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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).

BackgroundGuidelines about post-traumatic stress disorder (PTSD) recommend broad categories of drugs, but uncertainty remains about what pharmacological treatment to select among all available compounds.MethodsCochrane Central Register of Controlled Trials register, MEDLINE, PsycINFO, National PTSD Center Pilots database, PubMed, trial registries, and databases of pharmaceutical companies were searched until February 2016 for double-blind randomised trials comparing any pharmacological intervention or placebo as oral therapy in adults with PTSD. Initially, we performed standard pairwise meta-analyses using a random effects model. We then carried out a network meta-analysis. The main outcome measures were mean change on a standardised scale and all-cause dropout rate. Acute treatment was defined as 8-week follow up.ResultsDesipramine, fluoxetine, paroxetine, phenelzine, risperidone, sertraline, and venlafaxine were more effective than placebo; phenelzine was better than many other active treatments and was the only drug, which was significantly better than placebo in terms of dropouts (odds ratio 7.50, 95% CI 1.72–32.80). Mirtazapine yielded a relatively high rank for efficacy, but the respective value for acceptability was not among the best treatments. Divalproex had overall the worst ranking.ConclusionsThe efficacy and acceptability hierarchies generated by our study were robust against many sources of bias. The differences between drugs and placebo were small, with the only exception of phenelzine. Considering the small amount of available data, these results are probably not robust enough to suggest phenelzine as a drug of choice. However, findings from this review reinforce the idea that phenelzine should be prioritised in future trials in PTSD.