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Farhat LC, Reid M, Bloch MH, Olfson E. Prevalence and gender distribution of excoriation (skin-picking) disorder: A systematic review and meta-analysis. J Psychiatr Res 2023; 161:412-418. [PMID: 37023597 DOI: 10.1016/j.jpsychires.2023.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/21/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023]
Abstract
Epidemiological studies of excoriation disorder have reported different prevalence estimates for this condition, limiting our understanding of its public health impact. We performed a systematic review and meta-analysis to collate epidemiological studies of excoriation disorder. We aimed to estimate the pooled prevalence and the female-to-male ratio of excoriation disorder in the general population. We searched Embase, PsycInfo, and PubMed up to May 2020 and updated the PubMed search in October 2021. Studies which reported the frequency of excoriation disorder in a sample from the general population were included in our meta-analyses. We made no restrictions regarding the definition or assessment of excoriation disorder. Data were pooled through random-effects meta-analyses. Of the 677 records identified through database searches, 19 studies involving 38,038 participants met our inclusion criteria. Meta-analyses demonstrated that excoriation disorder has an overall prevalence of 3.45% (95% CI 2.55, 4.65%) and impacts women more than men (female-to-male OR = 1.45; 95% CI 1.15, 1.81, p = 0.001). These findings underscore the public health impact of excoriation disorder, which will hopefully motivate future research focused on advancing our understanding and management of this condition.
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Affiliation(s)
- Luis C Farhat
- Child Study Center, Yale University, New Haven, CT, USA; Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, BR, Brazil
| | - Madison Reid
- Child Study Center, Yale University, New Haven, CT, USA
| | - Michael H Bloch
- Child Study Center, Yale University, New Haven, CT, USA; Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Emily Olfson
- Child Study Center, Yale University, New Haven, CT, USA.
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2
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Moritz S, Penney D, Bruhns A, Weidinger S, Schmotz S. Habit Reversal Training and Variants of Decoupling for Use in Body-Focused Repetitive Behaviors. A Randomized Controlled Trial. Cognit Ther Res 2023; 47:109-122. [PMID: 36415779 PMCID: PMC9672630 DOI: 10.1007/s10608-022-10334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 11/18/2022]
Abstract
Background Behavioral interventions hold promise in improving body-focused repetitive behaviors (BFRBs), such as hair pulling and skin picking. The effect of combining different treatment techniques is currently unknown. Methods In the framework of a randomized controlled crossover trial, 334 individuals with at least one BFRB were allocated either to a waitlist control or to three experimental conditions (1:1:1:1). Participants in the experimental condition received self-help manuals teaching habit reversal training (HRT), decoupling (DC) and decoupling in sensu (DC-is) during a six-week period. Treatment conditions differed only in the order of manual presentation. We examined whether applying more than one technique would lead either to add-on or interference effects. Results The three treatment conditions were significantly superior to the waitlist control group in the improvement of BFRBs according to intention-to-treat analyses at a medium effect size (all p ≤ 0.002, d = 0.52 - 0.54). The condition displaying DC first significantly reduced depressive symptoms (p = 0.003, d = 0.47) and improved quality of life (p = 0.011, d = 0.39) compared to the waitlist control. Those using more techniques concurrently showed the strongest decline in BFRB symptoms, even after controlling for days practiced. Participants rated all manuals favorably, with standard DC and HRT yielding greatest acceptability. Discussion Results tentatively suggest the concurrent application of different behavioral treatments for BFRBs leads to add-on effects. Results were superior when DC was practiced first, with positive effects extending to depressive symptoms and quality of life. Integrating the three techniques into one self-help manual or video along with other treatment procedures (e.g., stimulus control techniques) is recommended.
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Affiliation(s)
- Steffen Moritz
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Danielle Penney
- grid.412078.80000 0001 2353 5268Centre Intégré Universitaire de Santé et de Services Sociaux de l’Ouest-de-l’Île-de-Montréal Douglas Mental Health University Institute, Verdun, Canada
| | - Alina Bruhns
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Weidinger
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stella Schmotz
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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4
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Turk T, Liu C, Straube S, Dytoc M, Hagtvedt R, Dennett L, Abba-Aji A, Fujiwara E. The Global Prevalence of Primary Psychodermatologic Disorders: A Systematic Review. J Eur Acad Dermatol Venereol 2022; 36:2267-2278. [PMID: 35924420 DOI: 10.1111/jdv.18478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
The management of primary psychodermatologic disorders (PPDs) (i.e., psychiatric disorders with dermatologic presentation) is challenging. The scarceness of reported prevalence hinders the development of coordinated interventions to improve healthcare delivery. This review aimed to explore the global prevalence of PPDs. The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Of the 4632 identified publications, 60 were included. Five PPDs were investigated from the included studies: delusional parasitosis (n=9), skin picking disorder (n=26), trichotillomania (n=22), tanning dependence (n=5), and repetitive nail biting (n=6). Delusional parasitosis was rare in the general population (prevalence ranging from 0.0002% to 0.03%), with higher rates in the psychiatric settings (outpatient=0.5%; inpatient=0.1%). Other pathologic or subclinical forms of PPDs had a minimum prevalence of 0.3% (median=7.0%; mean=17.0%). The distribution of the prevalence rates was highly skewed, with large differences based on the study setting (e.g., dermatologic settings, psychiatric settings, and general population). The most common condition was pathologic skin picking (prevalence, 1.2%-11.2%) in the general population. Its rates were higher in the psychiatric settings (obsessive-compulsive disorder, 38.5%; Tourette syndrome, 13.0%; body dysmorphic disorder, 26.8%-64.7%). The prevalence of trichotillomania in the general population ranged from 0.6% to 2.9%, while that of pathologic tanning and nail biting could not be ascertained as the studies were mainly in students (range; 12.0%-39.3% and 3.0%-10.1%, respectively). In conclusion, PPDs are common, especially in the dermatologic and psychiatric settings. Further population-based studies are needed to determine more accurate prevalence rates.
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Affiliation(s)
- T Turk
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Department of Dermatology and Venereology, Syrian Arab Red Crescent Hospital, Ministry of Health, Damascus, Syria
| | - C Liu
- Department of Dermatology and Skin Science, University of British Colombia, Vancouver, BC, Canada
| | - S Straube
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - M Dytoc
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - R Hagtvedt
- ABA, Alberta School of Business, University of Alberta, Edmonton, AB, Canada
| | - L Dennett
- Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - A Abba-Aji
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - E Fujiwara
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Abstract
INTRODUCTION Skin picking disorder (also known as excoriation disorder or dermatillomania) is a common mental health disorder currently classified as an obsessive-compulsive and related condition. Despite being first described in the 1800s, very little is known about its phenomenology and clinical presentation. Most information about this disorder to date is based on online surveys rather than in-person assessments. METHODS Clinical and demographic data were collected from individuals with skin-picking disorder taking part in research studies, using in-person assessments comprising validated instruments. Descriptive information was presented as to the nature of skin picking disorder. RESULTS The sample comprised 262 individuals, mean age 32.5 years, being 87% female. The peak age of onset of symptoms was 12.9 years, and most affected individuals (>90%) had symptom onset before age of 20 years. Typically, individuals reported picking from multiple body sites (most common was the face), and the most frequent triggers were stress and the 'feel' (i.e. texture) of the skin. Comorbidities were common, including trichotillomania, depression, generalized anxiety disorder, and impulsive/compulsive disorders (especially attention-deficit hyperactivity disorder and obsessive-compulsive disorder). The majority of people with the disorder (87.1%) had never received treatment. Of those who had received treatment in the past, 87% reported that they found the treatment helpful for their symptoms. DISCUSSION This study sheds new light on the clinical presentation and phenomenology of skin picking disorder. Results highlight the need for further research into its clinical presentation, longitudinal course, and treatment approaches.
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Affiliation(s)
- Jon E Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA.
| | - Samuel R Chamberlain
- Department of Psychiatry, Faculty of Medicine, University of Southampton, UK; Southern Health NHS Foundation Trust, Southampton, UK
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Prochwicz K, Antosz-Rekucka R, Kałużna-Wielobób A, Sznajder D, Kłosowska J. Negative Affectivity Moderates the Relationship between Attentional Control and Focused Skin Picking. IJERPH 2022; 19:ijerph19116636. [PMID: 35682222 PMCID: PMC9180320 DOI: 10.3390/ijerph19116636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022]
Abstract
Very little is known about the cognitive functioning of people with body-focused repetitive behaviours and the few existing studies provide mixed findings. The aim of this study was to investigate the interplay between attentional control, negative affectivity, and focused skin picking. We hypothesized that the control of attention is associated with focused style of skin picking and that this relationship is moderated by negative affectivity. The final sample consisted of 273 non-clinical subjects (79% women) aged 18 to 54 years; study variables were assessed using questionnaires. Moderation analysis was conducted, followed by a simple slope analysis, and the Johnson–Neyman technique was used to probe the interaction effect. We found that at the low level of negative affectivity, the relationship between attentional control and focused skin picking is negative, but not at the higher levels of this trait. Interestingly, when negative affectivity reaches very high intensity, the association between attentional control and skin picking becomes positive. This relationship seems to be quite complex and may depend on the way that cognitive abilities are used by the individual, as well as on the stage of cognitive processing that they are applied to. Further studies using behavioural measures of attention are needed to better understand this issue.
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Affiliation(s)
- Katarzyna Prochwicz
- Institute of Psychology, Jagiellonian University, ul. Ingardena 6, 30-060 Kraków, Poland; (K.P.); (R.A.-R.)
| | - Rachela Antosz-Rekucka
- Institute of Psychology, Jagiellonian University, ul. Ingardena 6, 30-060 Kraków, Poland; (K.P.); (R.A.-R.)
| | - Alina Kałużna-Wielobób
- Institute of Psychology, Pedagogical University, ul. Podchorążych 2, 30-084 Kraków, Poland; (A.K.-W.); (D.S.)
| | - Dominika Sznajder
- Institute of Psychology, Pedagogical University, ul. Podchorążych 2, 30-084 Kraków, Poland; (A.K.-W.); (D.S.)
| | - Joanna Kłosowska
- Institute of Psychology, Jagiellonian University, ul. Ingardena 6, 30-060 Kraków, Poland; (K.P.); (R.A.-R.)
- Correspondence:
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7
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Lochner C, Roos J, Kidd M, Hendricks G, Peris TS, Ricketts EJ, Dougherty DD, Woods DW, Keuthen NJ, Stein DJ, Grant JE, Piacentini J. Pain perception and physiological correlates in body-focused repetitive behavior disorders. CNS Spectr 2022; 28:1-8. [PMID: 35314011 DOI: 10.1017/s1092852922000062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Behaviors typical of body-focused repetitive behavior disorders such as trichotillomania (TTM) and skin-picking disorder (SPD) are often associated with pleasure or relief, and with little or no physical pain, suggesting aberrant pain perception. Conclusive evidence about pain perception and correlates in these conditions is, however, lacking. METHODS A multisite international study examined pain perception and its physiological correlates in adults with TTM (n = 31), SPD (n = 24), and healthy controls (HCs; n = 26). The cold pressor test was administered, and measurements of pain perception and cardiovascular parameters were taken every 15 seconds. Pain perception, latency to pain tolerance, cardiovascular parameters and associations with illness severity, and comorbid depression, as well as interaction effects (group × time interval), were investigated across groups. RESULTS There were no group differences in pain ratings over time (P = .8) or latency to pain tolerance (P = .8). Illness severity was not associated with pain ratings (all P > .05). In terms of diastolic blood pressure (DBP), the main effect of group was statistically significant (P = .01), with post hoc analyses indicating higher mean DBP in TTM (95% confidence intervals [CI], 84.0-93.5) compared to SPD (95% CI, 73.5-84.2; P = .01), and HCs (95% CI, 75.6-86.0; P = .03). Pain perception did not differ between those with and those without depression (TTM: P = .2, SPD: P = .4). CONCLUSION The study findings were mostly negative suggesting that general pain perception aberration is not involved in TTM and SPD. Other underlying drivers of hair-pulling and skin-picking behavior (eg, abnormal reward processing) should be investigated.
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Affiliation(s)
- Christine Lochner
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa
| | - Janine Roos
- Mental Health Information Centre of Southern Africa, Stellenbosch University, Stellenbosch, South Africa
| | - Martin Kidd
- Department of Statistics and Actuarial Sciences, Centre for Statistical Consultation, University of Stellenbosch, Stellenbosch, South Africa
| | - Gaironeesa Hendricks
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa
| | - Tara S Peris
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Emily J Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA
| | - Nancy J Keuthen
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Dan J Stein
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jon E Grant
- Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
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8
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Forbes CN, Tull MT, Lavender JM, Dixon-Gordon KL, Gratz KL. Development and Initial Validation of the Body-focused Self-damaging Behavior Expectancies Questionnaire. J Psychopathol Behav Assess 2022. [DOI: 10.1007/s10862-021-09906-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Topal Hangül Z, Tuman TC, Altunay-Tuman B, Saygılı GY, Tufan AE. Body-focused repetitive behaviors in children and adolescents, clinical characteristics, and the effects of treatment choices on symptoms: a single-center retrospective cohort study. Acta Dermatovenerologica Alpina Pannonica et Adriatica 2022. [DOI: 10.15570/actaapa.2022.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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10
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Gallinat C, Stürmlinger LL, Schaber S, Bauer S. Pathological Skin Picking: Phenomenology and Associations With Emotions, Self-Esteem, Body Image, and Subjective Physical Well-Being. Front Psychiatry 2021; 12:732717. [PMID: 34721107 PMCID: PMC8549828 DOI: 10.3389/fpsyt.2021.732717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Christina Gallinat
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Linda Luisa Stürmlinger
- Graduate School of Economic and Social Sciences (GESS) University of Mannheim, Mannheim, Germany
| | - Sandra Schaber
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
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11
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Kłosowska J, Antosz-Rekucka R, Kałużna-Wielobób A, Prochwicz K. Dissociative Experiences Mediate the Relationship Between Traumatic Life Events and Types of Skin Picking. Findings From Non-clinical Sample. Front Psychiatry 2021; 12:698543. [PMID: 34349684 PMCID: PMC8326802 DOI: 10.3389/fpsyt.2021.698543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/18/2021] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Joanna Kłosowska
- Institute of Psychology, Jagiellonian University, Krakow, Poland
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12
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Ravipati P, Conti B, Chiesa E, Andrieux K. Dermatillomania: Strategies for Developing Protective Biomaterials/Cloth. Pharmaceutics 2021; 13:341. [PMID: 33808008 DOI: 10.3390/pharmaceutics13030341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 01/30/2023] Open
Abstract
Dermatillomania or skin picking disorder (SPD) is a chronic, recurrent, and treatment resistant neuropsychiatric disorder with an underestimated prevalence that has a concerning negative impact on an individual’s health and quality of life. The current treatment strategies focus on behavioral and pharmacological therapies that are not very effective. Thus, the primary objective of this review is to provide an introduction to SPD and discuss its current treatment strategies as well as to propose biomaterial-based physical barrier strategies as a supporting or alternative treatment. To this end, searches were conducted within the PubMed database and Google Scholar, and the results obtained were organized and presented as per the following categories: prevalence, etiology, consequences, diagnostic criteria, and treatment strategies. Furthermore, special attention was provided to alternative treatment strategies and biomaterial-based physical treatment strategies. A total of six products with the potential to be applied as physical barrier strategies in supporting SPD treatment were shortlisted and discussed. The results indicated that SPD is a complex, underestimated, and underemphasized neuropsychiatric disorder that needs heightened attention, especially with regard to its treatment and care. Moreover, the high synergistic potential of biomaterials and nanosystems in this area remains to be explored. Certain strategies that are already being utilized for wound healing can also be further exploited, particularly as far as the prevention of infections is concerned.
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13
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Pathoulas JT, Olson SJ, Idnani A, Farah RS, Hordinsky MK, Widge AS. Cross-sectional survey examining skin picking and hair pulling disorders during the COVID-19 pandemic. J Am Acad Dermatol 2021; 84:771-773. [PMID: 33279648 PMCID: PMC7711196 DOI: 10.1016/j.jaad.2020.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/27/2020] [Accepted: 11/09/2020] [Indexed: 11/04/2022]
Affiliation(s)
| | - Sonia J. Olson
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | | | - Ronda S. Farah
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Maria K. Hordinsky
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Alik S. Widge
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota,Correspondence to: Alik Widge, MD, PhD, Department of Psychiatry, Lions Research Building/McGuire Translational Research Facility, 2001 6th St SE, Minneapolis, MN 55455
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15
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Abstract
Impulse control disorders (ICDs) are neuropsychiatric conditions characterized by the repeated inability to resist an impulse, drive, or temptation to perform an act that is harmful to the person or others. Although classification approaches to ICDs vary both diachronically and synchronically, this group of conditions encompasses a wide range of syndromes, including pathologic gambling, kleptomania, trichotillomania, excoriation (skin picking) disorder, intermittent explosive disorder, pyromania, oppositional defiant, conduct, and antisocial personality disorders. ICDs can play a significant role as comorbidities in both neurodevelopmental (eg, attention-deficit/hyperactivity disorder, Tourette syndrome) and neurodegenerative (eg, Parkinson disease) disorders.
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Affiliation(s)
- Bruno Silva
- Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK; NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Hugo Canas-Simião
- Department of Psychiatry, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Andrea E Cavanna
- Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK; Institute of Clinical Sciences, University of Birmingham, Birmingham, UK; School of Life and Health Sciences, Aston University, Birmingham, UK; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK.
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16
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Torales J, Díaz NR, Barrios I, Navarro R, García O, O'Higgins M, Castaldelli-Maia JM, Ventriglio A, Jafferany M. Psychodermatology of skin picking (excoriation disorder): A comprehensive review. Dermatol Ther 2020; 33:e13661. [PMID: 32447793 DOI: 10.1111/dth.13661] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 11/30/2022]
Abstract
Excoriation disorder (ED) is a primary psychiatric disorder characterized by recurrent skin picking, which may lead to self-induced cutaneous lesions and significant distress or functional impairment. The affected patient is aware of his/her self-destructive behavior but feels unable to give up this habit, despite having made repeated attempts to decrease or stop it. ED is a relatively frequent disorder, of notable heterogeneity and phenomenological complexity, accompanied by significant emotional and physical consequences. Therefore, further research is necessary to enhance the knowledge on its clinical manifestations, epidemiology, and comorbidities. This article presents an update regarding the etiopathogenesis, clinical aspects, and treatment options of ED to provide an up-to-date review for psychiatrists, dermatologists, and general practitioners.
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Affiliation(s)
- Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Noelia Ruiz Díaz
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Iván Barrios
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Rodrigo Navarro
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Oscar García
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Marcelo O'Higgins
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - João Mauricio Castaldelli-Maia
- Department of Neuroscience, Medical School, Fundação do ABC, Santo André, São Paulo, Brazil.,Department of Psychiatry, Medical School, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Mohammad Jafferany
- Department of Psychiatry, Central Michigan University, Mount Pleasant, Michigan, USA
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17
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Abstract
PURPOSE OF REVIEW Studies on the relations between shame and anxiety and obsessive-compulsive and related disorders (OCRDs) are reviewed, with a focus on recent work. RECENT FINDINGS Medium-sized positive correlations have been consistently found across anxiety disorders and OCRDs, suggesting that this relation is transdiagnostic. Most studies focused on shame-proneness and found similar relations across multiple types (e.g. internal, external) and domains (e.g. bodily, characterological, behavioural) of shame, with little variation between clinical and non-clinical populations and different age categories. However, most studies are cross-sectional and correlational and by separately studying clinical and non-clinical populations, they do not give a unitary dimensional view of the relation between shame and symptoms. Emerging findings suggest that shame may be a marker of the response to treatment in these disorders, and its relation with symptoms may be bidirectional. The consistent but medium-sized associations between shame and symptoms of anxiety and OCRDs warrant the future search for mediators and moderators.
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Affiliation(s)
- Aurora Szentágotai-Tătar
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania. .,The Institute for Research, Development and Innovation in Applied Natural Sciences, Babeş-Bolyai University, Cluj-Napoca, Romania.
| | - Diana-Mirela Nechita
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania.,International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Andrei C Miu
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania.,Cognitive Neuroscience Laboratory, Babeș-Bolyai University, Cluj-Napoca, Romania
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18
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Aranda M, Suárez GM, Henao AM, Oviedo GF. Skin Picking Disorder in a Woman with Polyarteritis Nodosa. Case Report. ACTA ACUST UNITED AC 2019; 48:261-265. [PMID: 31779877 DOI: 10.1016/j.rcp.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 02/03/2018] [Accepted: 03/18/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Excoriation (skin picking) disorder is included in the DSM-5 in the obsessive compulsive and related disorders category. It is defined as the recurrent urge to touch, scratch, scrape, scrub, rub, squeeze, bite or dig in the skin, leading to skin lesions. It is a rare disorder (1.4-5.4% of the population) and occurs mainly in women. CASE REPORT this article reports the case of a 31-year-old female patient, initially assessed by dermatology and orthopaedics for the presence of infected ulcerated lesions on her lower limbs, with other superficial lesions from scratching on her chest, arms, forearms, back and head. The patient also reported symptoms of anxiety, so was assessed by consultation-liaison psychiatry. DISCUSSION skin picking, normal behaviour in mammals, becomes pathological from a psychiatric point of view when it is repetitive and persistent, as in the case of excoriation disorder. In view of the reported relationship with the obsessive-compulsive spectrum, use of selective serotonin reuptake inhibitors and cognitive behavioural therapy are recommended.
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Affiliation(s)
| | | | | | - Gabriel Fernando Oviedo
- Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Colombia.
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19
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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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20
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Oliveirra ECB, Fitzpatrick CL, Kim HS, Gulassa DCR, Amaral RS, Cristiana NDM, Hayashiuchi AY, McGrath DS, Tavares H. Obsessive-compulsive or addiction? Categorical diagnostic analysis of excoriation disorder compared to obsessive-compulsive disorder and gambling disorder. Psychiatry Res 2019; 281:112518. [PMID: 31546148 DOI: 10.1016/j.psychres.2019.112518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 08/04/2019] [Accepted: 08/10/2019] [Indexed: 11/25/2022]
Abstract
Excoriation disorder (ED) is currently classified in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders' Obsessive-compulsive and Related Disorders section (OCRD). However, there remain debates regarding whether ED is related to obsessive-compulsive disorder (OCD) or whether it is better conceptualized as a behavioral addiction. The present research compared the diagnostic overlap and psychiatric comorbidities of 121 individuals seeking treatment for ED (n = 40), OCD (n = 41) and gambling disorder (GD) (n = 40). ED was more likely to overlap with OCD (n = 14) than GD (n = 3). Compared to OCD, ED had similar frequencies of other body focused repetitive behaviors (BFRBs), but higher frequency of addictive behaviors (Odds Ratio - OR = 11.82). In comparison to GD, ED had similar frequencies of addictive behaviors, but higher frequency of BFRBs (OR=19.67). The results support the recent classification of ED as an OCRD. However, ED presents an association with behavioral addictions that suggests a mixed impulsive-compulsive nature. A limitation of the present research was the use of a non-validated semi-structured clinical interview to diagnose impulse control disorders. Future research should examine other characteristics (e.g., epidemiology, neurobiology, genetics, treatment response) to further investigate whether ED should remain classified as an OCRD.
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Affiliation(s)
- Elen Cristina Batista Oliveirra
- Programa Ambulatorial de Transtornos do Impulso (PRO-AMITI), Instituto de Psiquiatria (IPq), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Artur de Azevedo, 145, Cerqueira Cesar, CEP: 05404-010, Sao Paulo, SP, Brazil.
| | | | - Hyoun S Kim
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Carr Ribeiro Gulassa
- Programa Ambulatorial de Transtornos do Impulso (PRO-AMITI), Instituto de Psiquiatria (IPq), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Artur de Azevedo, 145, Cerqueira Cesar, CEP: 05404-010, Sao Paulo, SP, Brazil
| | - Roberta Souza Amaral
- Programa Ambulatorial de Transtornos do Impulso (PRO-AMITI), Instituto de Psiquiatria (IPq), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Artur de Azevedo, 145, Cerqueira Cesar, CEP: 05404-010, Sao Paulo, SP, Brazil
| | - Nicoli de Mattos Cristiana
- Programa Ambulatorial de Transtornos do Impulso (PRO-AMITI), Instituto de Psiquiatria (IPq), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Artur de Azevedo, 145, Cerqueira Cesar, CEP: 05404-010, Sao Paulo, SP, Brazil
| | - Ana Yaemi Hayashiuchi
- Programa Ambulatorial de Transtornos do Impulso (PRO-AMITI), Instituto de Psiquiatria (IPq), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Artur de Azevedo, 145, Cerqueira Cesar, CEP: 05404-010, Sao Paulo, SP, Brazil
| | - Daniel S McGrath
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Hermano Tavares
- Programa Ambulatorial de Transtornos do Impulso (PRO-AMITI), Instituto de Psiquiatria (IPq), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Artur de Azevedo, 145, Cerqueira Cesar, CEP: 05404-010, Sao Paulo, SP, Brazil
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21
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Dieringer M, Beck C, Verrel J, Münchau A, Zurowski B, Brandt V. Quality and temporal properties of premonitory urges in patients with skin picking disorder. Cortex 2019; 121:125-34. [PMID: 31605885 DOI: 10.1016/j.cortex.2019.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/20/2019] [Accepted: 08/29/2019] [Indexed: 12/30/2022]
Abstract
Skin picking is a newly recognized obsessive-compulsive spectrum disorder in DSM-5. Similar to some repetitive behaviors in Gilles de la Tourette syndrome (GTS) and obsessive-compulsive disorder (OCD), premonitory urges are assumed to play a critical role in maintaining skin picking behavior, by creating a vicious cycle. The present study is the first to investigate the quality of premonitory urges, as well as the temporal relationship between urges and skin picking behavior in individuals with skin picking disorder. Quality and intensity of premonitory urges was assessed in 15 individuals with skin picking. Urge quality was assessed with the translated University of São Paulo Sensory Phenomena Scale (USP-SPS). Urge intensity was assessed continuously over 20 min using a computer-based tool. Participants were instructed either a) to pick freely or b) to suppress their skin picking behavior. Skin picking events during the free and suppression condition were recorded on video and coded manually. Regarding the types of urges, individuals with skin picking reported mainly physical urge sensations (80%), visual "just-right" feelings (80%), and urge-only sensations (80%) similar to urges reported by GTS and OCD patients. Moreover, the data showed a strong temporal relationship between the intensity of premonitory urges and the emergence of skin picking behavior (R2 = .23) that was weakened when skin picking was suppressed (R2 = .06). The results suggest that skin picking behavior is maintained by premonitory urges and that this vicious cycle of negative reinforcement can be, at least partially, broken by suppressing skin picking behavior.
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22
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Spunton M, Guala A, Liverani ME, Medolago L, Tognon F, Casado F, Del Valle M, Porras J, Larrea I, Porta G, Albani G, Nevado J, Danesino C. Skin picking disorder in 97 Italian and Spanish Cri du chat patients. Am J Med Genet A 2019; 179:1525-1530. [PMID: 31187941 DOI: 10.1002/ajmg.a.61259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 11/08/2018] [Accepted: 05/21/2019] [Indexed: 11/09/2022]
Abstract
Skin picking (SP) disorder is characterized by recurrent SP resulting in skin lesions. Several studies estimated its prevalence as approximately 2-4 % of the general population. It is also present in a high percentage of patients with intellectual and developmental disabilities, such as Cri du chat (CdC) syndrome, a rare genetic disorder caused by variable size deletions of the short arm of chromosome 5. The aim of this study was to evaluate, in 97 patients with CdC syndrome, the following data: frequency of SP, patient's age at onset, type, and topographic-anatomic distribution of the lesions presented. The results show that 85% of patients confirm a SP disorder, usually concentrated on the hands, fingers, and the face, with onset between 6 and 10 years of age, regardless of patient's sex. Evidence for early appearance of SP behavior, high prevalence in stressful circumstances, and efficacy of distracting actions immediately suggest the possibility that proper parental information about SP behavior and parental education concerning the methods to deal with this problem may result in its efficient reduction already in childhood.
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Affiliation(s)
| | - Andrea Guala
- SOC Pediatria, Ospedale Castelli, Verbania, Italy
| | | | | | - Fabio Tognon
- Associazione Bambini Cri du Chat (ABC), Florence, Italy
| | | | | | - Josefina Porras
- Asociación Nacional de Afectados por el Síndrome del Maullido del Gato (ASIMAGA), Barcelona, Spain
| | - Isabel Larrea
- Asociación Nacional de Afectados por el Síndrome del Maullido del Gato (ASIMAGA), Barcelona, Spain
| | - Giovanni Porta
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - Giovanni Albani
- Divisione di Neurologia e Neuro-Riabilitazione, IRCCS Istituto Auxologico Italiano, Ospedale San Giuseppe, Milan, Italy
| | - Julian Nevado
- Structural and Functional Genomics Section, Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario la PAZ-IdiPaz, Centro de Investigación Básica de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Cesare Danesino
- Department of Molecular Medicine, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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23
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Kupfer TR, Fessler DMT. Ectoparasite defence in humans: relationships to pathogen avoidance and clinical implications. Philos Trans R Soc Lond B Biol Sci 2019; 373:rstb.2017.0207. [PMID: 29866920 DOI: 10.1098/rstb.2017.0207] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2018] [Indexed: 11/12/2022] Open
Abstract
Currently, disgust is regarded as the main adaptation for defence against pathogens and parasites in humans. Disgust's motivational and behavioural features, including withdrawal, nausea, appetite suppression and the urge to vomit, defend effectively against ingesting or touching sources of pathogens. However, ectoparasites do not attack their hosts via ingestion, but rather actively attach themselves to the body surface. Accordingly, by itself, disgust offers limited defence against ectoparasites. We propose that, like non-human animals, humans have a distinct ectoparasite defence system that includes cutaneous sensory mechanisms, itch-generation mechanisms and grooming behaviours. The existence of adaptations for ectoparasite defence is supported by abundant evidence from non-human animals, as well as more recent evidence concerning human responses to ectoparasite cues. Several clinical disorders may be dysfunctions of the ectoparasite defence system, including some that are pathologies of grooming, such as skin picking and trichotillomania, and others, such as delusory parasitosis and trypophobia, which are pathologies of ectoparasite detection. We conclude that future research should explore both distinctions between, and overlap across, ectoparasite defence systems and pathogen avoidance systems, as doing so will not only illuminate proximate motivational systems, including disgust, but may also reveal important clinical and social consequences.This article is part of the Theo Murphy meeting issue 'Evolution of pathogen and parasite avoidance behaviours'.
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Affiliation(s)
- Tom R Kupfer
- School of Psychology, Keynes College, University of Kent, Canterbury, Kent CT2 7NP, UK
| | - Daniel M T Fessler
- Department of Anthropology and Center for Behavior, Evolution and Culture, University of California, Los Angeles, Los Angeles, CA 90095-1553, USA
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24
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Ricketts EJ, Rozenman M, Snorrason Í, Pérez JB, Peng MG, Kim J, Piacentini J. Confirmatory factor analysis of the SLEEP-50 Questionnaire in Trichotillomania (Hair-Pulling Disorder) and Excoriation (Skin-Picking) Disorder. Psychiatry Res 2019; 273:197-205. [PMID: 30654305 PMCID: PMC6561822 DOI: 10.1016/j.psychres.2019.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 12/17/2018] [Accepted: 01/05/2019] [Indexed: 11/29/2022]
Abstract
The study objective was to perform a confirmatory factor analysis of the SLEEP-50 Questionnaire (SLEEP-50) in Trichotillomania (Hair-Pulling Disorder) and Excoriation (Skin-Picking) Disorder and compare sleep complaints in adults with Trichotillomania, Excoriation Disorder and non-affected controls. Participants were 234 adults with Trichotillomania, 170 with Excoriation Disorder, and 146 non-affected controls. Participants rated sleep using the SLEEP-50 and Pittsburgh Sleep Quality Index (PSQI). Confirmatory factor analysis was used to assess fit of the originally-proposed SLEEP-50 factors within Trichotillomania and Excoriation Disorder. Findings revealed acceptable to good fit of the original factors. Internal consistency was excellent in Trichotillomania and good in Excoriation Disorder for the total score and poor to good for subscales. Convergent validity was strong for the total and weak to strong for subscales in both groups. Findings suggest greater sleep complaints in Trichotillomania and Excoriation Disorder than in the general population. Trichotillomania and Excoriation Disorder groups reported greater rates of sleep apnea, narcolepsy, restless leg syndrome/periodic limb movement disorder, circadian rhythms sleep disorder, and sleep-related affective disorder relative to controls. There were no significant differences for insomnia, sleep state misperception, sleepwalking, nightmares, or hypersomnia. Results underscore the importance of clinical assessment of sleep disorders in Trichotillomania and Excoriation Disorder.
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Affiliation(s)
- Emily J Ricketts
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, CA, USA.
| | - Michelle Rozenman
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, CA, USA; Department of Psychology, University of Denver, Denver, CO, USA
| | - Ívar Snorrason
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Jocelyn B Pérez
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, CA, USA
| | - Micalla G Peng
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, CA, USA
| | - Jessica Kim
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, CA, USA
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, CA, USA
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25
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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26
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Ricketts EJ, Snorrason I, Kircanski K, Alexander JR, Thamrin H, Flessner CA, Franklin ME, Piacentini J, Woods DW. A latent profile analysis of age of onset in pathological skin picking. Compr Psychiatry 2018; 87:46-52. [PMID: 30199665 PMCID: PMC6261272 DOI: 10.1016/j.comppsych.2018.08.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 08/02/2018] [Accepted: 08/13/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Pathological Skin Picking (PSP) may begin at any age, but the most common age of onset is during adolescence. Age of onset is a potentially useful clinical marker to delineate subtypes of psychiatric disorders. The present study sought to examine empirically defined age of onset groups in adults with PSP and assess whether groups differed on clinical characteristics. METHOD Participants were 701 adult respondents to an internet survey, who endorsed recurrent skin picking with tissue damage and impairment. Latent profile analysis (LPA) was conducted to identify subtypes of PSP based on age of onset. Then subgroups were compared on demographic and clinical characteristics. RESULTS The best fitting LPA model was a two-class solution comprised of a large group with average age of onset in adolescence (n = 650; 92.9% of the sample; Mean age of onset = 13.6 years) and a small group with average onset in middle adulthood (n = 50; 7.1% of the sample; Mean age of onset = 42.8 years). Relative to the early onset group, the late onset group reported significantly less focused picking, less skin picking-related impairment, lower rates of co-occurring body-focused repetitive behaviors, and trends towards reduced family history of PSP. Individuals in the late onset group also reported increased rates of comorbid depression, anxiety and posttraumatic stress disorder, and were more likely to report that initial picking onset seemed related to or followed depression/anxiety and physical illness. CONCLUSION Findings suggest the presence of two distinct PSP age of onset groups: (1) an early onset group with average onset in adolescence, clinical characteristics suggestive of greater picking-related burden and familiality, and a profile more representative of the general PSP population; and (2) a late onset group with average onset in middle adulthood, increased co-occurring affective and trauma conditions, and initial onset associated with or following other mental health and physical problems. Future replication is needed to assess the validity and clinical utility of these subgroups.
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Affiliation(s)
- Emily J. Ricketts
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA
| | - Ivar Snorrason
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | | | - Hardian Thamrin
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA
| | | | - Martin E. Franklin
- Children’s Hospital of Philadelphia, University of Pennsylvania,,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Philadelphia, PA
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA
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27
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Sidiropoulou P, Sgouros D, Theodoropoulos K, Katoulis A, Rigopoulos D. Onychotillomania: A Chameleon-Like Disorder: Case Report and Review of Literature. Skin Appendage Disord 2018; 5:104-107. [PMID: 30815444 DOI: 10.1159/000489941] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/08/2018] [Indexed: 11/19/2022] Open
Abstract
Onychotillomania, or nail-picking disorder, is an uncommon and misdiagnosed behavioral pattern focused on the nail apparatus. It is demarcated by the compulsive or irresistible urge in patients to constantly injure their own nails, with the fingers or tools, inflicting noticeable or even irreversible self-destruction of the nail unit. Despite its rarity, this self-injurious coercion often poses a diagnostic and therapeutic challenge. Not only do many patients deny nail manipulation, but also the disorder has long been recognized to present itself with a wide range of clinical features, which hampers early and indisputable diagnosis. Furthermore, onychotillomania constitutes a persistent and hardly manageable problem, mostly because of its psychocutaneous nature as well as its high propensity to coexist with underlying neuropsychiatric illnesses or other behavioral disorders. However, the medical literature concerning obsessive nail picking still remains relatively scarce. Herein, we present an extraordinary, yet very intriguing case of a Caucasian patient with onychotillomania and onychophagia coexistence masquerading a weird inflammation-like lesion.
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Affiliation(s)
- Polytimi Sidiropoulou
- 1st Department of Dermatology-Venereology, National Kapodistrian University of Athens, Medical School, "A. Sygros" Hospital, Athens, Greece
| | - Dimitrios Sgouros
- 1st Department of Dermatology-Venereology, National Kapodistrian University of Athens, Medical School, "A. Sygros" Hospital, Athens, Greece
| | - Konstantinos Theodoropoulos
- 2nd Department of Dermatology-Venereology, National Kapodistrian University of Athens, Medical School, ATTIKON University Hospital, Athens, Greece
| | - Alexander Katoulis
- 2nd Department of Dermatology-Venereology, National Kapodistrian University of Athens, Medical School, ATTIKON University Hospital, Athens, Greece
| | - Dimitrios Rigopoulos
- 1st Department of Dermatology-Venereology, National Kapodistrian University of Athens, Medical School, "A. Sygros" Hospital, Athens, Greece
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Abstract
Itch, also referred to as pruritus, is an unpleasant cutaneous sensation provoking the desire to scratch. It is often an uncomfortable, subjective sensation responsible for decreased quality of life in a variety of psychodermatological conditions. Comorbid psychiatric conditions, including depression and anxiety, are frequently associated with itch and scratch cycle. The reciprocal and intricate relationship between the psyche and itch has been widely studied. The neurobiology of itch involves the complexity of specific mediators, itch-related neuronal pathways, and central processing of itch. The connection between itch and the psyche can be grouped under three headings: pruritic diseases with psychosocial sequelae, pruritic diseases aggravated by psychosocial factors, and psychiatric disorders causing pruritus. Itch and pain modulation go together in most circumstances and involve various substances including histamine, interleukins, protease-activated receptors, transient receptor potential receptors, opioids, and cannabinoids. The close interaction between keratinocytes and nerve endings modulating pain and itch also play a major role. Management of itch associated with its psychosomatic components is directed at an underlying cause and adopting a holistic approach to address not only dermatologic and somatosensory aspects, but also the cognitive, emotional, and psychosocial components. An integrated multidisciplinary team consisting of a dermatologist, psychiatrist, psychologist, and social worker is vital in addressing the multifaceted aspects of pruritus.
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Prochwicz K, Kłosowska J, Kałużna-Wielobób A. The relationship between emotion regulation strategies, personality traits and skin picking behaviours in a non-clinical sample of Polish adults. Psychiatry Res 2018; 264:67-75. [PMID: 29627699 DOI: 10.1016/j.psychres.2018.03.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/11/2018] [Accepted: 03/20/2018] [Indexed: 12/15/2022]
Abstract
Although skin-picking is a relatively common behaviour, data concerning factors which underlie skin-picking severity and functional impairment caused by picking are still limited. In the present study we examined whether some emotion regulation strategies (cognitive reappraisal and expressive suppression) and personality features influence skin-picking in a university sample; the moderating role of personality traits in the relationship between emotion regulation strategies and skin-picking was also considered. A total sample of 252 adults (mean age 24.03; SD = 5.66) completed the Skin-Picking Scale-Revised, Temperament and Character Inventory and Emotion Regulation Questionnaire. The linear regression analyses indicated that the use of cognitive reappraisal as emotion regulation strategy decrease skin-picking severity. Reduced novelty seeking and reduced self-directedness were identified as significant predictors of skin-picking severity, whereas decreased self-directedness and elevated cooperativeness predicted functional impairment caused by skin-picking. Further moderation analysis revealed that cognitive reappraisal decreases skin-picking severity only among individuals with low and moderate novelty seeking, however, not among those with high novelty seeking. These results indicate that emotion regulation strategies and specific personality traits are important factors associated with skin-picking behaviours in a university sample. Further research is needed to establish the link between emotion regulation strategies and personality traits in clinical sample.
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Abramowitz JS. Presidential Address: Are the Obsessive-Compulsive Related Disorders Related to Obsessive-Compulsive Disorder? A Critical Look at DSM-5's New Category. Behav Ther 2018; 49:1-11. [PMID: 29405915 DOI: 10.1016/j.beth.2017.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 12/18/2022]
Abstract
The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) includes a new class of obsessive-compulsive and related disorders (OCRDs) that includes obsessive-compulsive disorder (OCD) and a handful of other putatively related conditions. Although this new category promises to raise awareness of underrecognized and understudied problems, the empirical validity and practical utility of this new DSM category is questionable. This article critically examines the arguments underlying the new OCRD class, illuminates a number of problems with this class, and then discusses implications for clinicians and researchers.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Wabnegger A, Übel S, Suchar G, Schienle A. Increased emotional reactivity to affective pictures in patients with skin-picking disorder: Evidence from functional magnetic resonance imaging. Behav Brain Res 2017; 336:151-155. [PMID: 28866131 DOI: 10.1016/j.bbr.2017.08.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/20/2017] [Accepted: 08/28/2017] [Indexed: 11/19/2022]
Abstract
The predominant symptom of skin-picking disorder (SPD) is the recurrent picking of one's own skin, leading to tissue damage and discomfort. Psychological disorder models suggest an enhanced emotional reactivity in patients with SPD, which contributes to the maintenance of symptoms. This functional magnetic resonance imaging (fMRI) experiment analyzed both subjective and neuronal responses to affective pictures (categories: fear, disgust, happiness, neutral) in 19 women with SPD and 16 healthy controls. Also, affective traits (disgust, anxiety, depression) were assessed. Those with SPD scored higher on trait anxiety/depression, and reported higher intensities of negative emotions experienced during the picture viewing. On the neuronal level, the clinical group showed enhanced localized brain activation to fear, disgust and happiness in the amygdala, the insula and the orbitofrontal cortex. These regions are part of a brain circuit mediating affective responses and affective awareness. The current fMRI study provides first data on the neuronal basis of elevated emotional reactivity to affective pictures in SPD.
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Affiliation(s)
- Albert Wabnegger
- Clinical Psychology, University of Graz, BioTechMedGraz, Universitätsplatz 2, 8010 Graz, Austria.
| | - Sonja Übel
- Clinical Psychology, University of Graz, BioTechMedGraz, Universitätsplatz 2, 8010 Graz, Austria
| | - Gerald Suchar
- Privatklinik St. Radegund, Diepoltsbergerstraße 38-40, 8061 St. Radegund, Austria
| | - Anne Schienle
- Clinical Psychology, University of Graz, BioTechMedGraz, Universitätsplatz 2, 8010 Graz, Austria
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Anzengruber F, Ruhwinkel K, Ghosh A, Klaghofer R, Lang UE, Navarini AA. Wide range of age of onset and low referral rates to psychiatry in a large cohort of acne excoriée at a Swiss tertiary hospital. J DERMATOL TREAT 2017; 29:277-280. [PMID: 28784003 DOI: 10.1080/09546634.2017.1364693] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Repetitive skin manipulation is the key symptom in skin picking disorder (SPD) or acne excoriée des jeunes filles Brocq. The diagnostic and statistical manual of mental disorders (DSM-5) has recognized SPD as an independent disease, namely an obsessive-compulsive disorder. Thus, psychiatric treatment is indicated. Therefore, in a large cohort of SPD, we asked whether dermatologists' treatment strategy includes routine referrals to psychiatry. In addition, we describe epidemiological data, treatments and follow up. METHODS We performed a retrospective study, searching in our hospital database between January 1 2011 and December 31 2016. RESULTS A total of 154 (141 female, 13 male) patients were included in our study. In less than 5% a referral to a psychologist or psychiatrist occurred. More than 90% of all patients received topical and almost 40% systemical anti-acne treatment. The loss of follow-up was very high. DISCUSSION Our study shows that dermatologists focus on treating acne-like lesions in SPD, but rarely refer to psychiatry. Possible reasons include considerations of patients' reactions who often reject the idea of a psychological origin of the disease. Our results suggest that new treatment strategies should be created to address SPD correctly, i.e. by combined consultations with psychiatrists or specific training of dermatologists in psychiatric therapy and diagnostics.
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Affiliation(s)
- Florian Anzengruber
- a Department of Dermatology , University Hospital Zurich , Zurich , Switzerland
| | - Katrin Ruhwinkel
- b Department of Psychiatry , University Hospital Zurich , Zurich , Switzerland
| | - Adhideb Ghosh
- a Department of Dermatology , University Hospital Zurich , Zurich , Switzerland.,c Competence Center for Personalized Medicine UZH/ETH , Zurich , Switzerland
| | - Richard Klaghofer
- d Department of Psychiatry and Psychotherapy , University Hospital of Zurich , Zurich , Switzerland
| | - Undine E Lang
- e Universitäre Psychiatrische Kliniken Basel, Universität Basel , Basel , Switzerland
| | - Alexander A Navarini
- a Department of Dermatology , University Hospital Zurich , Zurich , Switzerland.,c Competence Center for Personalized Medicine UZH/ETH , Zurich , Switzerland
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Ricketts EJ, Snorrason I, Rozenman M, Colwell CS, McCracken JT, Piacentini J. Sleep functioning in adults with trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder, and a non-affected comparison sample. J Obsessive Compuls Relat Disord 2017; 13:49-57. [PMID: 32467821 PMCID: PMC7255435 DOI: 10.1016/j.jocrd.2017.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The present study assessed sleep functioning in Trichotillomania (TTM; Hair-Pulling Disorder) and Excoriation (Skin-Picking) Disorder (ExD), and a non-affected comparison group, and examined the prevalence and correlates of bedtime and sleep-related hair pulling and skin picking. Participants were adult internet survey respondents, who met diagnostic criteria for TTM (N=259), ExD (N=182), or did not meet criteria for these disorders (N=148). Individuals with TTM and ExD endorsed significantly greater sleep disturbance relative to the comparison group, even after controlling for internalizing (anxiety and depression) symptoms. Hair pulling and skin picking severity were not significantly correlated with sleep disturbance after controlling for internalizing symptoms. Pulling and picking during sleep occurred at rates of 13% and 27%, respectively. Picking severity, anxiety and depressive symptoms, and sleep disturbance were significantly increased in those who engaged in picking during sleep relative to those who did not endorse this behavior. No significant differences were found between those endorsing pulling during sleep and those not endorsing this on demographic, clinical, or sleep variables. The present study highlights the potential role of sleep disturbance in TTM and ExD, and the need for further research in this area.
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Affiliation(s)
- Emily J. Ricketts
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, United States
| | - Ivar Snorrason
- University of Wisconsin-Milwaukee, Department of Psychology, United States
| | - Michelle Rozenman
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, United States
| | - Christopher S. Colwell
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, United States
| | - James T. McCracken
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, United States
| | - John Piacentini
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, United States
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Bain MA, Vincent J. Management of a Complex Excoriation Disorder-induced Wound with a Viable Cryopreserved Placental Membrane. Plast Reconstr Surg Glob Open 2016; 4:e1132. [PMID: 28293501 DOI: 10.1097/GOX.0000000000001132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 09/20/2016] [Indexed: 11/25/2022]
Abstract
Excoriation disorder (ED), also known as dermatotillomania, is a condition characterized by repeated "skin picking" that leads to the formation of skin lesions. Because of the similarity of its symptoms to obsessive compulsive disorder, ED is classified as a subcategory of obsessive compulsive disorder by Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. Although the majority of the self-inflicted wounds are not clinically significant, many wounds lead to social and occupational dysfunction by becoming infected, chronic, and life threatening. This report describes the successful use of a viable intact cryopreserved human amniotic membrane in conjunction with selective serotonin re-uptake inhibitors in treating an ED patient who presented with a large calvarial wound of 3-year duration that had failed previous extensive medical and surgical interventions.
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Rieder EA, Tosti A. Onychotillomania: An underrecognized disorder. J Am Acad Dermatol 2016; 75:1245-1250. [DOI: 10.1016/j.jaad.2016.05.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/13/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
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Prochwicz K, Kałużna-Wielobób A, Kłosowska J. Skin picking in a non-clinical sample of young Polish adults. Prevalence and characteristics. Compr Psychiatry 2016; 71:77-85. [PMID: 27639125 DOI: 10.1016/j.comppsych.2016.08.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The aim of the study was to examine the prevalence and characteristics of skin picking behaviors in a sample of young Polish adults. METHODS Five hundred and thirty-four participants completed measurements of skin picking frequency and severity. They also retrospectively rated the intensity of affective states experienced before, during and after skin picking episodes. RESULTS In total, 46.07% of the participants endorsed some forms of skin picking, and the prevalence of skin picking disorder (SPD) in the study sample amounted to 7.67%. The characteristics of skin picking episodes in young Polish adults were similar to those reported in previous studies conducted on different cultures. The results also showed that for the majority of individuals with skin picking, the intensity of particular emotions (i.e. fear, anxiety, guilt, shame, self-aversion, boredom, and sadness) decreased significantly in the period from before to after picking. CONCLUSION Larger community studies are needed to assess the SPD prevalence in Polish general population.
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Affiliation(s)
| | | | - Joanna Kłosowska
- Department of Psychology, Pedagogical University, Krakow, Poland
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Abstract
In this study, the authors collected data on the demographic characteristics, phenomenology, and social and economic impact of skin picking. A total of 92 participants completed an anonymous, Internet-based survey through a link to the Trichotillomania Learning Center’s home page. Results indicated that skin pickers experienced social, occupational, and academic impairment, a number of medical or mental health concerns, and financial burdens, which they attributed to skin picking. Results also revealed moderate, statistically significant relationships between skin picking severity and symptoms of depression, anxiety, and experiential avoidance. Subsequent mediational analyses demonstrated that the relationship between skin picking severity and symptoms of anxiety and depression was partially mediated by experiential avoidance. Implications, conclusions, and future areas of research are discussed.
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Pozza A, Giaquinta N, Dèttore D. Borderline, avoidant, sadistic personality traits and emotion dysregulation predict different pathological skin picking subtypes in a community sample. Neuropsychiatr Dis Treat 2016; 12:1861-7. [PMID: 27536108 PMCID: PMC4977073 DOI: 10.2147/ndt.s109162] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pathological skin picking (SP) is a strongly impairing condition characterized by repetitive picking behaviors resulting in significant tissue damage and distress. Recent research suggested the presence of different subtypes of SP. No study has investigated which personality traits could be specifically associated with different subtypes. In a community sample (N=285, 71.20% females, mean age =34.98 years, standard deviation =15.91), this cross-sectional study investigated which personality traits and emotion regulation deficits could predict specific SP subtypes. Participants completed the Milwaukee Inventory for the Dimensions of Adult Skin Picking (MIDAS), Millon Clinical Multiaxial Inventory-III personality scales (MCMI-III), and Difficulties in Emotion Regulation Scale (DERS) questionnaires. Higher scores on the MCMI-III borderline (β=0.28, t=4.88, P<0.001), MCMI-III avoidant scale (β=0.18, t=2.59, P<0.01), and DERS difficulties engaging in goal-directed behavior (β=0.19, t=3.27, P<0.01) predicted higher scores on the MIDAS automatic scale. Higher scores on the MCMI-III borderline (β=0.30, t=5.23, P<0.001) and DERS difficulties engaging in goal-directed behavior (β=0.15, t=2.52, P<0.05) and DERS limited access to emotion regulation strategies (β=0.21, t=3.26, P<0.01) predicted higher scores on the MIDAS focused scale. Higher scores on the MCMI-III sadistic (β=0.19, t=3.30, P<0.001) and DERS difficulties engaging in goal-directed behavior (β=0.15, t=2.68, P<0.01) predicted higher scores on the MIDAS mixed scale. Implications for future research and treatment are discussed.
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Affiliation(s)
- Andrea Pozza
- Department of Experimental and Clinical Medicine, University of Florence, Florence; Miller Institute of Behavioral and Cognitive Psychotherapy, Genoa
| | - Nicoletta Giaquinta
- Miller Institute of Behavioral and Cognitive Psychotherapy, Genoa; Centre of Cognitive and Behavioural Therapy (CTCC), Florence
| | - Davide Dèttore
- Department of Health Sciences, University of Florence, Florence, Italy
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Woods DW, Houghton DC. Evidence-Based Psychosocial Treatments for Pediatric Body-Focused Repetitive Behavior Disorders. Journal of Clinical Child & 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] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
- Jonathan S. Abramowitz
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599;
| | - Ryan J. Jacoby
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599;
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Weingarden H, Renshaw KD. Shame in the obsessive compulsive related disorders: a conceptual review. J Affect Disord 2015; 171:74-84. [PMID: 25299438 DOI: 10.1016/j.jad.2014.09.010] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Abstract
This article explores the way stress affects the skin, both at the molecular level, where the skin has an intricate connection to the neurocutaneous and immune systems, and at the clinical level. The concept of psychodermatology is reviewed with regard to the way skin reacts to stress, how stress is a trigger for several common skin diseases, and how neuropsychiatric disorders may have skin manifestations. The article is directed at making the dermatologist, the psychiatrist, the psychologist, and the primary physician familiar with the brain-skin mechanisms involved in stress and the resultant clinical expressions on the skin.
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Affiliation(s)
- Edgardo Rodriguez-Vallecillo
- Private Practice, 29 Washington Street, Suite 507, San Juan, PR 00907, USA; Dermatology, HIMA San Pablo Hospital, Sta. Cruz Street, Bayamon, PR 00961, USA.
| | - Michel A Woodbury-Fariña
- Department of Psychiatry, University of Puerto Rico School of Medicine, 307 Calle Eleonor Roosevelt, San Juan, PR 00918-2720, USA
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Leibovici V, Murad S, Cooper-Kazaz R, Tetro T, Keuthen NJ, Hadayer N, Czarnowicki T, Odlaug BL. Excoriation (skin picking) disorder in Israeli University students: prevalence and associated mental health correlates. Gen Hosp Psychiatry 2014; 36:686-9. [PMID: 25150776 DOI: 10.1016/j.genhosppsych.2014.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/19/2014] [Accepted: 07/22/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of the study was to examine the prevalence of excoriation (skin picking) disorder (SPD) and associated physical and mental health correlates in a sample of Israeli university students. METHODS Five thousand Israeli students were given questionnaires screening for SPD, depression, obsessive-compulsive disorder, body dysmorphic disorder and disruptive, impulse control and conduct disorders. A total of 2176 participants (43.6%) responded and were included in the analysis. Mean age was 25.1 ± 4.8 (range 17-60) years, and 64.3% were female. RESULTS The proportion of students who were screened positive for SPD was 3.03%, with a nearly equal gender distribution (3.0% in females and 3.1% in males). There was a trend toward significantly higher rates of psychiatric problems such as generalized anxiety, compulsive sexual behavior and eating disorders in these students. Within the group of students screening positive for SPD, alcohol intake was higher in male students, while female students perceived themselves as less attractive. No association was found between depression and SPD. A high prevalence rate of skin picking was found within first-degree family members of the participants screening positive for SPD. CONCLUSIONS Clinicians and public health officials within university settings should screen for SPD as it is common and associated with psychosocial dysfunction.
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Abstract
Nail picking disorder (onychotillomania) is characterized by excessive picking or pulling at one's own finger- or toenails. This condition has received scant research attention and may be related to other body focused repetitive behaviors such as pathological nail biting, skin picking and hair pulling. We present a case of a male client with a chronic and severe nail picking habit treated with acceptance-enhanced behavior therapy. The client showed clinical characteristics similar to other body focused repetitive behaviors and responded moderately well to the treatment.
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Abstract
We evaluated the effects of simplified habit reversal (HR) that combined competing response training and differential reinforcement on skin picking by an adolescent female with autism attending a classroom at a specialized school. The competing response training procedure allowed her to manipulate preferred sensory stimuli independently and when instructed by classroom staff. Differential reinforcement included praise and tokens that she received following intervals without skin picking and when she performed competing response training. Compared with a baseline phase, skin picking decreased with simplified HR and during a subsequent phase when treatment was faded by implementing differential reinforcement without competing response training. We discuss the clinical implications of these findings.
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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] [What about the content of this article? (0)] [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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