they are more practical and provide results in relatively shorter periods of time than the traditionally used psychodynamic therapies. However, here the author has developed an integrative approach, in which she has taken elements from cognitive, behaviour and mindfulness-based therapies along with the traditional psychodynamic approach. Such holistic approach makes this book a compelling read. Taking such an approach can start giving the results to the patients relatively quicker and maintain their compliance over the long periods that the psychodynamic approach can take for prevention of relapses.

The limitations of this book are few. It requires basic understanding of psychology and its various schools prior to picking up this book. This book is most useful for those clinicians who are dealing with patients with BFRBs on a regular basis. A background about how psychodynamic therapy works is necessary to implement this approach in practice, as it is out of the scope of this book to teach how to do psychodynamic therapy in detail. The author also acknowledges that this approach is a long-term approach that can take several years. Further research into the efficacy of an integrative psychodynamic approach for the treatment of BFRBs is recommended.