Abuse and self-inflicted disease

This chapter contains clinical images of artefactual/factitious disease noting that abuse may be accidental, perpetrated by others, or self-inflicted (dermatitis artefacta/factitia). A list of cutaneous signs suspicious of possible child abuse followed by pointers in the examination and history is provided. Suspicious bruising and purpura are covered with a list of conditions mimicking or causing bruising, including serious systemic diseases such as leukaemia, infections, and clotting disorders. An explanation is given of how to proceed in cases of suspected sexual abuse and highlights some diseases that might be mistaken for abuse. The different of types of factitious disease, including psychiatric disorders such as obsessive-compulsive disorder and dysmorphophobia, are described. Normal habit disorders are outlined including infant hair pulling, which should be differentiated from hair-pulling disorder (previously known as trichotillomania).

A short review on tics and habit disorders.

Repetitive behaviour disorders, including tic and habit disorders, are thought to be relatively common among children and adolescents. Tic disorders are characterized by repetitive, sudden movements and vocalizations that are seemingly purposeless in nature like trichotillomania, skin picking, nail biting, thumb sucking, and cheek chewing. These habits can be significant treated by habit reversible therapy.

HABIT DISORDERS

Introduction: Childhood habit behaviors appear in numerous different forms.Many people engage in some degree of habit like behavior in their lifetime. For example,habits can range from seemingly benign behaviors, such as nail biting or foot tapping, to morenoticeable physically damaging behaviors, such as teeth grinding (bruxism) and hair pulling.Habit disorders, now subsumed under the diagnostic term stereotypic movement disorder,consist of repetitive, seemingly driven, and nonfunctional motor behaviors that interfere withnormal activities or that result in bodily injury. Objectives: To determine the frequency ofdifferent habit disorders in children coming to outpatient department of Pediatrics unit of AlliedHospital Faisalabad. Study design: Cross sectional study. Setting: Pediatric department ofAllied Hospital Faisalabad. Duration of study: 1 year 06 months. (From 01-03-2015 to 01-09-2016). Results: We determined that majority of the patients i.e. 40.68%(n=72) were between49-72 months, mean and sd was 54.23+21.45 months of age, 54.80%(n=97) male and45.20%(n=80) females, frequency of different habit disorders in children coming to outpatientdepartment of pediatrics unit of Allied Hospital, Faisalabad revealed 19.31%(n=34), nail biting,22.03%(n=39) had thumb sucking, 41.81%(n=74) had bruxism, 11.86%(n=21) had hair pullingand 10.17%(n=18) subjects had other habits. Conclusion: We concluded that the frequency ofdifferent habit disorders i.e. nail biting, thumb sucking, bruxism, hair pulling and other is higheramong children coming to outpatient department of Pediatrics unit of Allied Hospital Faisalabadand comparable with other studies.

The Self-Control Cognition Questionnaire

Self-control cognitions arise right before or after someone gives in to an unwanted habit. This paper reports on the development of the 11-item Self-Control Cognition Questionnaire (SCCQ) in a series of three studies. In the first study (N = 308), we found that the SCCQ has a two-factor structure and is reliable. The factors were named “Giving way is rewarding” and “Resistance is impossible.” The construct validity of the SCCQ was assessed in the second study (N = 138). As expected, the SCCQ correlated positively and strongly with the preoccupation with unwanted habits and with the experience of craving, and correlations with one’s tendency to consider the long-term consequences of actions were small. The third study demonstrated that the SCCQ discriminates between patients with habit disorders (N = 63) and controls with non-pathological unwanted habits (N = 106). The SCCQ was sensitive to therapeutic change in two patient samples, one suffering from hair pulling disorder and the other from pathological skin picking. The SCCQ is applicable to unwanted habits in general, both pathological and non-pathological. It is proven to have sound psychometric properties and is suitable for use in practice.