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Anderson S, Clarke V, Thomas Z. The problem with picking: Permittance, escape and shame in problematic skin picking. Psychol Psychother 2023; 96:83-100. [PMID: 36117429 PMCID: PMC10087923 DOI: 10.1111/papt.12427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/25/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES 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. DESIGN An in-depth qualitative study of individuals who self-identified as picking their skin problematically and experienced related distress. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Suzy Anderson
- School of Social Sciences, College of Health, Science and Society, University of the West of England, Bristol, UK
| | - Victoria Clarke
- School of Social Sciences, College of Health, Science and Society, University of the West of England, Bristol, UK
| | - Zoe Thomas
- School of Social Sciences, College of Health, Science and Society, University of the West of England, Bristol, UK
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2
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Rizzo C, Sestino A, Pino G, Guido G, Nataraajan R, Harnish RJ. A Hierarchical Personality Approach Toward a Fuller Understanding of Onychophagia and Compulsive Buying. Psychol Rep 2022; 126:1322-1338. [PMID: 35147062 DOI: 10.1177/00332941211061696] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Employing a hierarchical model of personality, prior research suggests that cardinal traits such as conscientiousness and agreeability predict central traits such as materialism and need for arousal that in turn impact surface traits such as onychophagia and compulsive buying. More research is needed to explore additional central traits and their effect on onychophagia and compulsive buying. Thus, the goal of the current research is to examine how another central trait-negative perfectionism-impacts onychophagia and compulsive buying. DESIGN/METHODOLOGY/APPROACH A survey was administered both online and face-to-face resulting in a sample of 634 subjects of which 391 were individuals with onychophagia. Through a multi-group analysis, a causal model was tested to identify personality traits and their relationship with compulsive buying. RESULTS Results showed that onychophagia was affected by other obsessive-compulsive disorders-particularly trichotillomania, and excoriation disorder, which significantly increased the likelihood that the participant was a compulsive buyer.
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Affiliation(s)
| | | | | | | | | | - Richard J Harnish
- New Kensington Campus, Penn State University , Kensington, PA, U.S.A
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3
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Xie Z, Li D, Cheng X, Pei Q, Gu H, Tao T, Huang M, Shang C, Geng D, Zhao M, Liu A, Zhang C, Zhang F, Ma Y, Cao P. A brain-to-spinal sensorimotor loop for repetitive self-grooming. Neuron 2021; 110:874-890.e7. [PMID: 34932943 DOI: 10.1016/j.neuron.2021.11.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/27/2021] [Accepted: 11/20/2021] [Indexed: 01/04/2023]
Abstract
Self-grooming is a complex behavior with important biological functions and pathological relevance. How the brain coordinates with the spinal cord to generate the repetitive movements of self-grooming remains largely unknown. Here, we report that in the caudal part of the spinal trigeminal nucleus (Sp5C), neurons that express Cerebellin-2 (Cbln2+) form a neural circuit to the cervical spinal cord to maintain repetitive orofacial self-grooming. Inactivation of Cbln2+ Sp5C neurons blocked both sensory-evoked and stress-induced repetitive orofacial self-grooming. Activation of these neurons triggered short-latency repetitive forelimb movements that resembled orofacial self-grooming. The Cbln2+ Sp5C neurons were monosynaptically innervated by both somatosensory neurons in the trigeminal ganglion and paraventricular hypothalamic neurons. Among the divergent projections of Cbln2+ Sp5C neurons, a descending pathway that innervated motor neurons and interneurons in the cervical spinal cord was necessary and sufficient for repetitive orofacial self-grooming. These data reveal a brain-to-spinal sensorimotor loop for repetitive self-grooming in mice.
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Affiliation(s)
- Zhiyong Xie
- National Institute of Biological Sciences, Beijing 102206, China
| | - Dapeng Li
- Department of Neurobiology, School of Basic Medical Sciences, Beijing Key Laboratory of Neural Regeneration and Repair, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xinyu Cheng
- National Institute of Biological Sciences, Beijing 102206, China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qing Pei
- National Institute of Biological Sciences, Beijing 102206, China
| | - Huating Gu
- National Institute of Biological Sciences, Beijing 102206, China
| | - Ting Tao
- National Institute of Biological Sciences, Beijing 102206, China
| | - Meizhu Huang
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
| | - Congping Shang
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
| | - Dandan Geng
- The Key Laboratory of Neural and Vascular Biology, Ministry of Education and Department of Biochemistry and Molecular Biology, Hebei Medical University, Shijiazhuang, China
| | - Miao Zhao
- National Institute of Biological Sciences, Beijing 102206, China
| | - Aixue Liu
- National Institute of Biological Sciences, Beijing 102206, China
| | - Chen Zhang
- Department of Neurobiology, School of Basic Medical Sciences, Beijing Key Laboratory of Neural Regeneration and Repair, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Fan Zhang
- The Key Laboratory of Neural and Vascular Biology, Ministry of Education and Department of Biochemistry and Molecular Biology, Hebei Medical University, Shijiazhuang, China.
| | - Yuanwu Ma
- Key Laboratory of Human Disease Comparative Medicine, National Health Commission of China (NHC), Institute of Laboratory Animal Science, Peking Union Medicine College, Chinese Academy of Medical Sciences, Beijing 100021, China.
| | - Peng Cao
- National Institute of Biological Sciences, Beijing 102206, China; Tsinghua Institute of Multidisciplinary Biomedical Research, Tsinghua University, Beijing 100084, China.
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Mitra S, Bult-Ito A. Bidirectional Behavioral Selection in Mice: A Novel Pre-clinical Approach to Examining Compulsivity. Front Psychiatry 2021; 12:716619. [PMID: 34566718 PMCID: PMC8458042 DOI: 10.3389/fpsyt.2021.716619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) and related disorders (OCRD) is one of the most prevalent neuropsychiatric disorders with no definitive etiology. The pathophysiological attributes of OCD are driven by a multitude of factors that involve polygenic mechanisms, gender, neurochemistry, physiological status, environmental exposures and complex interactions among these factors. Such complex intertwining of contributing factors imparts clinical heterogeneity to the disorder making it challenging for therapeutic intervention. Mouse strains selected for excessive levels of nest- building behavior exhibit a spontaneous, stable and predictable compulsive-like behavioral phenotype. These compulsive-like mice exhibit heterogeneity in expression of compulsive-like and other adjunct behaviors that might serve as a valuable animal equivalent for examining the interactions of genetics, sex and environmental factors in influencing the pathophysiology of OCD. The current review summarizes the existing findings on the compulsive-like mice that bolster their face, construct and predictive validity for studying various dimensions of compulsive and associated behaviors often reported in clinical OCD and OCRD.
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Affiliation(s)
- Swarup Mitra
- Department of Pharmacology and Toxicology, State University of New York at Buffalo, Buffalo, NY, United States
| | - Abel Bult-Ito
- Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK, United States
- OCRD Biomed LLC, Fairbanks, AK, United States
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5
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Shin JO, Roh D, Son JH, Shin K, Kim HS, Ko HC, Kim BS, Kim MB. Onychophagia: detailed clinical characteristics. Int J Dermatol 2021; 61:331-336. [PMID: 34416026 DOI: 10.1111/ijd.15861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/14/2021] [Accepted: 07/30/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Onychophagia is a common disorder affecting 20% to 30% of the general population. It is defined as habitual nail biting and can cause various changes in the nail units. However, to date, there has been a paucity of data focusing on nail deformities related to onychophagia. This study was performed to investigate the clinical characteristics of onychophagia in Korea. METHODS This study included 53 patients with onychophagia who visited the Pusan National University Hospital (Busan and Yangsan) over a 10-year period (2011-2020). We retrospectively reviewed medical records and clinical and dermoscopic photographs. RESULTS All 10 fingernails were affected in 37.7% of the patients. The left thumbnail was the most predominantly affected site (81.1%). Clinical findings showed that short nails with ragged distal borders were the most common presentation (100.0%), followed by generalized or patchy rough areas (50.9%), linear and pinpoint hemorrhage (32.1%), longitudinal melanonychia (30.2%), transverse groove (28.3%), brittleness (28.3%), macrolunula (24.5%), washboard nail (13.2%), and pterygium (3.8%). Of the patients, 88.7% had periungual complications, such as periungual exfoliation (77.4%), absent or ragged cuticle (52.8%), hyponychial hyperkeratosis (37.7%), and paronychia (15.1%). CONCLUSIONS Although onychophagia is a common disorder, its clinical characteristics have not been reported in the literature. The results of this study may be helpful in managing patients with onychophagia.
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Affiliation(s)
- Jun-Oh Shin
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Department of Dermatology, Pusan National University, Yangsan Hospital, Yangsan, Korea
| | - Dongyoung Roh
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Department of Dermatology, Pusan National University, Yangsan Hospital, Yangsan, Korea
| | - Jin-Hwa Son
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Department of Dermatology, Pusan National University, Yangsan Hospital, Yangsan, Korea
| | - Kihyuk Shin
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Department of Dermatology, Pusan National University, Yangsan Hospital, Yangsan, Korea
| | - Hoon-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Department of Dermatology, Pusan National University, Yangsan Hospital, Yangsan, Korea
| | - Byung-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moon-Bum Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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6
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Mathew AS, Harvey AM, Lee HJ. Development of the social concerns in individuals with body-focused repetitive behaviors (SCIB) scale. J Psychiatr Res 2021; 135:218-229. [PMID: 33503548 DOI: 10.1016/j.jpsychires.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/18/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
Body-focused repetitive behaviors (BFRBs) include such disorders as compulsive hair pulling, skin picking, nail biting, and cheek biting, which can lead to significant psychosocial impairment (American Psychiatric Association, 2013). As such, social concerns (i.e., concerns about how others view their behavior or affected body sites) are common in these individuals, and may significantly associate with BFRB symptomology (Snorrason et al., 2012). Currently, there are no measures to adequately assess social concerns specific to BFRBs. To this end, we developed a new self-report measure called the Social Concerns in Individuals with BFRBs (SCIB) that aimed to assess these concerns using two independent samples of individuals reporting elevated BFRB symptoms. Results showed that the overall level of social concerns reported on the SCIB significantly explained the variance in hair pulling and skin picking symptom severity even after controlling for the influence of other general social concern and emotional distress measures. Exploratory and confirmatory factor analyses provided psychometric evidence for the two-factor structure of the SCIB: (1) Concern about Physical Unattractiveness and (2) Concern about Social Disapproval, which were found to assess distinguishable aspects of BFRB-relevant social concerns. Overall, the findings suggest that the SCIB is a useful measure that can be used to evaluate social concerns in those with BFRB disorders.
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Affiliation(s)
- Abel S Mathew
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | | | - Han-Joo Lee
- Department of Psychology, University of Wisconsin-Milwaukee, USA.
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7
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Houazene S, Leclerc J, O’Connor K, Aardema F. “Shame on you”: The impact of shame in body-focused repetitive behaviors and binge eating. Behav Res Ther 2021; 138:103804. [DOI: 10.1016/j.brat.2021.103804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/08/2020] [Accepted: 01/04/2021] [Indexed: 11/25/2022]
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8
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Abstract
AbstractBody-focused repetitive behaviours (BFRBs), such as hair-pulling, skin-picking, and nail-biting, are non-functional habits associated with difficulties in emotion regulation. Although several models have been developed to explain the difficulties experienced by people suffering from BFRBs, a number of cognitive and emotional processes have yet to be explored. This study sought to investigate the psychological characteristics involved in the development and maintenance of BFRB symptoms. In particular, we aimed to evaluate the relationship of self-criticism, shame, and maladaptive cognitive emotion strategies with symptoms and examine if the relationship between perfectionism and symptoms was mediated by self-criticism and shame. Seventy-six participants from a community sample completed a number of self-report measures. Findings from our multivariate linear regression model supported that shame and maladaptive cognitive emotion regulation strategies significantly predicted BFRB symptoms. Results of our mediational analyses revealed that shame significantly mediated the relationship between perfectionism and BFRB symptoms. Interventions that target shame may be beneficial for treating these conditions. Future studies should replicate these findings with clinical populations and other BFRB subtypes.
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9
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Oh Y, Choi J, Song YM, Jhung K, Lee YR, Yoo NH, Kim Y. Defining Subtypes in Children with Nail Biting: A Latent Profile Analysis of Personality. Psychiatry Investig 2020; 17:517-525. [PMID: 32450625 PMCID: PMC7324728 DOI: 10.30773/pi.2019.0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/07/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to examine personality profiles and behavioral problems of children with nail biting (NB) to gain insight into the developmental trajectory of pathological NB. METHODS 681 elementary school students were divided into non NB (n=436), occasional NB (n=173) and frequent NB group (n=72) depending on the frequency of NB reported in Child Behavioral Checklist (CBCL). Children's personality was assessed using the Junior Temperament and Character Inventory (JTCI), and behavioral problems were assessed using the CBCL. Latent Profile Analysis (LPA) was performed using JTCI profiles to classify personalities of the children with NB (belonging to frequent and occasional NB group, n=245). RESULTS For subscale scores of CBCL, the total, internalizing, externalizing, anxious/depressed withdrawn/depressed, depression, thought, rule-breaking, and aggressive behavior problems, were most severe in the frequent NB group followed by occasional NB and non NB group. LPA of personality profile in children with NB revealed four classes ('adaptiveness,' 'high reward dependence,' 'low self-directedness,' and 'maldaptiveness'). The four personality classes demonstrated significant group differences in all of the CBCL subscales. Children who showed low self-directedness and cooperativeness and high novelty seeking and harm avoidance personality profiles demonstrated highest tendency for problematic behavior irrespective of the frequency of NB. CONCLUSION Children with NB reported significantly more problematic behaviors compared to children without NB. Children with specific personality profile demonstrated higher tendency for problematic behavior irrespective of the frequency of NB. Therefore, accompanying personality profiles should be considered when assessing behavioral problems in children with NB.
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Affiliation(s)
- Yunhye Oh
- Department of Child and Adolescent Psychiatry, National Center for Mental Health, Seoul, Republic of Korea.,Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jungwon Choi
- Department of Child and Adolescent Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Yul-Mai Song
- Department of Nursing, Honam University, Gwangju, Republic of Korea
| | - Kyungun Jhung
- Department of Psychiatry, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Young-Ryeol Lee
- Incorporated Korea Family Association for the Mentally Disabled, Sejong, Republic of Korea
| | - Nam-Hee Yoo
- Department of Child and Adolescent Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Yeni Kim
- Department of Psychiatry, Dongguk University International Hospital, Institute of Clinical Psychopharmacology, Dongguk University School of Medicine, Goyang, Republic of Korea
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10
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Insights into recurrent body-focused repetitive behaviors: evidenced by New York Times commenters. Arch Dermatol Res 2020; 312:629-634. [DOI: 10.1007/s00403-020-02045-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/18/2020] [Accepted: 02/08/2020] [Indexed: 10/25/2022]
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11
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Anderson S, Clarke V. Disgust, shame and the psychosocial impact of skin picking: Evidence from an online support forum. J Health Psychol 2019; 24:1773-1784. [PMID: 28810443 DOI: 10.1177/1359105317700254] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
This article examines the accounts of individuals who problematically pick their skin and explores their subjective experiences. In total, 100 problem disclosure statements were taken from posts made to a publicly accessible online skin picking support forum. These posts were systematically analysed using thematic analysis. Themes of disgust, shame and psychosocial avoidance dominated the analysis and appeared central to the experience of skin picking. Skin picking was shown to be a heterogeneous experience with a complex emotional profile. We argue that disgust, shame and related avoidance behaviour should be considered when conceptualising skin picking and considering treatment interventions.
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12
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Houghton DC, Tommerdahl M, Woods DW. Increased tactile sensitivity and deficient feed-forward inhibition in pathological hair pulling and skin picking. Behav Res Ther 2019; 120:103433. [DOI: 10.1016/j.brat.2019.103433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/14/2019] [Accepted: 06/21/2019] [Indexed: 12/12/2022]
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13
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Braun TL, Patel V, DeBord LC, Rosen T. A review of N-acetylcysteine in the treatment of grooming disorders. Int J Dermatol 2019; 58:502-510. [PMID: 30667049 DOI: 10.1111/ijd.14371] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/24/2018] [Accepted: 12/05/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pathologic grooming disorders can lead to clinically significant distress and functional impairment. Studies on treatment of these disorders with selective serotonin reuptake inhibitors (SSRIs) and anticonvulsants have led to inconsistent findings. N-acetylcysteine (NAC) has shown promise in treatment of obsessive-compulsive and related disorders. The objective of this article is to perform an updated review of NAC in the treatment of grooming disorders. METHODS PubMed was searched from inception to October 2017 to identify literature on the use of NAC in the management of trichotillomania, onychophagia, and pathological skin picking. Case reports, case series, and randomized controlled trials were included. Data on study design, dosing regimens, comorbidities, concurrent treatment, and side effects were extracted from the included articles. RESULTS Fifteen articles were included in this review, which consisted of 10 case reports, one case series, and four randomized controlled trials. Dosing of oral NAC ranged from 450 to 2,400 mg per day, and treatment periods lasted from 1 to 8 months. Side effects were uncommon, mild, and usually gastrointestinal in nature, with severe aggression reported in one child. CONCLUSIONS While there are multiple reports of the safety and efficacy of NAC in the treatment of grooming disorders, there are currently few randomized controlled trials on this topic, and more research is needed to develop a formal treatment algorithm. While current data should be considered very preliminary, case reports have demonstrated mostly positive results and a lack of significant side effects. A trial of NAC may be a viable option for pathologic grooming disorders, especially in patients who have failed prior psychologic or pharmacologic treatment.
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Affiliation(s)
- Tara L Braun
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - Viraat Patel
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - Logan C DeBord
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - Theodore Rosen
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
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14
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Mouton-Odum S, Houghton DC. Comprehensive behavioral treatment for an adult with sensory-based trichotillomania: An illustrative case study. Bull Menninger Clin 2018; 82:288-307. [PMID: 30589578 DOI: 10.1521/bumc.2018.82.4.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Trichotillomania (TTM) is a poorly understood condition that causes significant impairment, but effective behavioral management strategies exist. The phenomenology of TTM is complex and requires an individualized treatment approach, and there are some important facets of TTM that have only recently been recognized. Specifically, contemporary research indicates that hair pulling is often performed to regulate aversive sensations and provide somatosensory reward. In this article, we describe the complex phenomenology of TTM, evidence-based treatment options, and illustrate a case of sensory-based TTM treated effectively with a comprehensive behavioral intervention.
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Affiliation(s)
- Suzanne Mouton-Odum
- Clinical assistant professor and director of Psychology Houston, PC: The Center for Cognitive Behavioral Treatment, Houston, Texas
| | - David C Houghton
- Post-doctoral fellow, Medical University of South Carolina, Charleston
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15
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Houghton DC, Alexander JR, Bauer CC, Woods DW. Body-focused repetitive behaviors: More prevalent than once thought? Psychiatry Res 2018; 270:389-393. [PMID: 30300869 DOI: 10.1016/j.psychres.2018.10.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 09/27/2018] [Accepted: 10/01/2018] [Indexed: 10/28/2022]
Abstract
Body-focused repetitive behaviors (BFRBs), such as hair pulling, skin picking, and nail biting are common habits, but their pathological manifestations have been considered rare. Growing evidence suggests pathological forms of these behaviors can be conceptualized as a class of related disorders. However, few previous studies have examined the collective prevalence of related pathological BFRBs. The current study examined the self-reported prevalence of current (past month) subclinical and pathological BFRBs in a large (n = 4335) sample of college students. The study also examined the chronicity and impact of these behaviors. Results showed that 59.55% of the sample reported occasionally engaging in subclinical BFRBs, and 12.27% met criteria for a pathological BFRB, suggesting these conditions may be quite common. Of the various BFRB topographies, cheek biting was the most common. Both subclinical and pathological BFRBs tended to be chronic (i.e., occurring for longer than 1 year). Although persons with pathological BFRBs were distressed about their behavior, few experienced functional impairment or sought help for the behavior. Implications of these findings for the conceptualization and treatment of body-focused repetitive behaviors are discussed.
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Affiliation(s)
- David C Houghton
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., Charleston, SC 29425, USA.
| | - Jennifer R Alexander
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA; Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Christopher C Bauer
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA; Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Douglas W Woods
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA; Department of Psychology, Marquette University, Milwaukee, WI, USA
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16
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Solley K, Turner C. Prevalence and correlates of clinically significant body-focused repetitive behaviors in a non-clinical sample. Compr Psychiatry 2018; 86:9-18. [PMID: 30041079 DOI: 10.1016/j.comppsych.2018.06.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Body-focused repetitive behaviors (BFRBs) are repetitive, ritualized behaviors focused on the body, involving compulsively damaging one's physical appearance or causing physical injury. They include skin picking, hair pulling, nail biting, and lip or cheek biting and chewing. This study sought to examine prevalence, clinical correlates and quality of life (QoL) impairment associated with these conditions in a non-clinical sample of adults. METHOD An online survey was completed by N = 1378 participants. Comparisons were made between those self-reporting body-focused repetitive behavior to those without, on a range of clinical correlates (depression, anxiety, obsessive-compulsive symptoms, body dysmorphic symptoms, fear of negative evaluation) and QoL domains. RESULTS Three-hundred and eighteen participants (23%) reported the presence of a probable BFRB; n = 85 (6%) nail biting, n = 88 (6%) lip or cheek biting/chewing, n = 187 (14%) skin picking, and n = 39 (2%) hair pulling. There were significant differences between those with and without a probable BFRB (pBFRB) across all clinical variables investigated, with the pBFRB group reporting higher levels of symptoms. The BFRB group reported reduced QoL on some domains. Few differences emerged between the BFRB groups, although individuals with probable skin picking reported higher levels of body image concern, than those with other pBFRB conditions, and there was a trend toward probable skin picking to endorse higher levels of OCD symptoms and anxiety. There were no significant differences between the BFRB groups on QoL domains. CONCLUSION Although differences were found between those with a pBFRB and those without, there were few differences between the different pBFRB groups, indicating that all BFRB conditions are concerning. Skin picking may be one of the more severe of the BFRB presentations, although the small number of differences between the groups may reflect a single pathological grooming factor underlying the BFRBs. These findings underscore the importance of recognizing that all body-focused behaviors can cause significant distress, impairment, and reduced QoL, and highlights the need for timely and accurate identification of these conditions by health professionals.
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Affiliation(s)
- Katelyn Solley
- School of Psychology, The University of Queensland, Australia
| | - Cynthia Turner
- School of Psychology, The University of Queensland, Australia; School of Psychology, Australian Catholic University, Brisbane, Australia.
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Houghton DC, Alexander JR, Bauer CC, Woods DW. Abnormal perceptual sensitivity in body-focused repetitive behaviors. Compr Psychiatry 2018; 82:45-52. [PMID: 29407358 DOI: 10.1016/j.comppsych.2017.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Several compulsive grooming habits such as hair pulling, skin picking, and nail biting are collectively known as body-focused repetitive behaviors (BFRBs). Although subclinical BFRBs are common and benign, more severe and damaging manifestations exist that are difficult to manage. Researchers have suggested that BFRBs are maintained by various cognitive, affective, and sensory contingencies. Although the involvement of cognitive and affective processes in BFRBs has been studied, there is a paucity of research on sensory processes. METHODS The current study tested whether adults with subclinical or clinical BFRBs would report abnormal patterns of sensory processing as compared to a healthy control sample. RESULTS Adults with clinical BFRBs (n = 26) reported increased sensory sensitivity as compared to persons with subclinical BFRBs (n = 48) and healthy individuals (n = 33). Elevations in sensation avoidance differentiated persons with clinical versus subclinical BFRBs. Sensation seeking patterns were not different between groups. Unexpectedly, BFRB severity was associated with lower registration of sensory stimuli, but this finding may be due to high psychiatric comorbidity rates in the BFRB groups. CONCLUSIONS These findings suggest that several sensory abnormalities may underlie BFRBs. Implications for the etiology and treatment of BFRBs are discussed.
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Affiliation(s)
- David C Houghton
- Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX 77843-4235, United States.
| | - Jennifer R Alexander
- Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX 77843-4235, United States; Department of Psychology, Marquette University, P.O. Box 1881, Milwaukee, WI 53201-0327, United States.
| | - Christopher C Bauer
- Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX 77843-4235, United States; Department of Psychology, Marquette University, P.O. Box 1881, Milwaukee, WI 53201-0327, United States.
| | - Douglas W Woods
- Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX 77843-4235, United States; Department of Psychology, Marquette University, P.O. Box 1881, Milwaukee, WI 53201-0327, United States.
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Daudin M, Calteau M. La trichotillomanie. À propos d’un cas de trichobézoard. ANNALES MEDICO-PSYCHOLOGIQUES 2017. [DOI: 10.1016/j.amp.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Maraz A, Hende B, Urbán R, Demetrovics Z. Pathological grooming: Evidence for a single factor behind trichotillomania, skin picking and nail biting. PLoS One 2017; 12:e0183806. [PMID: 28902896 PMCID: PMC5597179 DOI: 10.1371/journal.pone.0183806] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/13/2017] [Indexed: 01/18/2023] Open
Abstract
Although trichotillomania (TTM), skin picking (SP), and nail biting (NB) have been receiving growing scientific attention, the question as to whether these disorders can be regarded as separate entities or they are different manifestations of the same underlying tendency is unclear. Data were collected online in a community survey, yielding a sample of 2705 participants (66% women, mean age: 29.1, SD: 8.6). Hierarchical factor analysis was used to identify a common latent factor and the multiple indicators and multiple causes (MIMIC) modelling was applied to test the predictive effect of borderline personality disorder symptoms, impulsivity, distress and self-esteem on pathological grooming. Pearson correlation coefficients between TTM, SP and NB were between 0.13 and 0.29 (p < 0.01). The model yielded an excellent fit to the data (CFI = 0.992, TLI = 0.991, χ2 = 696.65, p < 0.001, df = 222, RMSEA = 0.030, Cfit of RMSEA = 1.000), supporting the existence of a latent factor. The MIMIC model indicated an adequate fit (CFI = 0.993, TLI = 0.992, χ2 = 655.8, p < 0.001, df = 307, RMSEA = 0.25, CI: 0.022-0.028, pclose = 1.000). TTM, SP and NB each were loaded significantly on the latent factor, indicating the presence of a general grooming factor. Impulsivity, psychiatric distress and contingent self-esteem had significant predictive effects, whereas borderline personality disorder had a nonsignificant predictive effect on the latent factor. We found evidence that the category of pathological grooming is meaningful and encompasses three symptom manifestations: trichotillomania, skin picking and nail biting. This latent underlying factor is not better explained by indicators of psychopathology, which supports the notion that the urge to self-groom, rather than general psychiatric distress, impulsivity, self-esteem or borderline symptomatology, is what drives individual grooming behaviours.
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MESH Headings
- Adult
- Animals
- Disruptive, Impulse Control, and Conduct Disorders/classification
- Disruptive, Impulse Control, and Conduct Disorders/diagnosis
- Disruptive, Impulse Control, and Conduct Disorders/epidemiology
- Disruptive, Impulse Control, and Conduct Disorders/etiology
- Female
- Grooming
- Humans
- Male
- Nail Biting/psychology
- Obsessive-Compulsive Disorder/classification
- Obsessive-Compulsive Disorder/diagnosis
- Obsessive-Compulsive Disorder/epidemiology
- Obsessive-Compulsive Disorder/etiology
- Self-Injurious Behavior/epidemiology
- Self-Injurious Behavior/etiology
- Skin/injuries
- Skin/pathology
- Stress, Psychological/complications
- Stress, Psychological/epidemiology
- Trichotillomania/epidemiology
- Trichotillomania/etiology
- Young Adult
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Affiliation(s)
- Aniko Maraz
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Borbála Hende
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Róbert Urbán
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
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Lochner C, Roos A, Stein DJ. Excoriation (skin-picking) disorder: a systematic review of treatment options. Neuropsychiatr Dis Treat 2017; 13:1867-1872. [PMID: 28761349 PMCID: PMC5522672 DOI: 10.2147/ndt.s121138] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Although pathological skin-picking has been documented in the medical literature since the 19th century, it has only recently been included as a distinct entity in psychiatric classification systems. In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition and the proposed International Classification of Diseases, Eleventh Revision, excoriation (skin-picking) disorder (ED), also known as neurotic excoriation, psychogenic excoriation, or dermatillomania), is described as recurrent picking of skin, leading to skin lesions and significant distress or functional impairment. ED is listed as one of the obsessive-compulsive and related disorders, given its overlap with conditions such as trichotillomania (hair-pulling disorder). Arguably, its inclusion and delineation in the diagnostic nomenclature will lead to increased awareness of the condition, more research, and ultimately in treatment advances. This systematic review aims to provide readers with an up-to-date view of current treatment options for ED. A MEDLINE search of the ED treatment literature was conducted to collate relevant articles published between 1996 and 2017. The findings indicate that a number of randomized controlled trails on ED have now been published, and that current management options include behavioral therapy (habit reversal or acceptance-enhanced behavior therapy), and medication (selective serotonin reuptake inhibitors or N-acetyl cysteine).
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Affiliation(s)
- Christine Lochner
- SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, South Africa
| | - Annerine Roos
- SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, South Africa
| | - Dan J Stein
- SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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Woods DW, Houghton DC. Evidence-Based Psychosocial Treatments for Pediatric Body-Focused Repetitive Behavior Disorders. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2015; 45:227-40. [DOI: 10.1080/15374416.2015.1055860] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Shame in the obsessive compulsive related disorders: a conceptual review. J Affect Disord 2015; 171:74-84. [PMID: 25299438 PMCID: PMC4252512 DOI: 10.1016/j.jad.2014.09.010] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/05/2014] [Accepted: 09/11/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Theoretical and anecdotal support for the role of shame in obsessive compulsive related disorders (OCRDs) is prominent. Developing our understanding of shame׳s role in OCRDs is important to building knowledge about this new diagnostic category. This review aims to consolidate our understanding of shame in each OCRD, through summarizing existing clinical, conceptual, and empirical work. METHODS We provide an overview of shame, its measurement considerations, and a full review of 110 articles addressing shame in OCRDs. RESULTS General shame and shame about having a mental illness are the broadest types of shame relevant to OCRDs; symptom-based shame and body shame may be more specific to OCRDs. In OCD, violent, sexual, or blasphemous obsessions may trigger symptom-based shame. In trichotillomania (TTM) and skin picking (SP), symptom-based shame may be related to pulling, picking, and post-pulling/picking behaviors. In hoarding disorder, symptom-based shame may accompany beliefs about being defective due to living with clutter. Body shame appears inherent to body dysmorphic disorder, while in TTM and SP it may arise as a secondary response to damage resulting from body focused repetitive behaviors. LIMITATIONS Much of the current knowledge on shame in OCRDs comes from anecdotal, case, and conceptual work. Empirical studies do not always assess specific types of shame, instead assessing shame as a general construct. CONCLUSIONS Shame is closely related to OCRDs. Clinical and research recommendations drawing from the literature are provided.
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ALTENBURGER ERINM, TUNG ESTHERS, KEUTHEN NANCYJ. Body esteem in adolescent hair pullers. J Behav Addict 2014; 3:124-7. [PMID: 25215223 PMCID: PMC4117287 DOI: 10.1556/jba.3.2014.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 01/18/2014] [Accepted: 01/19/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Trichotillomania (TTM) often first presents in adolescence, a developmental period marked by vulnerability in body image. To date, no one has studied the relationship between this disorder and body esteem. METHODS 49 adolescents with DSM-IV TTM or chronic hair pulling (HP) and 23 control adolescents were administered diagnostic assessments and self-report measures of hair pulling and body esteem. RESULTS HP youth vs. controls reported lower levels of body esteem on all Body-Esteem Scale for Adolescents and Adults (BESAA) subscales (appearance, attribution and weight satisfaction). HP contributed to lowered body esteem, independent of comorbid anxiety or depression. As expected, HP youth with vs. without comorbid anxiety or depression reported lowered levels of body esteem. Further, greater HP severity and distress were significantly associated with lower levels of body esteem. HP severity alone but not distress/impairment predicted lower levels of body esteem, independent of comorbid anxiety and depression. CONCLUSIONS Both hair pulling and comorbid anxiety and depression can independently impact body esteem in adolescent hair pullers.
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Affiliation(s)
- ERIN M. ALTENBURGER
- The Ohio State University, Columbus, OH, USA, Corresponding author: Erin M. Altenburger, BA; Psychology Department, The Ohio State University, 181 Psychology Building, 1835 Neil Avenue, Columbus, OH, 43210, USA; Phone: +1-614-292-9775; Fax: +1-614-688-8261; E-mail:
| | - ESTHER S. TUNG
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - NANCY J. KEUTHEN
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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Kool N, van Meijel B, Koekkoek B, van der Bijl J, Kerkhof A. Improving communication and practical skills in working with inpatients who self-harm: a pre-test/post-test study of the effects of a training programme. BMC Psychiatry 2014; 14:64. [PMID: 24592861 PMCID: PMC3975943 DOI: 10.1186/1471-244x-14-64] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/21/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Differing perspectives of self-harm may result in a struggle between patients and treatment staff. As a consequence, both sides have difficulty communicating effectively about the underlying problems and feelings surrounding self-harm. Between 2009 and 2011, a programme was developed and implemented to train mental health care staff (nurses, social workers, psychologists, psychiatrists, and occupational therapists) in how to communicate effectively with and care for patients who self-harm. An art exhibition focusing on self-harm supported the programme. Lay experts in self-harm, i.e. people who currently harm themselves, or who have harmed themselves in the past and have the skills to disseminate their knowledge and experience, played an important role throughout the programme. METHODS Paired sample t-tests were conducted to measure the effects of the training programme using the Attitude Towards Deliberate Self-Harm Questionnaire, the Self-Perceived Efficacy in Dealing with Self-Harm Questionnaire, and the Patient Contact Questionnaire. Effect sizes were calculated using r. Participants evaluated the training programme with the help of a survey. The questionnaires used in the survey were analysed descriptively. RESULTS Of the 281 persons who followed the training programme, 178 completed the questionnaires. The results show a significant increase in the total scores of the three questionnaires, with large to moderate effect sizes. Respondents were positive about the training, especially about the role of the lay expert. CONCLUSION A specialised training programme in how to care for patients who self-harm can result in a more positive attitude towards self-harm patients, an improved self-efficacy in caring for patients who self-harm, and a greater closeness with the patients. The deployment of lay experts is essential here.
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Affiliation(s)
- Nienke Kool
- Intensive Treatment Centre, Palier, The Hague, The Netherlands.
| | - Berno van Meijel
- Department of Health, Sports & Welfare/Cluster Nursing, Research Group Mental Health Nursing, Inholland University of Applied Sciences, Amsterdam, The Netherlands,Parnassia Academy, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Bauke Koekkoek
- Research group for Social Psychiatry & Mental Health Nursing, HAN University of Applied Sciences, Nijmegen, The Netherlands,ProCES, Pro Persona GGZ, Wolfheze, The Netherlands
| | - Jaap van der Bijl
- Department of Health, Sports & Welfare/Cluster Nursing, Research Group Mental Health Nursing, Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | - Ad Kerkhof
- Department of Clinical Psychology, and EMGO+, Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
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Grant JE, Odlaug BL. Obsessive–compulsive spectrum and disorders of the skin. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.09.40] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Roberts S, O'Connor K, Bélanger C. Emotion regulation and other psychological models for body-focused repetitive behaviors. Clin Psychol Rev 2013; 33:745-62. [DOI: 10.1016/j.cpr.2013.05.004] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 05/08/2013] [Accepted: 05/08/2013] [Indexed: 11/26/2022]
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How related are hair pulling disorder (trichotillomania) and skin picking disorder? A review of evidence for comorbidity, similarities and shared etiology. Clin Psychol Rev 2012; 32:618-29. [DOI: 10.1016/j.cpr.2012.05.008] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 05/15/2012] [Accepted: 05/16/2012] [Indexed: 01/27/2023]
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Lovato L, Ferrão YA, Stein DJ, Shavitt RG, Fontenelle LF, Vivan A, Miguel EC, Cordioli AV. Skin picking and trichotillomania in adults with obsessive-compulsive disorder. Compr Psychiatry 2012; 53:562-8. [PMID: 22014580 DOI: 10.1016/j.comppsych.2011.06.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 06/18/2011] [Indexed: 02/03/2023] Open
Abstract
The objective of this study was to compare patients with obsessive-compulsive disorder (OCD) associated with pathologic skin picking (PSP) and/or trichotillomania, and patients with OCD without such comorbidities, for demographic and clinical characteristics. We assessed 901 individuals with a primary diagnosis of OCD, using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I disorders. Diagnoses of PSP and trichotillomania were made in 16.3% and 4.9% of the sample, respectively. After the logistic regression analysis, the following factors retained an association with OCD-PSP/trichotillomania: younger (odds ratio [OR] = 0.979; P = .047), younger at the onset of compulsive symptoms (OR = 0.941; P = .007), woman (OR = 2.538; P < .001), with a higher level of education (OR = 1.055; P = .025), and with comorbid body dysmorphic disorder (OR = 2.363; P = .004). These findings support the idea that OCD accompanied by PSP/trichotillomania characterizes a specific subgroup.
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Affiliation(s)
- Lucas Lovato
- Department of Psychiatry, Federal University of Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
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Snorrason I, Smári J, Olafsson RP. Emotion regulation in pathological skin picking: findings from a non-treatment seeking sample. J Behav Ther Exp Psychiatry 2010; 41:238-45. [PMID: 20172501 DOI: 10.1016/j.jbtep.2010.01.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Revised: 01/25/2010] [Accepted: 01/27/2010] [Indexed: 11/26/2022]
Abstract
Pathological skin picking (PSP) is characterized by excessive picking of the skin, resulting in significant distress or functional impairment. The aim of the present study was to investigate the emotion regulation hypothesis of PSP. University students with PSP (n = 55) and without history of PSP (n = 55) were asked to retrospectively rate the intensity of affective states before, during, and after skin picking episodes. The results showed that for a majority of the PSP sufferers, intensity of certain negative affective states (i.e. anxiety, tension or boredom) was pronounced just before picking, and diminished significantly in the period from before to after picking. Relief and gratification increased during picking whereas guilt increased afterwards. A similar pattern emerged in the control group, although a much lower level of intensity was reported. Participants were also asked to fill out questionnaires concerning emotion regulation difficulties, emotion reactivity, depression, anxiety and worry. Hierarchical logistic regressions demonstrated that emotion regulation difficulties as well as emotion reactivity predicted PSP diagnosis after depression, anxiety and worry were controlled for. Furthermore, emotion regulation difficulties statistically mediated the relationship between emotion reactivity and PSP. Overall, the findings support an emotion regulation model of PSP.
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Affiliation(s)
- Ivar Snorrason
- University of Iceland, Department of Psychology, Sturlugata, 101 Reykjavík, Iceland.
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Stein DJ, Grant JE, Franklin ME, Keuthen N, Lochner C, Singer HS, Woods DW. Trichotillomania (hair pulling disorder), skin picking disorder, and stereotypic movement disorder: toward DSM-V. Depress Anxiety 2010; 27:611-26. [PMID: 20533371 DOI: 10.1002/da.20700] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In DSM-IV-TR, trichotillomania (TTM) is classified as an impulse control disorder (not classified elsewhere), skin picking lacks its own diagnostic category (but might be diagnosed as an impulse control disorder not otherwise specified), and stereotypic movement disorder is classified as a disorder usually first diagnosed in infancy, childhood, or adolescence. ICD-10 classifies TTM as a habit and impulse disorder, and includes stereotyped movement disorders in a section on other behavioral and emotional disorders with onset usually occurring in childhood and adolescence. This article provides a focused review of nosological issues relevant to DSM-V, given recent empirical findings. This review presents a number of options and preliminary recommendations to be considered for DSM-V: (1) Although TTM fits optimally into a category of body-focused repetitive behavioral disorders, in a nosology comprised of relatively few major categories it fits best within a category of motoric obsessive-compulsive spectrum disorders, (2) available evidence does not support continuing to include (current) diagnostic criteria B and C for TTM in DSM-V, (3) the text for TTM should be updated to describe subtypes and forms of hair pulling, (4) there are persuasive reasons for referring to TTM as "hair pulling disorder (trichotillomania)," (5) diagnostic criteria for skin picking disorder should be included in DSM-V or in DSM-Vs Appendix of Criteria Sets Provided for Further Study, and (6) the diagnostic criteria for stereotypic movement disorder should be clarified and simplified, bringing them in line with those for hair pulling and skin picking disorder.
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Affiliation(s)
- Dan J Stein
- Department of Psychiatry, University of Cape Town, Rondebosch, Cape Town, South Africa.
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Abstract
The basic science literature is replete with descriptions of naturally occurring or experimentally induced pathological grooming behaviors in animals, which are widely considered animal models of obsessive-compulsive disorder (OCD). These animal models rely largely on observed similarities between animal behaviors and human OCD behaviors, and on studies of animal pathological grooming disorders that respond to serotonin enhancing drugs. However, current limitations in assessment of complex cognition and affect in animals precludes the field's ability to match the driving primary processes behind observable phenomenology in animal "OCD" with human behavioral disorders. We propose that excessive grooming behaviors in animals may eventually prove to be equally, or possibly more relevant to, other conditions in humans that involve pathological grooming or grooming-like behaviors, such as trichotillomania, body dysmorphic disorder, olfactory reference syndrome, compulsive skin-picking, and onychophagia. Research is needed to better understand pathological grooming behaviors in both humans and animals, as animal models have the potential to elucidate pathogenic mechanisms and inform the treatment of these psychiatric conditions in humans.
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Abstract
Pathological skin picking (PSP) is a disabling disorder characterized by repetitive picking of the skin that causes tissue damage. Estimated to affect 2% to 5.4% of the population, PSP is currently listed as an impulse control disorder not otherwise specified. However, the repetitive and compulsive behaviors seen in PSP are phenomenologically and clinically similar to the behaviors seen in obsessive-compulsive disorder and other body-focused repetitive behaviors, such as trichotillomania and pathological nail biting. Animal neuroimaging research in related disorders such as obsessive-compulsive disorder and trichotillomania provides useful information for understanding PSP. Recent cognitive testing of individuals with PSP demonstrated impaired inhibitory control; these findings may assist in the proper characterization of PSP and aid in the development of effective treatment options. Although the disorder is common, appropriate treatments for PSP are limited. Pharmacotherapeutic and certain cognitive-behavioral interventions have demonstrated promise in treating this disorder and need to be explored further.
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Bienvenu OJ, Wang Y, Shugart YY, Welch JM, Grados MA, Fyer AJ, Rauch SL, McCracken JT, Rasmussen SA, Murphy DL, Cullen B, Valle D, Hoehn-Saric R, Greenberg BD, Pinto A, Knowles JA, Piacentini J, Pauls DL, Liang KY, Willour VL, Riddle M, Samuels JF, Feng G, Nestadt G. Sapap3 and pathological grooming in humans: Results from the OCD collaborative genetics study. Am J Med Genet B Neuropsychiatr Genet 2009; 150B:710-20. [PMID: 19051237 PMCID: PMC10885776 DOI: 10.1002/ajmg.b.30897] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
SAP90/PSD95-associated protein (SAPAP) family proteins are post-synaptic density (PSD) components that interact with other proteins to form a key scaffolding complex at excitatory (glutamatergic) synapses. A recent study found that mice with a deletion of the Sapap3 gene groomed themselves excessively, exhibited increased anxiety-like behaviors, and had cortico-striatal synaptic defects, all of which were preventable with lentiviral-mediated expression of Sapap3 in the striatum; the behavioral abnormalities were also reversible with fluoxetine. In the current study, we sought to determine whether variation within the human Sapap3 gene was associated with grooming disorders (GDs: pathologic nail biting, pathologic skin picking, and/or trichotillomania) and/or obsessive-compulsive disorder (OCD) in 383 families thoroughly phenotyped for OCD genetic studies. We conducted family-based association analyses using the FBAT and GenAssoc statistical packages. Thirty-two percent of the 1,618 participants met criteria for a GD, and 65% met criteria for OCD. Four of six SNPs were nominally associated (P < 0.05) with at least one GD (genotypic relative risks: 1.6-3.3), and all three haplotypes were nominally associated with at least one GD (permuted P < 0.05). None of the SNPs or haplotypes were significantly associated with OCD itself. We conclude that Sapap3 is a promising functional candidate gene for human GDs, though further work is necessary to confirm this preliminary evidence of association.
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Affiliation(s)
- O J Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
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Abstract
N-acetyl cysteine (NAC) is a widely available nutraceutical with a variety of actions. As a precursor of cysteine and glutathione, it has antioxidant properties that may impact on mood and contribute to an effect on impulsivity and obsessive behaviour. Via its additional effect on glutamate via the cystine-glutamate exchange system, NAC has been shown to mediate impulsivity in preclinical models of addiction, reduce craving, and cue extinction. Further, by boosting glutathione, NAC acts as a potent antioxidant and has been shown in two positive, large-scale randomized placebo-controlled trials to affect negative symptoms in schizophrenia and depression in bipolar disorder. We describe three cases in which its actions specifically on nail-biting and associated anxiety may offer a potential treatment. The spontaneous findings are reported as part of an ongoing treatment trial examining the utility of NAC in bipolar disorder. Its actions, if robustly replicated, also point to potential treatment targets in glutathione or glutamate pathways in the brain.
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Skin picking behaviors: An examination of the prevalence and severity in a community sample. J Anxiety Disord 2009; 23:314-9. [PMID: 19223150 DOI: 10.1016/j.janxdis.2009.01.008] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 12/11/2008] [Accepted: 01/14/2009] [Indexed: 11/23/2022]
Abstract
Body-focused repetitive behaviors such as skin picking have gained recent attention in the psychiatric literature. Prevalence of skin picking has not been well researched and is difficult to estimate; however, consequences of such behaviors can include severe medical complications and impaired social and occupational functioning. Given this, this study examined: (1) the prevalence and severity of skin picking in a nonclinical community sample, and (2) associations between skin picking and other measures of psychological functioning. Three hundred and fifty-four participants completed measures of psychological functioning and skin picking frequency and severity. A total of 62.7% endorsed some form of skin picking and 5.4% reported clinical levels of skin picking and associated distress/impact. Direct associations were found between skin picking and depressive, anxiety, and obsessive-compulsive symptoms, which may support the emotional regulation model of pathological skin picking. To establish proper diagnostic classification of pathological skin picking and optimize treatment planning and outcome, further investigation of functional relationships between skin picking and affective distress is needed.
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Perspectives of mental health professionals and patients on self-injury in psychiatry: a literature review. Arch Psychiatr Nurs 2008; 22:180-9. [PMID: 18640537 DOI: 10.1016/j.apnu.2007.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Revised: 07/18/2007] [Accepted: 07/20/2007] [Indexed: 11/23/2022]
Abstract
Professionals in psychiatry often encounter patients who injure themselves. To explore the perspectives of mental health professionals and patients on self-injurious behavior and treatment, the authors carried out a literature review. The reviewers found little documented data that elucidated or discussed any shared understanding about self-injurious behavior between patients and professionals or between professionals themselves. Many of the problems experienced in relation to self-injury may be due to this lack of a common view. There were few evidence-based strategies for managing self-injury that received any attention in the literature. Future studies should focus on the development and testing of preventative interventions, putting particular emphasis on effective communication between professionals and patients.
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Sacks MB, Flood AM, Dennis MF, Hertzberg MA, Beckham JC. Self-mutilative behaviors in male veterans with posttraumatic stress disorder. J Psychiatr Res 2008; 42:487-94. [PMID: 17606271 PMCID: PMC2441874 DOI: 10.1016/j.jpsychires.2007.05.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Revised: 02/13/2007] [Accepted: 05/01/2007] [Indexed: 10/23/2022]
Abstract
Self-mutilative behaviors (SMB) were examined in a sample of male veterans with posttraumatic stress disorder (PTSD). The primary objective was to determine the prevalence of SMB and any physical, cognitive, or affective antecedents and correlates for these behaviors. Participants included 509 male veterans with PTSD and levels of PTSD, depression, alcohol use, hostility, and impulsivity were evaluated to determine if these variables were related to SMB. Antecedents and sequelae of SMB were also examined to generate hypotheses regarding the functions of these behaviors. A second type of habit behavior, body-focused repetitive behaviors (BFRB), was also examined as part of the study. Findings indicated that veterans who engaged in either type of habit behavior were younger than those who did not engage in SMB or BFRB. Veterans reporting SMB also reported higher levels of PTSD, depression, hostility, and impulsivity compared to the BFRB and no-habit groups. Examination of habit antecedents and sequelae showed support for the automatic-positive reinforcement function of SMB. These findings are discussed in the context of research and treatment involving male veterans with PTSD who engage in SMB.
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Affiliation(s)
- Matthew B Sacks
- San Francisco VA Medical Center, San Francisco, CA, United States
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Odlaug BL, Grant JE. Clinical characteristics and medical complications of pathologic skin picking. Gen Hosp Psychiatry 2008; 30:61-6. [PMID: 18164942 DOI: 10.1016/j.genhosppsych.2007.07.009] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Revised: 07/26/2007] [Accepted: 07/30/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study sought to detail the phenomenology and medical consequences of pathologic skin picking (PSP). METHOD Sixty subjects (11.7% males) with PSP (mean+/-S.D.=33.7+/-11.6 years) were assessed. Subjects seen in a pharmacological study as well as those from an ongoing outpatient longitudinal study comprised this sample. Subjects were assessed for current and lifetime psychiatric comorbidity (using the Structured Clinical Interview for DSM-IV Axis I Disorders), clinical severity (using the Clinical Global Impression - Severity scale) and psychosocial interference due to picking (using the Sheehan Disability Scale). Clinical characteristic data, including time spent picking per day, sites picked and medical complications directly resulting from skin picking behavior, as well as family history, were also obtained. RESULTS The mean age (+/-S.D.) of onset for PSP was 12.3+/-9.6 years. The face was the most common area picked. Subjects reported picking a mean of 107.6 min each day. Scarring, ulcerations and infections were common. Few had ever sought psychiatric treatment for their behavior. Current comorbid Axis I psychiatric conditions were found in 38.3% of the sample. Trichotillomania (36.7%), compulsive nail biting (26.7%), depressive disorder (16.7%) and obsessive-compulsive disorder (15%) were the most common current comorbid conditions. CONCLUSION PSP appears to be time consuming and frequently associated with medical complications. Research is needed to optimize patient care for individuals with this behavior.
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Affiliation(s)
- Brian L Odlaug
- Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN 55454, USA
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Abstract
Trichotillomania and pathologic skin picking are pathologic versions of grooming behaviors. Although mentioned in the psychiatric literature for decades, little is known about how gender influences clinical presentation of these behaviors. Seventy-seven adult subjects (12 men) with trichotillomania or pathologic skin picking were examined on a variety of clinical measures including symptom severity, functioning, and comorbidity. There were more similarities than differences between men and women with these behaviors. Some significant differences, however, were that men with grooming disorders had a later age of onset of the behaviors, had greater functional impairment due to the behaviors, and were more likely to suffer from a co-occurring anxiety disorder. This study suggests that gender may be an important clinical factor when assessing and treating these disorders. Further research is needed to validate our findings and identify whether treatments should be specially tailored differently for men and women with grooming disorders.
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Affiliation(s)
- Jon E Grant
- Department of Psychiatry, University of Minnesota Medical Center, 2450 Riverside Avenue, Minneapolis, MN 55454, USA.
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Dalanora A, Uyeda H, Empinotti JC, Ruaro RT, Clarindo MV. Destruição de falanges provocada por onicofagia. An Bras Dermatol 2007. [DOI: 10.1590/s0365-05962007000500011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
É descrito o caso de paciente de 32 anos que relatava o hábito de roer as unhas há mais de 20 anos, apresentando destruição total das falanges distais do primeiro, segundo e terceiro quirodáctilos esquerdos.
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Abstract
About 30% of dermatology patients have signs or symptoms of psychological problems. Dermatologists should be familiar with the basics needed to identify, advise and treat these patients. Because of the complex interaction between skin and psyche, it is difficult to distinguish whether the primary problem is the skin or the psyche. Sometimes the clinical picture is a consequence of interactions between them and other factors. The interactions between skin and psyche are well known in history, art and literature--perhaps better known today because the marked emphasis on such images in our modern multimedia society. Aging is increasingly perceived as an illness and not as a physiological process. Through globalization, many different cultural approaches to the skin have entered in our daily life and influence our communication. This article considers the most important dermatoses which often show primary or secondary interaction with the psyche.
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Grant JE, Menard W, Phillips KA. Pathological skin picking in individuals with body dysmorphic disorder. Gen Hosp Psychiatry 2006; 28:487-93. [PMID: 17088164 PMCID: PMC1664624 DOI: 10.1016/j.genhosppsych.2006.08.009] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Revised: 08/30/2006] [Accepted: 08/30/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study was to examine the prevalence and clinical correlates of pathological skin picking (PSP) in a large sample of individuals with body dysmorphic disorder (BDD). METHOD One hundred seventy-six individuals with BDD (71.0% women; mean age, 32.5+/-12.3 years) were assessed with respect to comorbidity, BDD severity, delusionality (insight), quality of life and social/occupational functioning, using reliable and valid measures. All variables were compared in BDD subjects with and without lifetime PSP. RESULTS About 44.9% of subjects reported lifetime PSP, and 36.9% reported current PSP secondary to BDD. BDD subjects with PSP were more likely to be female, to have skin preoccupations, to have comorbid trichotillomania or a personality disorder, to camouflage with makeup and to seek and receive nonpsychiatric (e.g., dermatological) treatment for their skin preoccupations. CONCLUSION There is a high prevalence of PSP among individuals with BDD, and clinicians should be aware of the clinical correlates of this problematic behavior.
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Affiliation(s)
- Jon E Grant
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55454, USA.
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