Skin Picking Research Articles

Nutrition in Skin Picking Disorder and Trichotillomania.

Objective: Excessive calorie intake constitutes a global public health concern, due to its associated range of untoward outcomes. Impulsivity and compulsivity have been linked to dietary intake. However, nothing is known about dietary intake and body-focused repetitive behaviors, despite their classification as obsessive-compulsive related conditions, and high co-morbidity with impulsive and compulsive conditions.Methods: One hundred and ninety six adults with trichotillomania or skin picking disorder were recruited. Dietary intake over the preceding year was quantified using the Dietary Fat and Free Sugar Short questionnaire. Relationships between dietary fat/sugar intake and behaviors were evaluated using regression modeling.Results: Sugar intake was significantly related to higher trans-diagnostic compulsivity (p = 0.011) and higher non-planning impulsivity (p = 0.013) In terms of saturated fat intake, there was no significant relationship to the explanatory variables. A combination high fat/high sugar diet was significantly associated with higher motor impulsivity (p = 0.005).Conclusions: Past-year nutrition appears to be significantly associated with trans-diagnostic impulsivity and compulsivity. The role of poor nutrition in these disorders and related conditions, and its link with impulsivity and compulsivity, requires longitudinal research attention; and clinical work should address not only psychiatric symptoms but also impact of lifestyle of overall health.

Excoriation Disorder (Obsessive-Compulsive Spectrum Disorder)

Obsessive-compulsive spectrum mental disorder includes Excoriation disorder. It can be characterized by the repeated urge or impulse to pick at one’s own skin to the extent The prevalence of excoriation disorder is exactly unknown. Prevalence of the condition in the general population range from 1.4 to 5.4%. Body -Focused Repetitive Behaviour q (BFRB). Other types of BFRBs include pulling or picking of the hair or nails that damages the body. Some people repeatedly scratch skin or try to rub out “imperfections” they think they see in their skin.

Pathological Skin Picking: Phenomenology and Associations With Emotions, Self-Esteem, Body Image, and Subjective Physical Well-Being.

Pathological skin picking (PSP) refers to the repetitive manipulation of the skin causing wounds, scars, emotional distress, and social impairment. Skin picking disorder was first recognized as a distinct disorder in the DSM-5 and is still understudied in terms of phenomenology, etiology, and associated consequences. However, the body-related pathology suggests that the relation to the own body might be a crucial factor in PSP. Previous studies provided first insights that affected individuals show a more negative body image and lower self-esteem than healthy individuals. The present study sought to investigate skin picking phenomenology, related emotions as well as associations with self-esteem, body image, and subjective physical well-being. The study was conducted as an open online study, and recruitment was generally targeted to individuals of full age and in addition specifically to individuals with PSP. A total of 363 individuals (82.9% female; age: M = 32.6, SD = 13.92) participated and answered various self-report measures. Nearly half of the sample exceeded the cutoff score for pathological skin picking (N = 163; 44.9%). The results suggest that boredom, bodily tension and strong negative feelings often precede PSP episodes. During the episode most individuals seem to experience a loss of control, trance and positive feelings. After the PSP episode, shame, guilt, anger and anger toward themselves are most prominent. As expected, skin picking severity was positively associated with body image disturbances and negatively with self-esteem, and subjective physical well-being. When controlling for depressive symptoms, all associations were reduced, but those with body image disturbances (r = 0.44; p < 0.001), self-esteem (r = −0.27; p < 0.001), subjective physical well-being (r = −0.22; p < 0.001), and peace of mind (r = 0.30; p < 0.01) remained significant. Moreover, greater skin damage due to skin picking was moderately associated with higher body image disturbances. The results indicate that PSP severity is associated with a negative body image and low self-esteem, and suggest that it may be warranted to consider these aspects in the development of future interventions for PSP. However, relations with body image and self-esteem should be examined in longitudinal studies investigating causal relationships between body image, self-esteem and skin picking. Moreover, PSP phenomenology and the role of specific emotions should be investigated in more detail.

Parental Bonding in Trichotillomania and Skin Picking Disorder.

One means of understanding the effect of environmental factors on psychiatric disorders is by examining perceived parenting behavior in the childhood of individuals with trichotillomania and skin picking disorder (i.e. body focused repetitive behaviors (BFRBs)). We hypothesized that adults with BFRBs would show higher scores on dimensions of "care" and "overprotection". Specifically, we predicted that adults with BFRBs would have parents in the "affectionate constraint" quadrant, based on a combination of high care and high protection scores. We assessed demographic and clinical differences in 184 adults between the ages of 18 and 65 with Trichotillomania (TTM) (n = 43) and Skin Picking Disorder (SPD) (n = 75), and both (n = 66). The Parental Bonding Instrument (PBI) measured "care" and "overprotection" items. Results from the PBI were compared across groups and with normal control data using independent sample t-tests. Individuals in the BFRB group had significantly lower maternal and paternal care scores compared to controls. The TTM, SPD, and TTM + SPD (combined) groups all had lower maternal care scores than controls. The TTM + SPD (combined) group had significantly lower paternal care scores and higher maternal protection scores than the normative averages. The most common parenting patterns in subjects with BFRBs were maternal and paternal affectionless control (low care/high protection). From our sample, only 27 % reported optimal maternal parenting and 28 % reported optimal paternal parenting. These preliminary data suggest that low maternal and paternal care may be associated with BFRBs. However, the nature of this relationship should be further explored, as these results do not necessarily mean that affectionless control parenting leads to a predisposition to BFRBs, and there may in fact be other environmental factors at play. Identifying how individuals perceive familial relationships may provide direction for clinicians in developing tools to address the burden caused by BFRBs.

What Have We Learned About the Genetics of Obsessive-Compulsive and Related Disorders in Recent Years?

Obsessive-compulsive disorder (OCD) is a complex, multifactorial disorder with onset in either childhood or early adulthood. Lifetime prevalence has been estimated to be around 2%-3%. DSM-5 groups OCD together with closely related disorders-body dysmorphic disorder, trichotillomania (hair-pulling disorder), hoarding disorder, and excoriation disorder (skin-picking disorder)-as obsessive-compulsive and related disorders (OCRDs). In addition, DSM-5 includes a "tic-related" specifier, recognizing that OCD and Tourette syndrome/chronic tics are frequently comorbid. In recent years, the first large-scale genome-wide studies of OCRDs have emerged. These studies confirmed results from earlier twin and family studies that have demonstrated a strong genetic component to OCRDs. Furthermore, from analyses of common genetic variation, these studies offered a first insight into how the genetic risk of developing an OCRD might be connected to the genetic risk of developing another OCRD. This article is an update of the authors' previous report; it summarizes recent findings on the genetics of OCRDs and highlights some of the recent directions in OCRD genetics that will pave the way for new insights into OCRD pathophysiology.

The Ugly Face of Face Masks

Abstract Introduction: Prolonged and tightly use of face masks has been identified as cause for skin damage during the COVID-19 pandemic. Case series presentation: We evaluated patients seen in the outpatient clinic between March and May 2020, during the lockdown period, focusing on skin damage related to the use of face masks. We aimed to highlight the major impact of routine usage of face masks on the skin of individuals of different ages and professions. Contact dermatitis was prevalent, but we also recorded many cases of outbreak of seborrheic dermatitis, acne, rosacea, perioral dermatitis, atopic dermatitis, folliculitis, as well as neurotic excoriations caused by anxiety, tinea, and impetigo. We also observed a delay in the diagnosis of benign and malignant tumors. Conclusions: The most important step should be the assessment of dermatologic pathology related to the use of face masks. They say a picture is worth a thousand words. So take off the face mask, and look at the skin!

Evaluating the role of Approach-Avoidance Training on action-tendencies in individuals with skin-picking disorder: A preliminary randomized experiment.

Background and aimsPathological skin-picking (PSP) or excoriation disorder is a destructive behavior that affects 1-2% of the general population. The purpose of this pilot study was to evaluate the effect of a computerized behavior modification task on action-tendencies (i.e., approach or avoidance) in adults with PSP. We aimed to modify these action-tendencies by having participants with PSP complete the Approach-Avoidance Training (AAT) task, using a joystick to simulate an approach (=pull) or avoidance (=push) response.MethodForty-five participants diagnosed with PSP were randomized to one of three training conditions: (1) Avoidance Training (AvT; n = 15), (2) Approach Training (ApT; n = 15), or (3) Placebo Training (PT; n = 15). We hypothesized that after training, those in the AvT would have the greatest reduction in behavioral approach (i.e., their overall reaction time [RT] to approach pictures of irregular skin stimuli).ResultsResults of the pre-training assessment task revealed a positive correlation between behavioral approach to irregular skin stimuli and skin-picking severity as assessed by the Skin Picking Scale-Revised (SPS-R). After training, a lower behavioral approach and urges to pick were found in the AvT and PT groups, while those in the ApT reported higher behavioral approach and urges to pick. At two-week follow-up, no significant changes on the SPS-R were reported between groups.DiscussionOur preliminary data suggest that the AAT is a promising avenue of research to develop as a cognitive intervention to address an excessive behavioral approach tendency that characterizes skin-picking problems.

Trichotillomania and excoriation disorder: Primary care implications.

Trichotillomania and excoriation disorder are two psychiatric conditions that have similar origins to obsessive compulsive disorder. Both can cause patients significant distress and lead to medical consequences. It is important that primary care NPs identify and refer these individuals for psychiatric treatment.

Dissociative Experiences Mediate the Relationship Between Traumatic Life Events and Types of Skin Picking. Findings From Non-clinical Sample.

Aim: Skin-picking (excoriation) disorder is considered as a form of maladaptive coping methods used by individuals who have difficulties in applying more adaptive strategies. Skin-picking development has been suggested to be preceded by traumatic life events. Dissociative symptoms have been reported as experienced by skin-picking sufferers during picking episodes. The purpose of the study was to examine whether the link between trauma and automatic type of skin-picking is mediated by the frequency of dissociative experiences, and whether the COVID-19 pandemic conditions have changed this relationship in any way.Methods: The study sample consisted of 594 adults (76% women) aged from 18 to 60. Traumatic life events, dissociative experiences, and types of skin-picking (focused vs. automatic) were assessed with self-report questionnaires. Mediation analyses and multigroup path analyses were carried out.Results: Dissociative experiences partially mediated the link between traumatic events and both types of skin-picking. The model was robust considering the conditions in which survey was filled out (pre-pandemic vs. pandemic).Conclusions: Traumatic life events and dissociative experiences are associated with both automatic and focused skin-picking regardless of pandemic conditions. Further studies are needed to understand mechanisms underlying the relationship between dissociation and skin-picking styles.

Evidence of N-acetylcysteine efficacy for skin picking disorder: A retrospective cohort study

Evidence of N-acetylcysteine efficacy for skin picking disorder: A retrospective cohort study

Selection of Anti-Depressants in Geriatric Dermatoses- A Questionnaire Study of Dermatologists in Western Rajasthan, India

Background: The Global Wealth Migration Review 2019 report, published by New World Wealth, estimated that 48% of India's total wealth was held by high-net worth individuals. Distinct factors dominate the prescription of anti-depressants in the geriatric population. Accordingly, the intention of pharmacotherapy in geriatric psycho dermatoses is deciphered in the study. . Objective: To survey and analyze the selection of anti-depressants by the dermatologists in the practice of geriatric pharmacotherapy. Methods: A questionnaire was designed and circulated among ninety-three dermatologists in three sessions and the data collected was analyzed through the cross-sectional study statistics. Results: The typical senior people attending the specialist were 25-50%. A sizeable familiarity of psycho cutaneous disturbance was attributed to dermatophyte infections, lichen simplex chronic, and Prurigo in descending order. The largely established primary disorder was neurotic excoriation. The prescription pattern was classified and 51.9% dermatologists are customary with psychotropic agent Doxepin over other agents. The discipline of the multidisciplinary approach was also studied. Limitation: Small sample size, uniregional study, prevalence study. Conclusions: The survey aids in evaluating mental health in cutaneous dermatoses of the elderly and assists the dermatologists to offer understated economical options and amend existing guidelines.

Suicidality in patients with obsessive-compulsive and related disorders (OCRDs): A meta-analysis

IntroductionPrevious meta-analyses showed that OCD is associated with a substantial risk of suicidal behaviours. Conclusive rates of suicidal ideation (current and lifetime) and suicide attempts based on pooled prevalence rates have not so far been calculated using meta-analysis for the other DSM-5 Obsessive-Compulsive and Related Disorders (OCRDs). ObjectivesThis meta-analysis aims to separately calculate the pooled prevalence rates of lifetime suicide attempts and current or lifetime suicidal ideation in BDD, Hoarding Disorder (HD), Skin Picking Disorder (SPD) and Trichotillomania (TTM) and to identify factors associated with increased suicide rates. MethodsOur protocol was pre-registered with PROSPERO (CRD42020164395). A systematic review and meta-analysis following PRISMA reporting guidelines was performed by searching in PubMed/Medline, PsycINFO, Web of Science and CINAHL databases from the date of the first available article to April 20th, 2020. Stata version 15 was used for the statistical analysis. Given the small number of studies in TTM and SPD, the two grooming disorders were grouped together. Meta-analyses of proportions based on random effects (Der-Simonian and Laird method) were used to derive the pooled estimates. ResultsThirty-eigth studies (N = 4559 participants) were included: 23 for BDD, 8 for HD, 7 for Grooming Disorders. For BDD, the pooled prevalence of lifetime suicide attempts, current and lifetime suicidal ideation was, respectively 35.2% (CI:23.4–47.8), 37.2% (CI:23.8–51.6) and 66.1% (CI:53.5–77.7). For HD, the pooled prevalence of lifetime suicide attempts, current and lifetime suicidal ideation was 24.1% (CI:12.8–37.6), 18.4% (CI:10.2–28.3) and 38.3% (CI:35.0–41.6), respectively. For Grooming Disorders, the pooled prevalence of lifetime suicide attempts and current suicidal ideation were 13.3% (CI:5.9–22.8) and 40.4% (CI:35.7–45.3), respectively (no data available for lifetime suicidal ideation). ConclusionsThe OCRDs as a group are associated with relatively high rates of suicidal behaviour. Through indirect comparisons, we infer that BDD has the greatest risk. Comorbid substance abuse, possibly reflecting poor underlying impulse control, is associated with higher rates of suicidal behaviour in BDD. Our data emphasize the need for clinicians to consider the risk of suicidal behaviour in the management of patients presenting with all forms of OCRDs.

ACT-enhanced group behavior therapy for trichotillomania and skin-picking disorder: A feasibility study.

To evaluate the feasibility and efficacy of ACT-enhanced Group Behavior Therapy (AEGBT) for mixed diagnosis groups including patients with trichotillomania (TTM) and skin-picking disorder (SPD) in routine psychiatric care. Adult patients (N = 40) with TTM and/or SPD received 10 weeks of AEGBT followed by five booster sessions. The primary outcome measure for TTM was the Massachusetts General Hospital Hairpulling Scale (MGH-HPS) and for SPD the Skin Picking Scale-Revised(SPS-R), assessed at posttreatment and at booster sessions. Results showed significant reductions in hair pulling and skin-picking severity from baseline to posttreatment and large effect sizes at posttreatment. Improvements remained significant at the 12-month follow-up for patients with SPD, but not for patients with TTM. Group attendance was high and few patients dropped out from treatment. The group format enabled therapists to see 25% more patients compared with an individual format. The results provide initial support for the feasibility and efficacy of an adapted treatment approach for TTM and SPD.

The Spanish version of the Skin Picking Impact Scale (SPIS) and its Short form (SPIS-S)

Introduction: The Skin Picking Impact Scale (SPIS) is a self-report rating scale that assess the psychosocial impact of excoriation disorder. In this study the SPIS was translated into Spanish and its reliability was measured. Similarly, its short version (SPIS-S) has been translated and tested. Methodology: The recruitment has been performed through a survey launched on social media. All subjects were older than18 years and self-reported being diagnosed with an excoriation disorder. 281 individuals were rated for the validation analysis. SPIS has been translated into Spanish and validated through an. Exploratory and confirmatory factorial analysis. Participants have been also scored with the Skin Picking Scale-Revised (SPS-R). Results: On factor at the exploratory factorial analysis has a raw eigenvalue greater than 1, with 65.5% of total variance. The confirmatory analysis confirmed that the scale is one-dimensional. Cronbach’s alpha also confirmed a good internal consistency (?=0.934 for the SPIS and ?=0.882 for the SPIS-S). Scores between the two scales (SPIS and the SPS-R) have shown a good convergence (r=0.592, p&lt;0.0001). Conclusion: The Spanish version of SPIS and its short version show good psychometric properties and adequately reproduce the one-dimensional model of the original English version.

Identifying Subtypes of Trichotillomania (Hair Pulling Disorder) and Excoriation (Skin Picking) Disorder Using Mixture Modeling in a Multicenter Sample

Body-focused repetitive behavior disorders (BFRBs) include Trichotillomania (TTM; Hair pulling disorder) and Excoriation (Skin Picking) Disorder (SPD). These conditions are prevalent, highly heterogeneous, under-researched, and under-treated. In order for progress to be made in optimally classifying and treating these conditions, it is necessary to identify meaningful subtypes.

Prevalence of Trichotillomania and Excoriation Disorder: Results From a Large Community Sample

There are few large studies examining the prevalence of trichotillomania (TTM) and skin picking disorder (SPD). Here we present the results of a recent studies of the prevalence of TTM and SPD that involved a large community-based sample of over 10,000 subjects.

Excoriation (skin-picking) disorder among adolescents and young adults with acne-induced postinflammatory hyperpigmentation and scars.

A plethora of health-related concerns, including skin disorders, are particularly common during the critical periods of adolescence and young adulthood. Their reactions to skin-related disorders can be different from their reactions to other disorders. While medical problems could be physiologically impacting, skin disorders like excoriation disorder can, in addition, directly affect their physical appearance in ways that have psychological consequences like anxiety, low self-esteem, and impaired quality of life. The increasing prevalence of excoriation disorder has resulted in its inclusion in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the eleventh edition of the International Classification of Diseases (ICD-11) manuals as one of the obsessive-compulsive disorders (OCD)-related disorders. However, health care professionals may not often recognize this important entity especially among adolescents and young adults with acne vulgaris presenting with chronic or recurrent acne-induced postinflammatory hyperpigmentation and scars. A number of self-reported tools are available for use in screening and/or assessment of excoriation disorder and to aid its management. While both pharmacologic and non-pharmacologic therapies are available, patient education is important. Physicians who usually make first contact with patients, such as Family Medicine Physicians, Pediatricians, Dermatologists, and Aesthetic Medicine Physicians, should have a relatively high index of suspicion for this disorder, especially in those presenting rather frequently with new or repeat lesions. Prompt referral to licensed mental health specialists is encouraged in order to ensure the provision of holistic care to affected persons.

N-acetylcysteine for managing neurotic excoriation: encouraging results in two patients

N-acetylcysteine for managing neurotic excoriation: encouraging results in two patients

Heightened Sense of Incompleteness in Excoriation (Skin-Picking) Disorder

Excoriation (Skin-Picking) Disorder (SPD) is characterized by repetitive skin picking resulting in tissue damage. This study examined associations between the tendency to experience a sense of incompleteness (henceforth trait incompleteness) and pathological skin picking across two studies. In study 1, undergraduate students (n = 481) completed self-report measures of skin picking severity, trait incompleteness, perfectionism, obsessive-compulsive symptoms, and negative affect (i.e., depression, anxiety). In study 2, undergraduate students with a diagnosis of SPD (n = 61) and a control group without SPD (n = 63) rated skin picking severity, trait incompleteness, obsessive-compulsive symptoms, and negative affect (i.e., depression, anxiety, and stress). In study 1, linear regression showed that trait incompleteness significantly predicted skin picking severity, after controlling for other variables. In study 2, logistic regression showed trait incompleteness significantly predicted SPD diagnosis, after controlling for other variables. There was no significant correlation between incompleteness and symptom severity within the SPD group. The results indicate a robust association between SPD and trait incompleteness. More research is needed to establish whether trait incompleteness may represent a vulnerability factor underlying SPD, or if skin picking leads to susceptibility to trait incompleteness.

Selection of Anti-Depressants in Geriatric Dermatoses- A Questionnaire Study of Dermatologists in Western Rajasthan, India

Background: The Global Wealth Migration Review 2019 report, published by New World Wealth, estimated that 48% of India's total wealth was held by high-net worth individuals. Distinct factors dominate the prescription of anti-depressants in the geriatric population. Accordingly, the intention of pharmacotherapy in geriatric psycho dermatoses is deciphered in the study. . Objective: To survey and analyze the selection of anti-depressants by the dermatologists in the practice of geriatric pharmacotherapy. Methods: A questionnaire was designed and circulated among ninety-three dermatologists in three sessions and the data collected was analyzed through the cross-sectional study statistics. Results: The typical senior people attending the specialist were 25-50%. A sizeable familiarity of psycho cutaneous disturbance was attributed to dermatophyte infections, lichen simplex chronic, and Prurigo in descending order. The largely established primary disorder was neurotic excoriation. The prescription pattern was classified and 51.9% dermatologists are customary with psychotropic agent Doxepin over other agents. The discipline of the multidisciplinary approach was also studied. Limitation: Small sample size, uniregional study, prevalence study. Conclusions: The survey aids in evaluating mental health in cutaneous dermatoses of the elderly and assists the dermatologists to offer understated economical options and amend existing guidelines.