Skin Picking Research Articles

State and trait dissociation in pathological skin picking

Dissociative experiences like trance or depersonalization may play a prominent role in pathological skin picking (PSP). However, trait and state dissociation and their relation to skin picking have hardly been studied in those with PSP. By means of an anonymous online survey, we recruited 323 adults with PSP defined by Skin Picking Scale-Revised (SPS-R) scores ≥ 7 as well as Skin Picking Impact Scale (SPIS) scores ≥ 7. Participants were administered the Dissociative Experiences Scale-Taxon (DES-T) to determine trait dissociation as well as the modified Peritraumatic Dissociative Experiences Questionnaire (PDEQ) to assess state dissociation during a typical episode of PSP. Sixty-three participants (19.5%) were assigned to the pathological dissociative taxon, that is, were high in trait dissociation. State dissociation during episodes of skin picking was reported by 221 individuals (68.4%) with the feeling of being on “automatic pilot” (49.6%) and alterations in time perception (33.1%) being the most frequent phenomena. Both trait and state dissociation were significantly associated with skin picking-related impairment, but effect sizes were small. Dissociation conceived as trait and state might be an important psychopathological dimension in skin picking. Its systematic detection and recognition may hold therapeutic implications as dissociation is a negative predictor of treatment outcome.

Skin Excoriation Disorder with Comorbid Schizophrenia

Skin-picking Disorder (SPD) or Excoriation Disorder is an Obsessive Compulsive Spectrum Disorder where one compulsively picks at his skin. Obsessive Compulsive Spectrum Disorder is commonly seen to be associated with Schizophrenia

Chronic Skin Picking: Trigeminal Trophic Syndrome in the Setting of Meningioma.

Chronic Skin Picking: Trigeminal Trophic Syndrome in the Setting of Meningioma.

Prevalence of and Risk Factors for Skin Picking Disorder Symptoms Among Adults in an Arab Middle Eastern Population: A Cross-Sectional Study.

Skin Picking Disorder (SPD) is a skin-related disease, also recognized as psychogenic excoriation, dermatillomania, or excoriation disorder. SPD is defined as a habitual picking of skin, which in turn harms skin tissue. Given the paucity of information on SPD symptoms, their prevalence, and risk factors in Saudi Arabia, the present study seeks to fill this gap by investigating these factors in a community sample from Jeddah. This descriptive cross-sectional study was conducted in the city of Jeddah. The Skin Picking Scale-Revised (SPS-R) scale was administered to a convenience sample of 520 respondents. A partial least squares path model (PLS-PM) for "impairment" and "symptoms severity" subscales was assessed by evaluating the validity of measurement and structural models. Skin picking behavior was reported by 28.8% (n=150). A significant level of skin picking disorder symptoms was present in 1.2% (n=6). Skin picking visual effect, depressive symptoms, and being unmarried were the only positive independent predictors of the total SPS-R score. SPD symptoms are relatively common among the adult population in Jeddah, but those with threshold symptoms indicative of SPD are relatively few. Such behavior is particularly common in vulnerable groups such as those with depressive symptoms and the unmarried. More attention to this condition by clinicians will improve the quality of life of those affected, and reduce the emotional and physical health consequences of this often unrecognized condition.

Trichotillomania, Skin Picking Disorder, and Different Aspects of Impulsivity: A Systematic Review

Trichotillomania and skin picking disorder are psychiatric disorders with body-focused repetitive behaviors (BFRB). Impulsivity is considered to have a role in the etiology of BFRB. Various methods have been implemented to demonstrate different aspects of impulsivity due to its multidimensional construct. This systematic review aimed to synthesize existing studies to examine different aspects of impulsivity in BFRB. A systematic literature review was conducted in January 2021. Some original studies evaluating the relationship between impulsivity and trichotillomania or skin picking disorder were obtained. Twenty studies were examined after a systematic search of the MEDLINE database. The findings revealed that impulsivity was investigated using a self-report scale in five studies and behavioral tasks in 18 studies. Five studies reported higher trait impulsivity in BFRB with different self-report scales. Differences have been found in the urgency, motor, and attentional subscales. Eight studies measuring motor impulsivity (response inhibition) with behavioral tasks showed higher impulsivity in BFRB and its subgroups. Three studies evaluating cognitive impulsivity with behavioral tasks reported that BFRB is not related to reflection and decision-making impulsivity. However, functional alterations in BFRB patients fMRI, during a choice impulsivity task, were shown in one study only. Different aspects of impulsivity are associated with BFRB. The most commonly identified impairment with behavioral tasks, response inhibition impairment, is conceptually similar to the urgency and motor subscales determined by self-report scales. These results support the patients' self-reports and explain the patients' tendency to act rashly under an increasing sense of tension. However, further studies should be conducted to make a definite conclusion about cognitive impulsivity characteristics of BFRB patients. [ Psychiatr Ann . 2022;52(12):527–540.]

Impulsivity in patients with acne excoriee.

Impulsivity is the tendency to make decisions and act quickly without adequate planning and anticipating risks. Impulsivity is among the core symptoms of many psychiatric disorders. In addition, impulsivity can affect the course of various diseases shaped by behaviors. This study aimed to evaluate the relationship between the presence of acne excoriee and different impulsivity dimensions. A case-control study. Thirty patients with acne excoriee (AE+) and 30 acne vulgaris patients without excoriated lesions (AE-) enrolled in this study. Impulsivity was evaluated by The Barratt Impulsivity Scale (BIS). In addition, The Beck Anxiety Inventory, The Beck Depression Inventory, and The Skin Picking Scale were applied to assess the clinical characteristics of the participants. AE+ patients had higher non-planning subscale scores of BIS than AE- patients in this study. In addition, the acne-picking severity score determined by The Skin Picking Scale was positively correlated with non-planning subscale scores of BIS. There was no significant difference between the groups regarding the Beck Depression Inventory and Beck Anxiety Inventory. These results indicate that AE patients have a lack of forethought. In other words, it has been shown that impulsive personality traits, which indicate a lack of planning for the future, may be associated with the acne-picking behavior of the patients.

Skin Picking and Trichotillomania Disorders in the Era of COVID-19: Cross-Sectional Study

Background: Trichotillomania and skin picking are two forms of body focused repetitive behaviors [BFRBs] classified among Obsessive Compulsive Disorders. Socio-governmental changes which had accompanied COVID-19 overwhelmed patients with BFRBs whom already experienced anxiety and social isolation. Our study was designed to determine if there is an association between COVID-19 pandemic and worsening of symptoms of BFRB disorders ( in particular, trichotillomania and skin picking patients).Methods: Cross-sectional online survey-based study conducted from June to August 2021. The survey collected data about participants sociodemographic, knowledge, concerns, and psychological impacts by using Massachusetts General Hospital Hair Pulling Scale (MGH-HPS) and/or modified skin picking scale-revised (SPS-R).Results: A total of 171 participants joined the study including 34 (19.9%) male and 137 (80.1%) females. There was a significant difference of the total modified SPS-R (max 32), the mean score has increased by 7.62 during COVID-19 (t=6.42, p<0.001). Also, 7 parameters (subscales) are statistically significant. There was a significant difference of Frequency of urges, the mean score has increased during COVID-19 by 1.33 (t=3.16, p<0.05=0.025).Conclusion: Throughout COVID-19 pandemic in Saudi Arabia, results revealed clearly the significant negative psychological impact of it on the population, specifically on those with BFRBs. The study gives a clue that both diseases are under-diagnosed, hence, the authors suggest conducting community screening programs for early and proper management. We suggest providing more attention and further protective psychological strategies during such stressful situations that go parallel with the physical health care plans.

Dermatology urgent care model reduces costs and healthcare utilization for psychodermatology patients - a retrospective chart review.

Patients with psychiatric dermatoses may be high users of healthcare, especially emergency services. A dermatology urgent care model may reduce healthcare utilization in this population. To determine whether a dermatology urgent care model can reduce healthcare utilization among patients with psychiatric dermatoses. We conducted a retrospective chart review of patients seen in dermatology urgent care at Oregon Health and Science University between 2018 and 2020 with diagnoses of Morgellons disease and neurotic excoriations. Rates of diagnosis-related healthcare visits and emergency department visits were annualized before and during engagement with the dermatology department. Rates were compared using paired t-tests. We found an 88.0% reduction in annual rates of healthcare visits (P<0.001) and 77.0% reduction in emergency room visits (P<0.003). Results were unchanged when controlled for gender identity, diagnosis, and substance use. We could not account for healthcare use not included in electronic health record. Urgent care models in dermatology may reduce overuse of healthcare and emergency services among patients with psychiatric dermatoses.

(146) Excoriation Disorder, Self-Induced Craniectomy, and the Limitations of Telepsychiatry

(146) Excoriation Disorder, Self-Induced Craniectomy, and the Limitations of Telepsychiatry

(140) Successful Treatment of Excoriation Disorder with IV N-Acetylcysteine

(140) Successful Treatment of Excoriation Disorder with IV N-Acetylcysteine

Clinical Characteristics of Youth with Trichotillomania (Hair-Pulling Disorder) and Excoriation (Skin-Picking) Disorder.

Body-focused repetitive disorders (BFRBDs) are understudied in youth and understanding of their underlying mechanisms is limited. This study evaluated BFRBD clinical characteristics, and two factors commonly implicated in their maintenance - emotion regulation and impulsivity - in 53 youth aged 11 to 17 years: 33 with BFRBDs and 20 controls. Evaluators administered psychiatric diagnostic interviews. Participants rated BFRBD severity, negative affect, quality of life, family functioning, emotion regulation, distress tolerance, and impulsivity. Youth with BFRBDs showed poorer distress tolerance and quality of life, and higher impulsivity and negative affect than controls, with no differences in family impairment. BFRBD distress/impairment, but not BFRBD severity, correlated with anxiety and depression, and poorer distress tolerance. Findings suggest youth with BFRBDs show clinical patterns aligning with prior research; highlight the role of distress tolerance in child BFRBDs; and suggest the utility of acceptance and mindfulness-based therapies for unpleasant emotions in BFRBDs. Continued research should evaluate factors underlying BFRBDs in youth.

Simultaneous presentation of trichotillomania and neurotic excoriation in a schizophrenic patient: case report

The present report aims to describe the case of a patient with excoriation disorder and trichotillomania comorbid with schizophrenia. This is a patient diagnosed with schizophrenia more than 30 years ago and who had a stabilized psychic condition. In one of his periodic evaluations, he began to demonstrate compulsive acts of picking at the skin and from then onwards, lesions appeared on the face, upper limbs and scalp with progressive involvement of other regions. The approach of these mental disorders represented a challenge, because despite a growing number of studies, clinical and therapeutic questions remain open.

The problem with picking: Permittance, escape and shame in problematic skin picking.

Problematic skin picking (SP) is a poorly understood experience characterised by a drive to pick the skin and related psychosocial impact. In the DSM-5, problematic SP is classified as 'excoriation (skin picking) disorder'. The aim of this article is to present a rare qualitative perspective on the lived experience of problematic SP, prioritising participants' voices and sense-making. An in-depth qualitative study of individuals who self-identified as picking their skin problematically and experienced related distress. Seventeen UK-based participants were recruited online and interviewed about their SP. Participants were given choice of interview modality, including instant messenger platforms, telephone, email and Skype, to maximise comfort and improve the accessibility of the study. Transcripts were analysed using thematic analysis. Three themes offering novel insight into the phenomenology of participants' SP are highlighted and explored: (1) how cognitions and circumstances drove and permitted SP, (2) how participants 'zoned out' while SP and the escape or relief that this attentional experience offered and (3) participants' feelings of shame and distress in how they felt their SP may appear to others. This study contributes in-depth and novel ideas to the understanding of SP phenomenology and identifies how environmental factors, cognitions, contextual distress and shame may be considerations in therapeutic intervention. It presents the complexity of SP sense-making and demonstrates the need for individual formulation.

The Generic BFRB Scale-8 (GBS-8): a transdiagnostic scale to measure the severity of body-focused repetitive behaviours.

Body-focused repetitive behaviours (BFRBs) such as skin picking and hair pulling are frequent but under-diagnosed and under-treated psychological conditions. As of now, most studies use symptom-specific BFRB scales. However, a transdiagnostic scale is needed in view of the high co-morbidity of different BFRBs. We aimed to assess the reliability as well as concurrent and divergent validity of a newly developed transdiagnostic BFRB scale. For the first time, we administered the 8-item Generic BFRB Scale (GBS-8) as well as the Repetitive Body Focused Behavior Scale (RBFBS), modified for adults, in 279 individuals with BFRBs. The GBS-8 builds upon the Skin Picking Scale-Revised (SPS-R), but has been adapted to capture different BFRBs concurrently. A total of 170 participants (61%) were re-assessed after 6 weeks to determine the test-retest reliability of the scale. Similar to the SPS-R, factor analysis yielded two dimensions termed symptom severity and impairment. The test-retest reliability of the scale was satisfactory (r = .72, p<.001). Concurrent validity (r = .74) with the RBFBS was good (correlational indexes for concurrent validity were significantly higher than that for discriminant validity). The GBS-8 appears to be a reliable and valid global measure of BFRBs. We recommend usage of the scale in combination with specific BFRB scales to facilitate comparability across studies on obsessive-compulsive spectrum disorders.

Characteristics of 262 adults with skin picking disorder

IntroductionSkin picking disorder (also known as excoriation disorder or dermatillomania) is a common mental health disorder currently classified as an obsessive-compulsive and related condition. Despite being first described in the 1800s, very little is known about its phenomenology and clinical presentation. Most information about this disorder to date is based on online surveys rather than in-person assessments. MethodsClinical and demographic data were collected from individuals with skin-picking disorder taking part in research studies, using in-person assessments comprising validated instruments. Descriptive information was presented as to the nature of skin picking disorder. ResultsThe sample comprised 262 individuals, mean age 32.5 years, being 87% female. The peak age of onset of symptoms was 12.9 years, and most affected individuals (>90%) had symptom onset before age of 20 years. Typically, individuals reported picking from multiple body sites (most common was the face), and the most frequent triggers were stress and the ‘feel’ (i.e. texture) of the skin. Comorbidities were common, including trichotillomania, depression, generalized anxiety disorder, and impulsive/compulsive disorders (especially attention-deficit hyperactivity disorder and obsessive-compulsive disorder). The majority of people with the disorder (87.1%) had never received treatment. Of those who had received treatment in the past, 87% reported that they found the treatment helpful for their symptoms. DiscussionThis study sheds new light on the clinical presentation and phenomenology of skin picking disorder. Results highlight the need for further research into its clinical presentation, longitudinal course, and treatment approaches.

A Case Report On Excoriation Disorder and Type 1 Hypersensitivity; A District Health Facility-Based Study

Excoriation disorder (ED) or psychogenic excoriation is a "repetitive and compulsive picking of skin which results in tissue damage" characterized by an obsessive-compulsive spectrum mental disorder with a repeated urge or impulse to pick at one's own skin to theextent of causing psychological or physical damage. Prevalence of this condition is unavailable in developing countries of the world. It is classified as "L98.1 Excoriation (skin-picking) Disorder" in ICD-10 and referred in some literature as "dermatillomania". ED is characterized by, but not invariably, the compulsive urge to pick, squeeze or scratch skin surfaces experienced by patients. Commonly picked parts of the body include the face (most picked), arms, legs, back, gums, neck, shoulders, scalp, abdomen, chest, the knuckles (via mouth leading to temporary disfiguration of distal and proximal joints of the middle and little fingers) and other extremities e.g. the fingernails, cuticles, and toe nails;5 skin picking may be accompanied by anxiety with depression following picking. It is often triggered by factors that include feeling or examining irregularities on the skin, feeling anxious etc. Complications include infections, tissue damage and sepsis. Rarely, severe cases cause lifethreatening injuries. Risk of self-harm is increased by feelings of intense helplessness, guilt, shame and embarrassment.8 Studies further describe significant associations between ED and suicidal ideation, suicidal attempts and psychiatric hospitalizations.

Psychopathological symptoms in dermatology: A basic approach toward psychocutaneous disorders.

Dermatological conditions impact not only an individual's physical body but also their psychological health. Similar to how cutaneous conditions can affect one's psychological health, worsening psychological conditions can exacerbate or even induce dermatological conditions. There are four common psychiatric pathologies typically found in dermatology practices: depressive symptoms, anxiety symptoms, obsessive-compulsive disorder behaviors, and psychosis. Common cutaneous disorders associated with these psychopathological symptoms include, but are not limited to, psoriasis, acne vulgaris, atopic dermatitis, urticaria, trichotillomania, excoriation disorder, and delusions of parasitosis. The goal of this review is to examine the relationship between these four psychopathological symptoms with common psychodermatological conditions and to help providers better diagnose and implement appropriate psychological support to treat their patients.

Skin Picking Scale-Revised: Diagnostic accuracy and optimal cut-off scores in university and psychiatric settings

The Skin Picking Scale-Revised (SPS-R) is an eight-item self-report measure of skin picking disorder (SPD) severity. The aim of this study was to examine the diagnostic accuracy of the SPS-R and develop cut-off scores in university and psychiatric settings. We administered the SPS-R to (1) university students with SPD (n = 73) and without SPD (n = 148) and (2) patients in a psychiatric partial hospital with SPD (n = 50) and without SPD (n = 403). Scores on the SPS-R accurately predicted SPD diagnostic status in both samples (area under the curve >0.95). A total score of 9 demonstrated an optimal balance between sensitivity, specificity, and predictive values in both samples. The results suggests that SPS-R has acceptable diagnostic accuracy and can be used as a screening tool to help identify individuals with SPD for research purposes in university and partial hospital settings.

Obsessive-compulsive and related disorders according to ICD-11 and DSM-5 : With brief consideration of the new obsessive-compulsive disorders olfactory reference disorder and hypochondriasis

This article summarizes the current state of research with respect to the new obsessive-compulsive and related disorders (OCRD) grouping according to the International Statistical Classification of Diseases and Related Health Problems (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The ICD-11 grouping of OCRD is based on common clinical features, such as repetitive undesired thoughts and repetitive behavior and is supported by the literature and empirical data from the fields of imaging and genetics. The disorders in this grouping in ICD-11 include obsessive-compulsive disorder, pathological hoarding, body dysmorphic disorder, trichotillomania, excoriation disorder, and as new disorders differing to DSM‑5, hypochondriasis, olfactory reference disorder and Tourette syndrome. The aim of the OCRD grouping is an improvement of the diagnostics and appropriate treatment strategies as well as a further stimulation of research. The new disorders olfactory reference disorder and hypochondriasis are presented and discussed.

Childhood maltreatment, traumatic experiences, and posttraumatic stress disorder in pathological skin picking: An online case-control study

ObjectiveAlthough traumatic stress including childhood maltreatment (CM) has a profound impact on mental health, its relation to pathological skin picking (PSP) has been understudied and results remain inconclusive. Likewise, posttraumatic stress disorder (PTSD) as the most typical sequelae of traumatic stress has hardly been investigated in those with PSP. The objective of our online case-control study was to shed further light on this issue. MethodsUsing an anonymous online survey, 325 adult participants with PSP defined by Skin Picking Scale-Revised (SPS-R) scores ≥ 7 as well as Skin Picking Impact Scale (SPIS) scores ≥ 7 were administered the Childhood Trauma Questionnaire (CTQ), the Short Screening Scale for DSM-IV PTSD (PTSD-7) including a list of traumatic events, and a brief measure of psychopathological distress. They were compared to an age-, sex-, and education-matched control group recruited online by means of analyses of variance (ANOVA). ResultsThe PSP sample scored significantly higher on the CTQ dimensions of sexual and emotional abuse as well as emotional neglect with small to moderate effect sizes (d between 0.27 and 0.49). Accounting for psychological distress, the only significant difference related to emotional abuse with a small effect (d = 0.23). Participants with PSP reported significantly more traumatic experiences in adulthood than the control group (59.1% vs. 38.2%; χ2(1; N=638) = 28.02, p < .001). Among those with PSP, a probable diagnosis of PTSD was found in 44 (13.5%) compared to zero cases in the control group. ConclusionsOur findings indicate that emotional abuse in childhood may be of relevance in skin picking. Since exposure to traumatic events in adulthood as well as PTSD seem to be more frequent in those with PSP compared to a control group, it might be worthwhile to consider these factors in the assessment of patients with skin picking.