Lip Biting Research Articles

A Mindfulness-Integrated Therapeutic Approach to Enhance Client Engagement with Prolonged Exposure and Habit Reversal Therapy and Bolster Therapist Trainee Self-Efficacy and Distress Tolerance

Despite the established efficacy of exposure-based trauma treatments, such as prolonged exposure (PE), clinicians’ and clients’ concerns about these therapies hinder their widespread implementation. Clinicians report experiencing low self-efficacy and high distress when delivering PE, while patients doubt the credibility of this treatment, contributing to patient dropout. To tackle such challenges, mindfulness-based therapeutic approaches have been used. In the current case involving PTSD due to childhood sexual abuse (CSA) and coercive sex, trichotillomania, excoriation disorder, and depression, mindfulness practices and principles were woven into PE and habit reversal therapy (HRT). The therapist, a trainee with no prior trauma treatment experience, felt that her ability to manage the client’s distress during treatment and her confidence in delivering therapy was enhanced by her own mindfulness practice, and further reinforced by the pervasive integration of mindfulness throughout treatment. Likewise, the client attributed her capacity to engage in PE and HRT to the mindfulness practices and principles woven into treatment. Mindfulness also assisted in coalescing the concomitant delivery of PE and HRT. Following 21 sessions of mindfulness-integrated PE and 17 sessions of mindfulness-integrated HRT, the client no longer met criteria for PTSD and depression, eradicated her body-focused repetitive behaviors (BFRBs), and disclosed her index trauma with loved ones. These improvements were maintained at one-year follow-up, underscoring the potency of mindfulness therapeutic integration to enhance therapists’ distress tolerance and self-efficacy, clients’ treatment engagement, and overall therapeutic outcomes in complex cases.

Skin picking disorder in sexual minority individuals

BackgroundSkin picking disorder (SPD) is common, but little is known about whether or how it differs in sexual minorities. We explored whether sexual minority individuals differ from heterosexual individuals in terms of skin picking and comorbidities. We also evaluated potential differences between gay or lesbian and bisexual individuals. Methods293 participants with SPD completed an online survey. Sexual minority participants were compared to heterosexual participants on demographics, how often they picked their skin, and validated self-report measures of SPD and comorbidities. Gay or lesbian and bisexual participants were compared on the same variables. ResultsSexual minority status was associated with more body-focused repetitive behavior (BFRB) impairment and a greater likelihood of picking 7 days per week. Heterosexual participants reported more alcohol misuse, aggression, and compulsive sexual behavior than sexual minority participants. The groups did not differ in overall BFRB severity or rates of other disorders. Gay or lesbian and bisexual participants did not differ in SPD or comorbidities. ConclusionsThe rate of sexual minority individuals in this study (37.9%) is much higher than the rate in the community (about 10%). Sexual minority individuals with SPD may present with unique clinical symptoms. Treatments should be tailored for this population.

Examining Self-Guided Interventions for Body-Focused Repetitive Behaviors in Dermatology: A Literature Review

Examining Self-Guided Interventions for Body-Focused Repetitive Behaviors in Dermatology: A Literature Review

Informing the Design of Intervention Solutions for Body-Focused Repetitive Behaviors

Body-Focused Repetitive Behaviors (BFRBs), such as nail biting, impact a wide demographic, and can negatively affect physical, psychological, and social well-being. Although pharmacological and behavioral therapies are common treatments, many avoid seeking help, and not everyone responds fully to treatment. Recent advances in wearable sensing enable new digital solutions that can detect BFRB episodes and intervene to mitigate them. While BFRBs have been extensively studied in medical research, translating this knowledge into effective digital intervention solutions may not be straightforward, and the end user's perspective may be overlooked. We report a user study with 12 frequent nail biters, who shared their experiences about nail biting and expectations of intervention solutions in semi-structured qualitative interviews. We describe the progression of a nail biting episode from a nail biter's perspective and present a taxonomy of intervention strategies to mitigate nail biting. Our results inform the design of future digital BFRB intervention solutions.

Prevalence and Influencing Factors of Body-focused Repetitive Behaviors in Turkish Medical Students

Background/Aims: Body-focused repetitive behaviors (BFRBs) such as skin-picking, trichotillomania, nail-picking, nail-biting, lip-biting and skin-biting have adverse physical and psychological effects. This study aimed to investigate the prevalence and associated factors of BFRBs in a sample of Turkish medical students. Methods: An online survey was used to investigate the prevalence of six BFRBs —skin-picking, trichotillomania, nail-biting, nail-picking, lip-biting and skin-biting-- and psychological factors such as anxiety, depression, stress levels, impulsivity and difficulties in emotional regulation (DER) in a sample of 200 medical students. Skin Picking Scale-Revised (SPS-R), Massachusetts General Hospital Hairpulling Scale (MGH-HPS), Depression Anxiety Stress Scales-21 (DASS-21), Barratt Impulsiveness Scale–Short Form and Difficulty in Emotion Regulation Scale—Brief Form and specific questions for four BFRBs (nail-picking, nail-biting, lip biting and skin biting) were administered. Results: The prevalence of at least one BFRB disorder was 28.0% (n=56). The most common diagnoses were skin-picking (17.0%) and trichotillomania (10.5%), followed by skin-picking (9.0%), lip biting (8.5%), nail-picking (7%) and nail-biting (5.0%). The gender difference was found only in skin-picking disorders (females=22.9%; males=8.5%). Students with BFRB disorder (n=56) were found to have higher levels of anxiety, depression, stress, impulsivity and DER. Students in 2nd, 3rd and 5th grade are more likely to have BFRB disorders than interns. DER was a partial mediating variable between impulsivity and the presence of BFRB disorder. Conclusions: The findings of the study suggest that BFRBs are common among medical students and that these behaviors are associated with psychological factors such as depression, anxiety, stress levels, impulsivity and difficulties in emotion regulation. Screening programs and intervention strategies for BFRBs in medical students should be developed, and it is recommended that psychological factors should be considered in these interventions, emotion regulation and stress management skills should be significantly improved, and comorbid depression and anxiety should be treated.

Quo vadis DSM-6? An expert survey on the classification, diagnosis, and differential diagnosis of body-focused repetitive behaviors

BackgroundMany conditions we now call body-focused repetitive behaviors (BFRBs) have been subject to research for several decades, most notably trichotillomania and skin picking. However, the American Psychiatric Association did not combine these conditions into a single category, body-focused repetitive behavior disorder (BFRBD), until the fifth edition of the DSM (2013). Several aspects of the disorder remain uncertain and debatable. For example, ongoing debate surrounds which specific conditions fall under this diagnostic category and how to best differentiate BFRBs from conditions such as nonsuicidal self-injury (NSSI). The current article presents results from a study of experts' opinions on diagnostic criteria and descriptions, with the goal of refining the diagnostic criteria. MethodWe contacted experts on BFRB via various sources and invited them to an online survey on the phenomenology, classification, and differential diagnosis of BFRB. We also asked about possible alternative syndrome labels (e.g., body-focused habit). ResultsData from the final sample of 50 experts demonstrates that most experts agree with the present classification of BFRB as an obsessive-compulsive and related disorder and recommend retaining the labels BFRB or BFRBD. The experts considered the following conditions BFRB, with an agreement of over 60 %: trichotillomania, skin picking, dermatophagia, nail biting, and lip-cheek biting. Mixed results emerged for awake bruxism and thumb sucking in adults. In contrast, only a minority regarded night bruxism and knuckle cracking as BFRB. To differentiate BFRB from NSSI, the experts noted that the motive behind the urge (self-harm/injury versus release of tension) should be considered. Analyses of a sub-sample of experts with at least six years of clinical and/or research experience yielded results compatible with those of the entire sample. DiscussionThe survey supports the usefulness of the BFRB or BFRBD diagnostic entity. However, some criteria require further refinement. Future editions of the DSM should more explicitly delineate which conditions qualify as BFRB. Furthermore, it is important to give more attention to the primary motivation behind BFRB to distinguish it from NSSI and potentially from stereotypic movement behavior.

Oral health status and dental treatment needs in children with autism spectrum disorder

ObjectiveTo evaluate oral health care practices, health status, and dental treatment needs in children with Autism Spectrum Disorder (ASD). MethodsThis cross-sectional study included 96 children diagnosed with ASD per the DSM-V criteria and 96 typically developing healthy children. The WHO form assessed oral health status and dental treatment needs. ResultsOver 50 % of ASD children had mild/moderate autism, 35.4 % had severe autism, and 13.5 % had autistic traits. ASD children experienced more toothbrushing difficulties compared to non-ASD children. Based on Nyvad's criteria and decayed/filled teeth (dft) index, non-ASD children had higher caries prevalence than ASD children, indicating less need for restorative treatments in the ASD group. However, ASD children had poorer plaque scores than non-ASD children. A significantly higher percentage of ASD children exhibited harmful oral behaviors, including mouth breathing, lip biting, bruxism, nail biting, object biting, and self-injury (p < 0.001). ASD children also showed increased traumatic dental injuries compared to non-ASD children. ConclusionCompared to non-ASD peers, children with ASD have lower dental caries prevalence and less need for restorations, yet poorer plaque control. They also demonstrate more frequent oral self-injuries. ASD status appears related to toothbrushing difficulties. These findings highlight the need for tailored oral health interventions for children with ASD.

A Systematic Review of Non-Pharmacological Treatment Options for Skin Picking Disorder (SPD).

While Skin Picking Disorder (SPD) is a well-described neuropsychiatric disorder that causes severe stress and impairment, there is no clear protocol for treating patients and a relatively small body of literature evaluating treatment approaches. This review aims to summarize and compare recent publications and provide an up-to-date guide of current non-pharmacological treatments for SPD. A literature review was conducted on all non-pharmacological SPD treatment studies published between 2017-2023 using PubMed, CINAHL Plus with Full text (EBSCO), and Scopus. Search terms included skin picking, excoriation, psychiatry, treatment, and psychodermatology. Studies including SPD within other body-focused repetitive behaviors (BFRBs), studies using pharmacological agents, and studies not available in English were excluded. A minimum of 2 authors screened each abstract while blinded to minimize bias to assess for inclusion. 11 studies (2068 participants) were included, with a variety of study designs including feasibility, randomized control trial, longitudinal cohort, multiple baseline experimental, naturalistic trial, and controlled single case design with multiple baseline studies. The treatments include cognitive behavioral therapy (CBT), Acceptance and Commitment Therapy (ACT), ACT-Enhanced Group Behavioral Therapy (AE-GBT), ACT-Informed Exposure Therapy, group therapy, psychotherapy, Repetitive Transcranial Magnetic Stimulation (rTMS), online self-help modules, and Expressive Writing (EW). Studies implementing CBT, Habit Reversal Therapy (HRT), AE-GBT, online self-help modules, and EW demonstrated the best results in treating SPD. Several studies achieved significant outcomes for SPD participants, confirming the usefulness of non-pharmacological treatment in SPD. Based on our results, CBT, AE-GBT, online self-help modules, and EW appear to be the most effective in treating SPD. Additionally, most of these treatment modalities can be tailored to meet patient-specific needs. Some limitations of the studies include small sample sizes, lack of control groups/randomization, limited long-term follow-up data, and lack of gender variability.

Driving Stress-Induced Effects on the Orofacial Region and Its Functions and Health Behaviors in Riyadh: A Cross-Sectional Survey.

Driving stress is a multifaceted phenomenon, and the experience of driving invokes stress. Driving causes the activation of stress-response mechanisms, leading to short-term and long-term stress responses resulting in physiological and behavioral changes. The aim of this study was to evaluate driving stress-initiated effects on orofacial functions and health behaviors in the Riyadh population. A cross-sectional survey was conducted in Riyadh using a pre-validated set of questionnaires for habitual information, a driving stress assessment using a driving-behavior inventory, and an assessment of parafunctional habits and effects on orofacial functions. The results indicate that nearly 50% of the sample spends more than two hours commuting, and more than 50% of the sample has inadequate sleep and insufficient exercise. Oral parafunctional habits like nail biting (p = 0.039) and lip or object biting (p = 0.029) had a significant correlation with aggressive driving behaviors, whereas the grinding of teeth (p = 0.011), the clenching of jaws (p = 0.048), lip or object biting (p = 0.018), and pain in mastication (p = 0.036) had a positive correlation with driving dislikes. Driving stress can be detrimental to one's health and not only impacts health behaviors but also induces oral parafunctional habits and adversely affects orofacial regions and functions. Acute driving stress responses may be transient. However, prolonged driving stress can be maladaptive and can increase the risk of chronic diseases including chronic temporomandibular joint disorders and parafunctional habit-related changes in the oral cavity.

Non-suicidal self-injury in trichotillomania and skin picking disorder.

Trichotillomania and skin picking disorder have been characterized as body-focused repetitive behavior (BFRB) disorders (i.e., repetitive self-grooming behaviors that involve biting, pulling, picking, or scraping one's own hair, skin, lips, cheeks, or nails). Trichotillomania and skin picking disorder have also historically been classified, by some, as types of compulsive self-injury as they involve repetitive hair pulling and skin picking, respectively. The question of the relationship of these disorders to more conventional forms of self-injury such as cutting or self-burning remains incompletely investigated. The objective of this study was to examine the relationship of these two disorders with non-suicidal self-injury (NSSI). Adults with trichotillomania (n=93) and skin picking (n=105) or both (n=82) were recruited from the general population using advertisements and online support groups and completed an online survey. Participants completed self-report instruments to characterize clinical profiles and associated characteristics. In addition, each participant completed a mental health history questionnaire. Of the 280 adults with BFRB disorders, 141 (50.1%) reported a history of self-injury independent of hair pulling and skin picking. Participants with a history of self-injury reported significantly worse pulling and picking symptoms (p<.001) and were significantly more likely to have co-occurring alcohol problems (p<.001), borderline personality disorder (p<.001), buying disorder (p<.001), gambling disorder (p<.001), compulsive sex behavior (p<001), and binge eating disorder (p=.041). NSSI appears common in trichotillomania and skin picking disorder and may be part of a larger constellation of behaviors associated with impulse control or reward-related dysfunction.

Patterns of Skin Picking in Skin Picking Disorder: Ecological Momentary Assessment Study.

Skin picking disorder (SPD) is an understudied mental illness that is classified as a body-focused repetitive behavior disorder. Literature suggests that pathological skin picking is strongly integrated into the daily lives of affected individuals and may involve a high degree of variability in terms of episode characteristics, frequency, and intensity. However, existing data on the phenomenology of SPD are limited and typically involve retrospective assessments, which may fail to accurately capture the behavior's variability. This study aimed to investigate skin picking in the daily lives of individuals with SPD by using ecological momentary assessment (EMA). The first aim focused on the description of skin picking patterns (eg, characteristics, intensity, and distribution of episodes and urges), and the second aim explored differences in characteristics and patterns between automatic and focused skin picking. Participants were recruited online and underwent a web-based screening, a diagnostic telephone interview, and a comprehensive online self-report questionnaire before participating in an EMA protocol. The latter included 10 consecutive days with 7 pseudorandom, time-contingent assessments per day between 8 AM and 10 PM. The EMA questionnaire assessed the current skin picking urge, the occurrence of the behavior, and a detailed assessment of the episodes' characteristics (eg, length, intensity, and consciousness) if applicable. The final sample consisted of 57 participants, who completed at least 70% of the scheduled assessments (n=54, 94.7% female: mean age 29.3, SD 6.77 years). They completed 3758 EMAs and reported 1467 skin picking episodes. Skin picking occurred frequently (mean 2.57, SD 1.12 episodes per day and person) in relatively short episodes (10-30 min; 10 min: nepisodes=642, 43.8%; 20 min: nepisodes=312, 21.3%; 30 min: nepisodes=217, 14.8%), and it was distributed quite evenly throughout the day and across different days of the week. Focused and automatic episodes were relatively balanced across all reported episodes (focused: nepisodes=806, 54.9%) and over the course of the day. The analyses showed statistically significant differences between self-reported triggers for the different styles. Visual or tactile cues and the desire to pick the skin were more important for the focused style (visual or tactile cues: mean focused style [Mf]=4.01, SD 0.69 vs mean automatic style [Ma]=3.47, SD 0.99; P<.001; SMD=0.64; desire to pick: Mf=2.61, SD 1.06 vs Ma=1.94, SD 1.03; P<.001; SMD=0.82), while boredom and concentration problems were more prominent in automatic skin picking (boredom: Mf=1.69, SD 0.89 vs Ma=1.84, SD 0.89; P=.03; SMD=-0.31; concentration problems: Mf=2.06, SD 0.87 vs Ma=2.31, SD 1.06; P=.006; SMD=-0.41). These results contribute to an enhanced understanding of the phenomenology of SPD using a more rigorous assessment methodology. Our findings underscore that picking can impact affected persons multiple times throughout their daily lives. German Clinical Trials Register DRKS00025168; https://tinyurl.com/mr35pdwh.

Motives for Performing Body-Focused Repetitive Behaviors (BFRBs): Similarities to and Differences from Non-Suicidal Self-Injurious and Stereotypic Movement Behaviors

BackgroundIn the DSM-5, body-focused repetitive behaviors (BFRBs) are now classified in the obsessive-compulsive and related disorders section. Differential diagnosis is complicated by the overlap of BFRBs with other disorders, especially non-suicidal self-injurious behavior (NSSI) and stereotypic movement behavior (SMB). The present study examined participants’ motives for performing BFRBs to provide a better understanding of how BFRBs may differ from NSSI and SMB and to determine whether BFRB is best characterized as an obsessive-compulsive spectrum disorder.MethodsA total of 268 individuals with various BFRBs were assessed with respect to their motives for performing BFRBs, comorbid diagnoses, emotions accompanying their BFRBs, and whether they felt an urge to perform the behavior on others as well as themselves.ResultsThe main motives for performing BFRBs were release of stress (84.7%), boredom (51.5%), and gratification/pleasure (34.7%). Approximately one third of the sample were unable to provide a clear motive. The majority were ambivalent about their behavior. Participants rarely engaged in cutting; 16.4% performed a BFRB on someone else’s body or wanted to do so. OCD was self-reported by only 7.5% of the participants.DiscussionAmbivalence towards symptoms is high in individuals with BFRBs; the main motive for performing the behavior was emotion regulation, particularly of stress. Limitations of the study are the self-reported assessment and the high attrition during the assessment. Further research is needed to clarify whether BFRBs, NSSI, and SMB should be kept separate or should be combined into one category, perhaps with specifiers. The current classification of BFRBs as an OCD-related disorder should be reconsidered.

Impact of alexithymia, attachment styles, and childhood traumas on the severity of body-focused repetitive behavior disorders

It is known that childhood traumas is associated with attachment problems, alexithymia and lead to some psychiatric disease. This study was investigated the relationship of body focused repetitive behavior disorders (BFRBDs) to childhood trauma, attachment styles, and alexithymia, and the impact of these factors on the severity of the disorder. 105 patients with BFRBDs and 90 healthy controls matched for age and sex were comprised in the study. Participants were administered sociodemographic data form, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Clinical Global Impression (CGI), Toronto Alexythimia Scale (TAS-20), Experiences in Close Relationships-II (ECR-II) and Childhood Traumatic Experiences Questionnairre (CTQ-28). Presence of childhood trauma, depression and anxious attachment score were found to be risk factors for the occurrence of BFRBDs. Physical neglect was found to have an indirect effect on the disease severity through the high score of externally-oriented thinking. Therefore, it should be kept in mind that patients who tend to present themselves as normal and do not express their problems/conflicts have a high severity of disease. In addition, it may be important to plan therapeutic interventions in patients according to their comorbidities such as alexithymia, attachment and childhood trauma.

The genetics of trichotillomania and excoriation disorder: A systematic review

BackgroundTrichotillomania (TTM) and excoriation disorder (ED) are impairing obsessive-compulsive related disorders that are common in the general population and for which there are no clear first-line medications, highlighting the need to better understand the underlying biology of these disorders to inform treatments. Given the importance of genetics in obsessive-compulsive disorder (OCD), evaluating genetic factors underlying TTM and ED may advance knowledge about the pathophysiology of these body-focused repetitive behaviors. AimIn this systematic review, we summarize the available evidence on the genetics of TTM and ED and highlight gaps in the field warranting further research. MethodWe systematically searched Embase, PsycInfo, PubMed, Medline, Scopus, and Web of Science for original studies in genetic epidemiology (family or twin studies) and molecular genetics (candidate gene and genome-wide) published up to June 2023. ResultsOf the 3536 records identified, 109 studies were included in this review. These studies indicated that genetic factors play an important role in the development of TTM and ED, some of which may be shared across the OCD spectrum, but there are no known high-confidence specific genetic risk factors for either TTM or ED. ConclusionsOur review underscores the need for additional genome-wide research conducted on the genetics of TTM and ED, for instance, genome-wide association and whole-genome/whole-exome DNA sequencing studies. Recent advances in genomics have led to the discovery of risk genes in several psychiatric disorders, including related conditions such as OCD, but to date, TTM and ED have remained understudied.

Cautery excision of oral mucocele in pediatric children: A case report

Introduction: Oral mucocele is a common, oral lesions that mostly present as painless, clear, or bluish cysts on the lower lip of children and young adults. These are harmless, mucus-filled growths usually resulting from a little salivary gland or duct injury. Mucus can leak into surrounding subepithelial tissue when the salivary glands are injured by lip biting, sucking, or trauma. This is known as a mucus extravasation cyst, and it is the most frequent variety of mucoceles. This report presents two cases of mucocele. Case History: Two case studies of oral mucoceles reported that almost all included lip mucoceles were clinically bullous lesions, it was soft, fluctuant, and palpable, which corroborates the hypothesis that lip mucoceles are commonly incited by traumatic injury such as tooth impingement and lip-biting habit. All cases were treated with a simple excision using an electrocautery. Two lesion diagnosis was confirmed by Histopathology anatomy (HPA). Discussion: Mucoceles are common oral lesions often seen in children and adolescents, typically caused by lip biting due to psychological stress. Diagnosis is based on clinical features such as rapid appearance, size variations, and bluish color. Treatments include scalpel excision and electrocautery, with electrocautery providing minimal bleeding and painless wounds. Conclusion: One of the typical salivary gland lesions in the oral cavity is mucocele. The use of electrocautery is known to be beneficial for wound healing. Awareness education for children and parents is necessary to eliminate a lip-biting habit.

Comparing the 'When' and the 'Where' of Electrocortical Activity in Patients with Tourette Syndrome, Body-Focused Repetitive Behaviors, and Obsessive Compulsive Disorder.

Background/Objectives: Tourette Syndrome (TS), Obsessive Compulsive Disorder (OCD), and Body-Focused Repetitive Behaviors (BFRB) are three disorders that share many similarities in terms of phenomenology, neuroanatomy, and functionality. However, despite the literature pointing toward a plausible spectrum of these disorders, only a few studies have compared them. Studying the neurocognitive processes using Event-Related Potentials (ERPs) offers the advantage of assessing brain activity with excellent temporal resolution. The ERP components can then reflect specific processes known to be potentially affected by these disorders. Our first goal is to characterize 'when' in the processing stream group differences are the most prominent. The second goal is to identify 'where' in the brain the group discrepancies could be. Methods: Participants with TS (n = 24), OCD (n = 18), and BFRB (n = 16) were matched to a control group (n = 59) and were recorded with 58 EEG electrodes during a visual counting oddball task. Three ERP components were extracted (i.e., P200, N200, and P300), and generating sources were modelized with Standardized Low-Resolution Electromagnetic Tomography. Results: We showed no group differences for the P200 and N200 when controlling for anxiety and depressive symptoms, suggesting that the early cognitive processes reflected by these components are relatively intact in these populations. Our results also showed a decrease in the later anterior P300 oddball effect for the TS and OCD groups, whereas an intact oddball effect was observed for the BFRB group. Source localization analyses with sLORETA revealed activations in the lingual and middle occipital gyrus for the OCD group, distinguishing it from the other two clinical groups and the controls. Conclusions: It seems that both TS and OCD groups share deficits in anterior P300 activation but reflect distinct brain-generating source activations.

A pilot study examining hemomania behaviors in psychiatry outpatients engaged with nonsuicidal self-injury.

This study aims to conduct the first-ever evaluation of our previously proposed behaviors of "hemomania" in individuals engaged with nonsuicidal self-injury (NSSI). The study encompassed 130 outpatients engaged with NSSI who applied at the psychiatry outpatient clinic. NSSI behaviors were assessed using the Inventory of Statements About Self-Injury, while psychiatric diagnoses were evaluated using the Structured Clinical Interview for DSM-5 Disorders-Clinician Version. Subsequently, participants completed the Depression Anxiety Stress Scale-21 and Short Form of Barratt Impulsiveness Scale. The prevalence of at least one hemomania behavior including seeing blood, tasting blood, bloodletting, and blood-drinking was observed to be 43.1% in individuals with NSSI. When participants were divided into two groups, individuals with hemomania exhibited: (1) a higher incidence of psychiatric comorbidities, increased suicide attempts, and more severe symptoms of depression, anxiety, stress, and impulsivity, (2) higher comorbidity rates of borderline personality disorder, body-focused repetitive behaviors, and dissociative disorders, and (3) elevated frequencies of certain NSSI behaviors, including cutting, biting, needle-ticking, and carving, compared to those without. Hemomania could be considered a specific impulse control disorder, characterized by heightened impulsivity and a persistent urge to obtain one's own blood. However, further studies are needed to validate this hypothesis.

Sensory processing in skin picking disorder

BackgroundSkin Picking Disorder (SPD) is an oftentimes disabling disorder wherein people compulsively pick their skin. While sensory processing abnormalities have been examined in body-focused repetitive behaviors more broadly, relatively little attention has been played to the role of sensory processing in SPD specifically. MethodsA total of 183 adults, 118 with SPD and 65 healthy controls, completed the Adolescent Adult Sensory Profile (AASP) to assess sensory processing patterns. Those with SPD also completed measures to assess skin picking severity, quality of life, and functional impairment. We examined whether scores on the four AASP subscales differ between individuals with SPD and healthy controls, and whether sensory processing among those with SPD affects disorder severity, quality of life, or functional impairment. ResultsParticipants with SPD scored significantly higher on the AASP subscales of low registration, sensory sensitivity, and sensation avoiding than healthy controls (all p's < 0.01). There were no differences in sensation seeking between the two groups. Among those with SPD, those scoring “high” on the low registration subscale reported significantly greater skin picking severity and reduced quality of life as compared to those scoring lower on this subscale (p's < 0.001) Additionally, those scoring “high” on sensory sensitivity reported greater functional impairment than those scoring lower on this subscale (p < 0.01). ConclusionsThese data suggest that individuals with SPD display abnormalities in sensory processing relative to unaffected individuals. Future research should examine whether targeting sensory abnormalities among a subset of individuals with SPD may reduce the severity and associated burden caused by the disorder.

Utility of MR Neurography for the Evaluation of Peripheral Trigeminal Neuropathies in the Postoperative Period.

Peripheral trigeminal neuropathies are assessed by MR neurography for presurgical mapping. In this clinical report, we aimed to understand the utility of MR neurography following nerve-repair procedures. We hypothesized that postoperative MR neurography assists in determining nerve integrity, and worsening MR neurography findings will corroborate poor patient outcomes. Ten patients with peripheral trigeminal neuropathy were retrospectively identified after nerve-repair procedures, with postsurgical MR neurography performed from July 2015 to September 2023. Postsurgical MR neurography findings were graded as per postintervention category and subcategories of the Neuropathy Score Reporting and Data System (NS-RADS). Descriptive statistics of demographics, inciting injury, injury severity, NS-RADS scoring, and clinical outcomes were obtained. There were 6 women and 4 men (age range, 25-73 years). Most injuries resulted from third molar removals (8/10), with an average time from the inciting event to nerve-repair surgery of 6.1 (SD, 4.6) months. In Neuropathy Score Reporting and Data System-Injury (NS-RADS I), NS-RADS I-4 injuries (neuroma in continuity) were found in 8/10 patients, and NS-RADS I-5 injuries were found in the remaining patients, all confirmed at surgery. Surgeries performed included microdissection with neurolysis, neuroma excision, and nerve allograft with Axoguard protection. Three patients with expected postsurgical MR neurography findings experienced either partial improvement or complete symptom resolution, while among 7 patient with persistent or recurrent neuropathy on postsurgical MR neurography, one demonstrated partial improvement of sensation, pain, and taste and one experienced only pain improvement; the remaining 5 patients demonstrated no improvement. Postsurgical MR neurography consistently coincided with clinical outcomes related to pain, sensation, and lip biting and speech challenges. Lip biting and speech challenges were most amenable to recovery, even with evidence of persistent nerve pathology on postsurgical MR neurography.

Unmet Needs in Psychodermatology: A Narrative Review.

Psychodermatology, the multidisciplinary field that explores the intricate interplay between the mind and the skin, has gained increasing recognition over the past decade. However, several knowledge gaps and unmet needs persist in the field. The objective of this narrative review was to investigate the unmet needs in the field of psychodermatology as they pertain to medical training, treatment, research, and care access. PubMed was searched from inception through December 2023 to identify articles related to psychodermatology. Findings revealed several unmet needs within the field of psychodermatology. First, there is a need for further investigation into the pathophysiology that links psychological stress to cutaneous disease including the development of novel therapies targeting key neuropeptides. Second, the existing literature focuses primarily on the pharmacologic treatment of body dysmorphic disorder and body-focused repetitive behaviors, as well as delusional parasitosis, for which the first-line agents are selective serotonin reuptake inhibitors and atypical antipsychotics, respectively. However, additional research into the efficacy and safety of the remaining psychotropic medications and the treatment of other common psychocutaneous diseases is required. Finally, there exists a significant gap in knowledge amongst clinicians tasked with treating psychocutaneous diseases. Dermatologists report low rates of training in psychodermatology and discomfort with prescribing psychotropic medications. In conclusion, increasing resources for dermatologist education on psychotropic agent use, development of new drugs targeting stress-induced skin conditions, and research on the psychocutaneous applications of current medications may greatly improve the quality and access of psychodermatology care.