Beyond the surface: Neurocognitive deficits in body-focused repetitive behaviors

Objectives: Body-focused repetitive behaviors (BFRBs) include activities like hair pulling and skin-picking that can lead to functional impairment. The neurocognitive underpinnings of BFRBs remain unclear, with inconsistent findings across domains. Methods: This online study aimed to investigate the neuropsychological capacities of individuals with self-reported BFRBs. We administered the Go/No-Go test to assess inhibitory control and attention and the Verbal Learning and Memory Test to evaluate learning, recall, and memory confidence. From the 2,129 participants who entered the survey, 412 individuals with self-reported BFRBs and 412 matched controls from the general population were included. Drop-out was high. Results: Individuals with BFRBs showed no inhibitory deficits on the Go/No-Go test but made fewer hits on the Go trials compared to controls, indicating attentional lapses. Regarding memory, only immediate recall was worse in the BFRB sample. Controls were biased toward being more confident. When we divided the sample by impairment (>1 SD below the mean of controls), a minority of the BFRB group showed deficits in attention and immediate recall. Conclusions: Our findings suggest that neurocognitive deficits are not prevalent in BFRB, affecting less than 20% of our sample. Yet, attentional problems in a subgroup of individuals with BFRB highlights the need to study heterogeneity within BFRBs. Potential moderators such as motivation, stress, and self-stigma remain to be explored. Our findings must be interpreted with caution given the study’s limited generalizability due to its online format, high drop-out rate, and absence of independent diagnostic confirmation.