1
|
Ricketts EJ, Peris TS, Grant JE, Valle S, Cavic E, Lerner JE, Lochner C, Stein DJ, Dougherty DD, O'Neill J, Woods DW, Keuthen NJ, Piacentini J. Clinical Characteristics of Youth with Trichotillomania (Hair-Pulling Disorder) and Excoriation (Skin-Picking) Disorder. Child Psychiatry Hum Dev 2024; 55:975-986. [PMID: 36315372 DOI: 10.1007/s10578-022-01458-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/02/2022] [Accepted: 10/08/2022] [Indexed: 11/24/2022]
Abstract
Body-focused repetitive disorders (BFRBDs) are understudied in youth and understanding of their underlying mechanisms is limited. This study evaluated BFRBD clinical characteristics, and two factors commonly implicated in their maintenance - emotion regulation and impulsivity - in 53 youth aged 11 to 17 years: 33 with BFRBDs and 20 controls. Evaluators administered psychiatric diagnostic interviews. Participants rated BFRBD severity, negative affect, quality of life, family functioning, emotion regulation, distress tolerance, and impulsivity. Youth with BFRBDs showed poorer distress tolerance and quality of life, and higher impulsivity and negative affect than controls, with no differences in family impairment. BFRBD distress/impairment, but not BFRBD severity, correlated with anxiety and depression, and poorer distress tolerance. Findings suggest youth with BFRBDs show clinical patterns aligning with prior research; highlight the role of distress tolerance in child BFRBDs; and suggest the utility of acceptance and mindfulness-based therapies for unpleasant emotions in BFRBDs. Continued research should evaluate factors underlying BFRBDs in youth.
Collapse
Affiliation(s)
- Emily J Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Tara S Peris
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jon E Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Stephanie Valle
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Elizabeth Cavic
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Juliette E Lerner
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Christine Lochner
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa
| | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph O'Neill
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Nancy J Keuthen
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
2
|
Reid M, Lin A, Farhat LC, Fernandez TV, Olfson E. The genetics of trichotillomania and excoriation disorder: A systematic review. Compr Psychiatry 2024; 133:152506. [PMID: 38833896 DOI: 10.1016/j.comppsych.2024.152506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/09/2024] [Accepted: 05/30/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Trichotillomania (TTM) and excoriation disorder (ED) are impairing obsessive-compulsive related disorders that are common in the general population and for which there are no clear first-line medications, highlighting the need to better understand the underlying biology of these disorders to inform treatments. Given the importance of genetics in obsessive-compulsive disorder (OCD), evaluating genetic factors underlying TTM and ED may advance knowledge about the pathophysiology of these body-focused repetitive behaviors. AIM In this systematic review, we summarize the available evidence on the genetics of TTM and ED and highlight gaps in the field warranting further research. METHOD We systematically searched Embase, PsycInfo, PubMed, Medline, Scopus, and Web of Science for original studies in genetic epidemiology (family or twin studies) and molecular genetics (candidate gene and genome-wide) published up to June 2023. RESULTS Of the 3536 records identified, 109 studies were included in this review. These studies indicated that genetic factors play an important role in the development of TTM and ED, some of which may be shared across the OCD spectrum, but there are no known high-confidence specific genetic risk factors for either TTM or ED. CONCLUSIONS Our review underscores the need for additional genome-wide research conducted on the genetics of TTM and ED, for instance, genome-wide association and whole-genome/whole-exome DNA sequencing studies. Recent advances in genomics have led to the discovery of risk genes in several psychiatric disorders, including related conditions such as OCD, but to date, TTM and ED have remained understudied.
Collapse
Affiliation(s)
- Madison Reid
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA; The University of the South, USA
| | - Ashley Lin
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Luis C Farhat
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Thomas V Fernandez
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Emily Olfson
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA; Wu Tsai Institute, Yale University, New Haven, CT, USA.
| |
Collapse
|
3
|
Gallinat C, Moessner M, Wilhelm M, Keuthen N, Bauer S. Patterns of Skin Picking in Skin Picking Disorder: Ecological Momentary Assessment Study. Interact J Med Res 2024; 13:e53831. [PMID: 39024568 PMCID: PMC11294777 DOI: 10.2196/53831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/12/2023] [Accepted: 05/03/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Skin picking disorder (SPD) is an understudied mental illness that is classified as a body-focused repetitive behavior disorder. Literature suggests that pathological skin picking is strongly integrated into the daily lives of affected individuals and may involve a high degree of variability in terms of episode characteristics, frequency, and intensity. However, existing data on the phenomenology of SPD are limited and typically involve retrospective assessments, which may fail to accurately capture the behavior's variability. OBJECTIVE This study aimed to investigate skin picking in the daily lives of individuals with SPD by using ecological momentary assessment (EMA). The first aim focused on the description of skin picking patterns (eg, characteristics, intensity, and distribution of episodes and urges), and the second aim explored differences in characteristics and patterns between automatic and focused skin picking. METHODS Participants were recruited online and underwent a web-based screening, a diagnostic telephone interview, and a comprehensive online self-report questionnaire before participating in an EMA protocol. The latter included 10 consecutive days with 7 pseudorandom, time-contingent assessments per day between 8 AM and 10 PM. The EMA questionnaire assessed the current skin picking urge, the occurrence of the behavior, and a detailed assessment of the episodes' characteristics (eg, length, intensity, and consciousness) if applicable. RESULTS The final sample consisted of 57 participants, who completed at least 70% of the scheduled assessments (n=54, 94.7% female: mean age 29.3, SD 6.77 years). They completed 3758 EMAs and reported 1467 skin picking episodes. Skin picking occurred frequently (mean 2.57, SD 1.12 episodes per day and person) in relatively short episodes (10-30 min; 10 min: nepisodes=642, 43.8%; 20 min: nepisodes=312, 21.3%; 30 min: nepisodes=217, 14.8%), and it was distributed quite evenly throughout the day and across different days of the week. Focused and automatic episodes were relatively balanced across all reported episodes (focused: nepisodes=806, 54.9%) and over the course of the day. The analyses showed statistically significant differences between self-reported triggers for the different styles. Visual or tactile cues and the desire to pick the skin were more important for the focused style (visual or tactile cues: mean focused style [Mf]=4.01, SD 0.69 vs mean automatic style [Ma]=3.47, SD 0.99; P<.001; SMD=0.64; desire to pick: Mf=2.61, SD 1.06 vs Ma=1.94, SD 1.03; P<.001; SMD=0.82), while boredom and concentration problems were more prominent in automatic skin picking (boredom: Mf=1.69, SD 0.89 vs Ma=1.84, SD 0.89; P=.03; SMD=-0.31; concentration problems: Mf=2.06, SD 0.87 vs Ma=2.31, SD 1.06; P=.006; SMD=-0.41). CONCLUSIONS These results contribute to an enhanced understanding of the phenomenology of SPD using a more rigorous assessment methodology. Our findings underscore that picking can impact affected persons multiple times throughout their daily lives. TRIAL REGISTRATION German Clinical Trials Register DRKS00025168; https://tinyurl.com/mr35pdwh.
Collapse
Affiliation(s)
- Christina Gallinat
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Maximilian Wilhelm
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Mental Health (DZPG), partner site Mannheim-Heidelberg-Ulm, Heidelberg, Germany
| | - Nancy Keuthen
- Trichotillomania and Excoriation Disorder Program, Center for OCD and Related Disorders, Massachusetts General Hospital, Boston, MA, United States
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Mental Health (DZPG), partner site Mannheim-Heidelberg-Ulm, Heidelberg, Germany
- Heidelberg University, Heidelberg, Germany
| |
Collapse
|
4
|
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 PMCID: PMC11137851 DOI: 10.1016/j.jpsychires.2023.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [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.
Collapse
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.
| |
Collapse
|
5
|
Anderson S, Clarke V, Thomas Z. The problem with picking: Permittance, escape and shame in problematic skin picking. Psychol Psychother 2023; 96:83-100. [PMID: 36117429 PMCID: PMC10087923 DOI: 10.1111/papt.12427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/25/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Problematic skin picking (SP) is a poorly understood experience characterised by a drive to pick the skin and related psychosocial impact. In the DSM-5, problematic SP is classified as 'excoriation (skin picking) disorder'. The aim of this article is to present a rare qualitative perspective on the lived experience of problematic SP, prioritising participants' voices and sense-making. DESIGN An in-depth qualitative study of individuals who self-identified as picking their skin problematically and experienced related distress. METHODS Seventeen UK-based participants were recruited online and interviewed about their SP. Participants were given choice of interview modality, including instant messenger platforms, telephone, email and Skype, to maximise comfort and improve the accessibility of the study. Transcripts were analysed using thematic analysis. RESULTS Three themes offering novel insight into the phenomenology of participants' SP are highlighted and explored: (1) how cognitions and circumstances drove and permitted SP, (2) how participants 'zoned out' while SP and the escape or relief that this attentional experience offered and (3) participants' feelings of shame and distress in how they felt their SP may appear to others. CONCLUSIONS This study contributes in-depth and novel ideas to the understanding of SP phenomenology and identifies how environmental factors, cognitions, contextual distress and shame may be considerations in therapeutic intervention. It presents the complexity of SP sense-making and demonstrates the need for individual formulation.
Collapse
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
| |
Collapse
|
6
|
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. COGNITIVE THERAPY AND RESEARCH 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] [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.
Collapse
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
| |
Collapse
|
7
|
Khatib HA, Alghamdi WA, Subki AH, Butt NS, Alsallum MS, Alsulaimani AS, Alnajjar SF, Alzaidi FD, Alasmari AA, Alshamrani HM, Al-Zaben F, Koenig HG. Prevalence of and Risk Factors for Skin Picking Disorder Symptoms Among Adults in an Arab Middle Eastern Population: A Cross-Sectional Study. Clin Cosmet Investig Dermatol 2022; 15:2583-2591. [DOI: 10.2147/ccid.s348258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 08/23/2022] [Indexed: 12/03/2022]
|
8
|
Internet-delivered acceptance-based behavior therapy for trichotillomania and skin-picking disorder in a psychiatric setting: A feasibility trial. Internet Interv 2022; 30:100573. [PMID: 36133915 PMCID: PMC9483632 DOI: 10.1016/j.invent.2022.100573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 12/21/2022] Open
Abstract
Trichotillomania (TTM) and skin-picking disorder (SPD) are two clinically related conditions that can be successfully treated with behavior therapy (BT). There is some research indicating that BT for TTM and SPD can be efficacious also when delivered online instead of face-to-face, however, previous studies have mainly used self-recruited samples in a university context and it is unclear if the effects of online BT also extend to regular psychiatric patients. The current study set out to investigate if internet-delivered BT (I-BT) is a feasible, acceptable and preliminarily efficacious treatment for patients in a routine psychiatric setting. Twenty-five adult clinician-referred patients with TTM (n = 7) and/or SPD (n = 18) received 10 weeks of therapist-guided I-BT. The I-BT program incorporated both traditional interventions (e.g. habit reversal) as well as more recent acceptance-based techniques (e.g. embracing the urges and mindfulness). Clinician- and self-rated outcomes were assessed at pretreatment, posttreatment and at the delivery of 4 additional booster modules. Results showed that the majority of the participants were satisfied with the treatment and found it credible. The average number of completed internet modules was 7.2/10; five participants ended treatment prematurely. Significant decreases in hair pulling and skin picking severity were demonstrated from pretreatment to posttreatment with within-group effect sizes ranging from d = 0.89 to 1.75. The results remained significant up to the 12-month follow-up on most outcome measures. Altogether, the results provide initial evidence suggesting that I-BT could be a feasible, acceptable and potentially effective treatment for TTM and SPD for patients in a regular psychiatric setting.
Collapse
|
9
|
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: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [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.
Collapse
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
| |
Collapse
|
10
|
Grant JE, Chamberlain SR. Characteristics of 262 adults with skin picking disorder. Compr Psychiatry 2022; 117:152338. [PMID: 35843137 DOI: 10.1016/j.comppsych.2022.152338] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/24/2022] [Accepted: 07/11/2022] [Indexed: 11/24/2022] Open
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.
Collapse
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
| |
Collapse
|
11
|
Nemeh MN, Hogeling M. Pediatric skin picking disorder: A review of management. Pediatr Dermatol 2022; 39:363-368. [PMID: 35194832 DOI: 10.1111/pde.14953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/29/2022] [Accepted: 02/06/2022] [Indexed: 12/16/2022]
Abstract
Skin picking disorder (SPD) commonly presents in childhood; often, families will first turn to dermatologists for evaluation. It is imperative that dermatologists accurately diagnose and treat the disorder as children are vulnerable to face significant negative psychosocial impacts. This article reviews the limited literature on the management of SPD in pediatric patients to better prepare dermatologists for educating families and recommending treatment options. We discuss studies evaluating behavioral and pharmacologic therapies, as well as emerging skin barrier treatments.
Collapse
Affiliation(s)
- Michael N Nemeh
- University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Marcia Hogeling
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| |
Collapse
|
12
|
Tetrahydrocannabinol fails to reduce hair pulling or skin picking: results of a double-blind, placebo-controlled study of dronabinol. Int Clin Psychopharmacol 2022; 37:14-20. [PMID: 34825898 DOI: 10.1097/yic.0000000000000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Body-focused repetitive behaviors (BFRBs) such as trichotillomania and skin picking disorder are associated with decreased self-esteem and poor quality of life. The objective of this study was to evaluate dronabinol, a cannabinoid agonist, for the reduction of BFRB symptoms. Fifty adults with either trichotillomania (n = 34) or skin picking disorder (n = 16) were recruited for a randomized, double-blind, placebo-controlled study. Participants received 10-week treatment with dronabinol (5-15 mg/day) or placebo. The primary efficacy outcome measure was the change on the clinician-rated National Institute of Mental Health scale for hair pulling or skin picking. Both dronabinol and placebo treatment were associated with significant reductions in BFRB symptoms. Dronabinol did not significantly separate from placebo on any efficacy measure. At week 10, 67% of the treatment group were classified as responders (Clinical Global Impressions-Improvement Score of very much or much improved) compared to 50% in the placebo group (P value = 0.459). This study assessed the efficacy of dronabinol, a synthetic form of tetrahydrocannabinol, in the treatment of BFRBs, and found no differences in symptom reductions between dronabinol and placebo.
Collapse
|
13
|
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] [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.
Collapse
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
| |
Collapse
|
14
|
Grant JE, Chamberlain SR. Trichotillomania and Skin-Picking Disorder: An Update. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:405-412. [PMID: 35747295 DOI: 10.1176/appi.focus.20210013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Trichotillomania (hair pulling disorder) and skin-picking (excoriation) disorder are common neuropsychiatric disorders (each with a point prevalence of around 2%) but are underrecognized by professionals. Affected individuals repeatedly pull out their own hair or pick at their skin, and these symptoms not only have a negative impact on these individuals because of the time they occupy but can also lead to considerable physical disfigurement, with concomitant loss of self-esteem and avoidance of social activities and intimate relationships. The behaviors may also have serious physical consequences. Trichotillomania and skin picking frequently co-occur, and both disorders commonly present with co-occurring depression, anxiety, impulsive, and obsessive-compulsive disorders. Behavioral therapy currently appears to be the most effective treatment for both. Pharmacotherapy, in the form of N-acetylcysteine or olanzapine, may also play a role in treatment.
Collapse
Affiliation(s)
- Jon E Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago (Grant); Department of Psychiatry, Faculty of Medicine, University of Southampton, and Southern Health NHS Foundation Trust, both in Southampton, United Kingdom (Chamberlain)
| | - Samuel R Chamberlain
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago (Grant); Department of Psychiatry, Faculty of Medicine, University of Southampton, and Southern Health NHS Foundation Trust, both in Southampton, United Kingdom (Chamberlain)
| |
Collapse
|
15
|
Mathew AS, Rech MA, Lee HJ. Evaluating the role of Approach-Avoidance Training on action-tendencies in individuals with skin-picking disorder: A preliminary randomized experiment. J Behav Addict 2021; 10:827-838. [PMID: 34388110 PMCID: PMC8997211 DOI: 10.1556/2006.2021.00031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/31/2021] [Accepted: 05/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Pathological skin-picking (PSP) or excoriation disorder is a destructive behavior that affects 1-2% of the general population. The purpose of this pilot study was to evaluate the effect of a computerized behavior modification task on action-tendencies (i.e., approach or avoidance) in adults with PSP. We aimed to modify these action-tendencies by having participants with PSP complete the Approach-Avoidance Training (AAT) task, using a joystick to simulate an approach (=pull) or avoidance (=push) response. METHOD Forty-five participants diagnosed with PSP were randomized to one of three training conditions: (1) Avoidance Training (AvT; n = 15), (2) Approach Training (ApT; n = 15), or (3) Placebo Training (PT; n = 15). We hypothesized that after training, those in the AvT would have the greatest reduction in behavioral approach (i.e., their overall reaction time [RT] to approach pictures of irregular skin stimuli). RESULTS Results of the pre-training assessment task revealed a positive correlation between behavioral approach to irregular skin stimuli and skin-picking severity as assessed by the Skin Picking Scale-Revised (SPS-R). After training, a lower behavioral approach and urges to pick were found in the AvT and PT groups, while those in the ApT reported higher behavioral approach and urges to pick. At two-week follow-up, no significant changes on the SPS-R were reported between groups. DISCUSSION Our preliminary data suggest that the AAT is a promising avenue of research to develop as a cognitive intervention to address an excessive behavioral approach tendency that characterizes skin-picking problems.
Collapse
Affiliation(s)
- Abel S. Mathew
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Madeline A. Rech
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Han-Joo Lee
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA,Corresponding author. E-mail:
| |
Collapse
|
16
|
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] [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.
Collapse
Affiliation(s)
- Joanna Kłosowska
- Institute of Psychology, Jagiellonian University, Krakow, Poland
| | | | | | | |
Collapse
|
17
|
Angelakis I, Pseftogianni F. Association between obsessive-compulsive and related disorders and experiential avoidance: A systematic review and meta-analysis. J Psychiatr Res 2021; 138:228-239. [PMID: 33866051 DOI: 10.1016/j.jpsychires.2021.03.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 12/22/2022]
Abstract
The associations between the distinct types of obsessive-compulsive and related disorders and experiential avoidance have received mixed evidence. We, thus, undertook this meta-analysis to i) re-examine the association between obsessive-compulsive disorder and experiential avoidance, ii) extend this association to hoarding disorder, trichotillomania, and body dysmorphic disorder, and iii) identify potential variables affecting these associations. Five databases, including Medline, Embase, PsychINFO, Web of Science and CINAHL, were searched until March 15th, 2021. Meta-analyses based on random-effect models were performed. Heterogeneity and publication bias tests were applied using the I2 statistic and the Egger's test. Meta-regression analyses were performed to identify potential moderators affecting the strength of these associations. Thirty-six unique studies based on n = 11,859 participants were identified. The association between obsessive-compulsive disorder and experiential avoidance was moderate (SMD = 0.75, 95% CI = 0.57-0.92), whereas the associations between individual obsessive-compulsive symptoms, including obsessions, responsibility for harm, ordering, checking, washing and neutralizing, and experiential avoidance ranged from low to strong (SMD ranged between 0.41 and 1.06, 95% CI = 0.25 to 1.40). The associations between hoarding disorder (SMD = 0.93, 95% CI = 0.46-1.40), trichotillomania (SMD = 0.56, 95% CI = 0.48-0.63), body dysmorphic disorder (SMD = 1.55, 95% CI = 0.72-2.37) and experiential avoidance were moderate to strong. Meta-regression analyses demonstrated that studies using the AAQ/AAQ-II scales for measuring experiential avoidance, and/or self-report scales for assessing OCRDs contributed smaller effect sizes. These findings suggest that reducing experiential avoidance may be a viable way of complementing exposure strategies in alleviating obsessive-compulsive and related symptoms.
Collapse
Affiliation(s)
- Ioannis Angelakis
- University of South Wales, School of Psychology, Pontypridd, Wales, UK.
| | | |
Collapse
|
18
|
Asplund M, Rück C, Lenhard F, Gunnarsson T, Bellander M, Delby H, Ivanov VZ. ACT-enhanced group behavior therapy for trichotillomania and skin-picking disorder: A feasibility study. J Clin Psychol 2021; 77:1537-1555. [PMID: 33937998 DOI: 10.1002/jclp.23147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/28/2021] [Accepted: 03/28/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the feasibility and efficacy of ACT-enhanced Group Behavior Therapy (AEGBT) for mixed diagnosis groups including patients with trichotillomania (TTM) and skin-picking disorder (SPD) in routine psychiatric care. METHOD Adult patients (N = 40) with TTM and/or SPD received 10 weeks of AEGBT followed by five booster sessions. The primary outcome measure for TTM was the Massachusetts General Hospital Hairpulling Scale (MGH-HPS) and for SPD the Skin Picking Scale-Revised (SPS-R), assessed at posttreatment and at booster sessions. RESULTS Results showed significant reductions in hair pulling and skin-picking severity from baseline to posttreatment and large effect sizes at posttreatment. Improvements remained significant at the 12-month follow-up for patients with SPD, but not for patients with TTM. Group attendance was high and few patients dropped out from treatment. The group format enabled therapists to see 25% more patients compared with an individual format. CONCLUSION The results provide initial support for the feasibility and efficacy of an adapted treatment approach for TTM and SPD.
Collapse
Affiliation(s)
- Mia Asplund
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Fabian Lenhard
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Tove Gunnarsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Martin Bellander
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Hanna Delby
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Volen Z Ivanov
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Sweden
| |
Collapse
|
19
|
Russell A, Pozo de bolger A, Moses K, Luo A, Wootton BM. Psychometric properties of the excoriation (skin‐picking disorder) dimensional scale. CLIN PSYCHOL-UK 2021. [DOI: 10.1111/cp.12207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Angela Russell
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, New South Wales, Australia,
| | - Andrea Pozo de bolger
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, New South Wales, Australia,
| | - Karen Moses
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia,
| | - Aileen Luo
- Discipline of Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia,
| | - Bethany M. Wootton
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, New South Wales, Australia,
- Discipline of Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia,
| |
Collapse
|
20
|
Dermatillomania: Strategies for Developing Protective Biomaterials/Cloth. Pharmaceutics 2021; 13:pharmaceutics13030341. [PMID: 33808008 PMCID: PMC8001957 DOI: 10.3390/pharmaceutics13030341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [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.
Collapse
|
21
|
Mathew AS, Harvey AM, Lee HJ. Development of the social concerns in individuals with body-focused repetitive behaviors (SCIB) scale. J Psychiatr Res 2021; 135:218-229. [PMID: 33503548 DOI: 10.1016/j.jpsychires.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/18/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
Body-focused repetitive behaviors (BFRBs) include such disorders as compulsive hair pulling, skin picking, nail biting, and cheek biting, which can lead to significant psychosocial impairment (American Psychiatric Association, 2013). As such, social concerns (i.e., concerns about how others view their behavior or affected body sites) are common in these individuals, and may significantly associate with BFRB symptomology (Snorrason et al., 2012). Currently, there are no measures to adequately assess social concerns specific to BFRBs. To this end, we developed a new self-report measure called the Social Concerns in Individuals with BFRBs (SCIB) that aimed to assess these concerns using two independent samples of individuals reporting elevated BFRB symptoms. Results showed that the overall level of social concerns reported on the SCIB significantly explained the variance in hair pulling and skin picking symptom severity even after controlling for the influence of other general social concern and emotional distress measures. Exploratory and confirmatory factor analyses provided psychometric evidence for the two-factor structure of the SCIB: (1) Concern about Physical Unattractiveness and (2) Concern about Social Disapproval, which were found to assess distinguishable aspects of BFRB-relevant social concerns. Overall, the findings suggest that the SCIB is a useful measure that can be used to evaluate social concerns in those with BFRB disorders.
Collapse
Affiliation(s)
- Abel S Mathew
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | | | - Han-Joo Lee
- Department of Psychology, University of Wisconsin-Milwaukee, USA.
| |
Collapse
|
22
|
Gieler U, Gieler T, Peters EMJ, Linder D. Haut und Psychosomatik – Psychodermatologie heute. J Dtsch Dermatol Ges 2020; 18:1280-1300. [PMID: 33251743 DOI: 10.1111/ddg.14328_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Uwe Gieler
- Universitäts-Hautklinik, Universitätsklinikum Gießen
| | - Tanja Gieler
- Kinder- und Jugendpsychosomatik, Universitäts-Kinderklinik, Universitätsklinikum Gießen
| | - Eva Milena Johanne Peters
- Psychoneuroimmunologie Labor, Klinik für Psychosomatik und Psychotherapie, Universitätsklinikum Gießen, Gießen in Kooperation mit der Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin - Charité, Berlin
| | - Dennis Linder
- Universitäts-Hautklinik, Universität Padua, Italien, Institut für Medizinische Psychologie und Psychotherapie, Medizinische Universität Graz, Österreich
| |
Collapse
|
23
|
Gieler U, Gieler T, Peters EMJ, Linder D. Skin and Psychosomatics - Psychodermatology today. J Dtsch Dermatol Ges 2020; 18:1280-1298. [PMID: 33251751 PMCID: PMC7756276 DOI: 10.1111/ddg.14328] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 02/06/2023]
Abstract
Modern psychodermatology relies on the bio-psycho-social disease model in psychosomatics, according to which biological, psychological and social factors (on various levels, from molecules to the biosphere) play a major role in the disease pathogenesis through complex, non-linear interactions over the entire disease course. It is nowadays experimentally proven that "emotions get into the skin". Recent research shows close anatomical, physiological and functional connections between skin and nervous system, already known to be ontogenetically related. These connections are reflected in many skin diseases where psychological and somatic etiological factors are closely intertwined. A holistic approach by the physician should do justice to this interdependence; biological, psychological and social factors should be adequately taken into account when taking anamnesis, making a diagnosis and choosing a therapy. The "visibility" of the skin organ bestows dermatology a special position among the various other clinical subjects, and renders a holistic, psychosomatic approach to the patient that is particularly important. The life course belongs also to modern psychodermatological approaches. Based on the modern psychodermatology concept, other corresponding sub-areas such as psychogastroenterology, psychocardiology etc. have emerged. After the theoretical part of this article, some selected skin diseases are discussed in more detail from the psychosomatic point of view.
Collapse
Affiliation(s)
- Uwe Gieler
- Department of DermatologyUniversity Hospital Gießen
| | - Tanja Gieler
- Psychosomatic Medicine for Children and AdolescentsDepartment of PediatricsUniversity Hospital Gießen
| | - Eva Milena Johanne Peters
- Laboratory for PsychoneuroimmunologyDepartment of Psychosomatic Medicine and PsychotherapyUniversity Hospital Gießen in cooperation with the Department of Psychosomatic Medicine and PsychotherapyUniversity Hospital – CharitéBerlin
| | - Dennis Linder
- Department of DermatologyUniversity of PaduaItalyInstitute for Medical Psychology and PsychotherapyMedical University GrazAustria
| |
Collapse
|
24
|
Jafferany M, Mkhoyan R, Arora G, Sadoughifar R, Jorgaqi E, Goldust M. Treatment of skin picking disorder: Interdisciplinary role of dermatologist and psychiatrist. Dermatol Ther 2020; 33:e13837. [DOI: 10.1111/dth.13837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Mohammad Jafferany
- Division of Psychodermatology Central Michigan University Saginaw Michigan USA
| | | | - Gulhima Arora
- Division of Dermatology Mehektagul Skin Center New Delhi India
| | | | - Etleva Jorgaqi
- Division of Dermatology Mother Theressa Hospital Tirana Albania
| | - Mohamad Goldust
- Division of Dermatology University of Basel Basel Switzerland
| |
Collapse
|
25
|
Badenoch J, Searle T, Watson I, Cavanna AE. Sensory symptoms in body-focused repetitive behaviors, restless legs syndrome, and Tourette syndrome: An overlap? Neurosci Biobehav Rev 2020; 119:320-332. [PMID: 33086129 DOI: 10.1016/j.neubiorev.2020.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 12/25/2022]
Abstract
Tourette syndrome (TS) is a neurodevelopmental condition characterized by multiple tics. Sensory symptoms play a key role in the clinical phenomenology and pathophysiology of TS, as most patients report premonitory urges driving tic expression. Interestingly, sensory symptoms have also been reported in other conditions characterized by repeated behaviors. This review explores the nature of sensory symptoms reported by patients with body focused repetitive behaviors (BFRBs, especially trichotillomania and skin picking disorder) and restless legs syndrome (RLS) in comparison to TS. A sense of mounting inner tension and reinforcement mechanisms driven by gratification and relief on expression of the tic or repetitive behavior appear to be implicated across all conditions. Subjective urges can be temporarily suppressed by patients with TS and selected BFRBs, whereas patients with RLS tend to report dysesthesia more frequently than a suppressible urge to move. The observed similarities in the phenomenology of sensory symptoms across these conditions raise the possibility of a comparable underlying pathophysiology. Preliminary findings suggest an overlap of neural pathways encompassing the insula, basal ganglia (putamen), and posterior cingulate cortex.
Collapse
Affiliation(s)
- James Badenoch
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, United Kingdom
| | - Tamara Searle
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, United Kingdom
| | - Iona Watson
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, United Kingdom
| | - Andrea E Cavanna
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, United Kingdom; School of Life and Health Sciences, Aston University, Birmingham, United Kingdom; University College London and Institute of Neurology, London, United Kingdom.
| |
Collapse
|
26
|
La Buissonnière-Ariza V, Alvaro J, Cavitt M, Rudy BM, Cepeda SL, Schneider SC, McIngvale E, Goodman WK, Storch EA. Body-focused repetitive behaviors in youth with mental health conditions: A preliminary study on their prevalence and clinical correlates. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2020. [DOI: 10.1080/00207411.2020.1824111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Jeffrey Alvaro
- Department of Psychiatry, All Children’s Hospital, St. Petersburg, Florida, USA
- Department of Psychiatry, University of South Florida, Tampa, Florida, USA
| | - Mark Cavitt
- Department of Psychiatry, All Children’s Hospital, St. Petersburg, Florida, USA
- Department of Psychiatry, University of South Florida, Tampa, Florida, USA
| | | | - Sandra L. Cepeda
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Sophie C. Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Elizabeth McIngvale
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Wayne K. Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Eric A. Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
27
|
Abbott DJ, Lack CW. Conventional versus Mindfulness-based Interventions for Anxiety and Worry: A Review and Recommendations. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082216666200220121648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Anxiety disorders are among the most prevalent and most functionally impairing psychiatric
problems experienced by the population. Both pharmacological and psychological evidencebased
treatments exist for a number of specific disorders, but may fail to fully relieve symptoms,
pointing to the need for additional treatment options. Often considered to be part of the “third wave”
of cognitive-behavioral therapies, treatments incorporating mindfulness have emerged in the past
two decades as increasingly popular with clinicians and frequently sought out by consumers. The
present article reviews the extant literature regarding the efficacy and effectiveness of mindfulnessbased
treatments for anxiety, worry, and related problems. Although they have not attained the solid
empirical status of CBT or certain pharmacological treatments, the extant research shows mindfulness-
based interventions appear to be a promising and useful treatment for people suffering from
anxiety and worry. Further work should be done, levels 3-5 of the NIH stage model to determine
whether or not they should be further implemented.
Collapse
Affiliation(s)
- Deah Jo Abbott
- Department of Psychology, Georgia State University, Atlanta, GA 30302, United States
| | - Caleb Wayne Lack
- Department of Psychology, University of Central Oklahoma, Edmond, OK 73034, United States
| |
Collapse
|
28
|
|
29
|
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] [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.
Collapse
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
| |
Collapse
|
30
|
Singh RS, Wetterneck C, O'Brien W. Psychometric evaluation of the Functional Analytic Psychotherapy Intimacy Scale in obsessive-compulsive and related disorders. Bull Menninger Clin 2020; 84:156-179. [PMID: 32101025 DOI: 10.1521/bumc_2020_84_06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Functional Analytic Psychotherapy (FAP) is a contextual behavioral therapy that targets specific ideographic behaviors related to interpersonal functioning and intimacy. There is a scarcity of measures specifically focused on behavioral measurement of intimacy as well as limited studies that examine intimacy in obsessive-compulsive and related disorders (OCRDs). Leonard and colleagues (2014) created the Functional Analytic Psychotherapy Intimacy Scale (FAPIS). The purpose of this study was to investigate the validity of the FAPIS in evaluating those with OCRDs. The FAPIS and other measures of intimacy were administered to 549 nonreferred adults endorsing OCRD symptoms. Several confirmatory factor analyses were conducted to assess the best fitting factor structure, and convergent validity and divergent validity were also assessed. Given the psychometric properties of the FAPIS in this sample, future research may be helpful in assessing if the FAPIS would be beneficial in measuring change related to intimacy when working with people with OCRDs.
Collapse
Affiliation(s)
- R Sonia Singh
- Psychology postdoctoral fellow, South Central Mental Illness, Research and Clinical Center, Central Arkansas Veterans Healthcare System, University of Arkansas for Medical Sciences, North Little Rock, Arkansas
| | - Chad Wetterneck
- Cognitive-behavior specialist and clinical supervisor, Rogers Memorial Hospital, Oconomowoc, Wisconsin
| | - William O'Brien
- Professor, Department of Psychology, Bowling Green State University, Bowling Green, Ohio
| |
Collapse
|
31
|
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] [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.
Collapse
Affiliation(s)
| | | | | | - Gabriel Fernando Oviedo
- Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Colombia.
| |
Collapse
|
32
|
Anderson S, Clarke V. Disgust, shame and the psychosocial impact of skin picking: Evidence from an online support forum. J Health Psychol 2019; 24:1773-1784. [PMID: 28810443 DOI: 10.1177/1359105317700254] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
This article examines the accounts of individuals who problematically pick their skin and explores their subjective experiences. In total, 100 problem disclosure statements were taken from posts made to a publicly accessible online skin picking support forum. These posts were systematically analysed using thematic analysis. Themes of disgust, shame and psychosocial avoidance dominated the analysis and appeared central to the experience of skin picking. Skin picking was shown to be a heterogeneous experience with a complex emotional profile. We argue that disgust, shame and related avoidance behaviour should be considered when conceptualising skin picking and considering treatment interventions.
Collapse
|
33
|
Quality and temporal properties of premonitory urges in patients with skin picking disorder. Cortex 2019; 121:125-134. [PMID: 31605885 DOI: 10.1016/j.cortex.2019.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [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.
Collapse
|
34
|
Gallinat C, Moessner M, Haenssle HA, Winkler JK, Backenstrass M, Bauer S. An Internet-Based Self-Help Intervention for Skin Picking (SaveMySkin): Pilot Randomized Controlled Trial. J Med Internet Res 2019; 21:e15011. [PMID: 31586368 PMCID: PMC6779027 DOI: 10.2196/15011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/19/2019] [Accepted: 07/19/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND In spite of the psychosocial burden and medical risks associated with skin picking disorder, the health care system does not provide sufficient treatment for affected individuals to date. Therefore, an internet-based self-help program for skin picking was developed to offer easily accessible support for this population. OBJECTIVE This pilot study evaluated the internet-based self-help program SaveMySkin. The 12-week program is based on cognitive-behavioral therapy and contains comprehensive information and exercises, a daily supportive monitoring system, and dermatological and psychological counseling via internet chat. Primary objectives were the investigation of attitudes and expectations toward the program, intervention effects on skin picking severity, user satisfaction, adherence, and willingness to participate. Secondary outcomes included the feasibility of study procedures, adequacy of assessment instruments, effects on skin picking-related impairment, dimensions of skin picking, and general psychological impairment. METHODS A two-arm randomized controlled trial was conducted in a sample of 133 participants (female: 124/133, 93.2%; mean age 26.67 [SD 6.42]) recruited via the internet. Inclusion required a minimum age of 17 years and at least mild skin picking severity. Participants were randomly allocated to the intervention (64/133, 48.1%) or waitlist control group (69/133, 51.9%). All assessments were conducted online and based on self-report. RESULTS The willingness to participate was very high in the study, so the initially planned sample size of 100 was exceeded after only 18 days. Participant expectations indicate that they believed the program to be beneficial for them (131/133, 98.5%) and provide a feeling of support (119/133, 89.5%). Reasons for study participation were insufficient outpatient health care (83/133, 62.4%) and flexibility regarding time (106/133, 79.7%) and location (109/133, 82.0%). The post-assessment was completed by 65.4% (87/133) of the sample. The majority of the intervention group who completed the entire post-assessment were satisfied with SaveMySkin (28/38, 74%) and agreed that the program is an appropriate support service (35/38, 92%). On average, participants viewed 29.31 (SD 42.02) pages in the program, and 47% (30/64) of the intervention group used the monitoring at least once a week. In comparison with the control group, the intervention group displayed substantial improvements in the skin picking severity total score (Cohen d=0.67) and especially on the subscale Symptom Severity (Cohen d=0.79). No effects on secondary outcomes were found. CONCLUSIONS This study confirms the need for easily accessible interventions for skin picking disorder and the high interest in internet-based self-help within the target population. It provides important insights into the attitudes toward online support and actual user experiences. Participant feedback will be used to further enhance the intervention. Our results point to the preliminary efficacy of SaveMySkin and may lay the foundation for future research into the efficacy and cost-effectiveness of the program in a multicenter clinical trial. TRIAL REGISTRATION German Clinical Trial Register DRKS00015236; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00015236. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.conctc.2018.100315.
Collapse
Affiliation(s)
- Christina Gallinat
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Holger A Haenssle
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia K Winkler
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Backenstrass
- Institute of Clinical Psychology, Hospital Stuttgart, Stuttgart, Germany.,Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Heidelberg University, Heidelberg, Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
35
|
Gallinat C, Moessner M, Claes L, Müller A. Skin picking in patients with obesity: Associations with impulsiveness and self-harm. Scand J Psychol 2019; 60:361-368. [PMID: 31006888 DOI: 10.1111/sjop.12536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 03/04/2019] [Indexed: 11/29/2022]
Abstract
Previous studies suggest elevated prevalence rates of skin picking and self-harm in patients with obesity compared to individuals in the general population. Hence, further studies should investigate prevalence rates and correlates of skin picking in this population - especially its differentiation to self-harm. Skin picking and obesity are both associated with specific facets of impulsiveness. This relation should be explored to shed light on potentially shared mechanisms in etiology. Therefore, the present study examined the occurrence of skin picking and its associations with impulsiveness and self-harm in a sample of pre-bariatric surgery patients with obesity class II/III. Within the routine preoperative psychiatric evaluation, a total of 139 bariatric surgery candidates (78% female, BMI range 35-69) completed a self-report questionnaire assessing sociodemographic variables, anxiety, depression, self-harm, impulsiveness, and skin picking severity (urges: frequency, intensity, controllability; behavior: frequency, intensity, controllability; resistance, emotional distress, impairment, and avoidance). Ten participants (7.2% of the sample) reported recurrent skin picking leading to skin damage, repeated attempts to decrease skin picking, and psychosocial impairment (emotional distress, impairment in functional areas, avoidance) due to skin picking. In line with previous findings, skin picking severity shows a medium correlation with attentional impulsiveness. The majority of self-harm types were not associated with skin picking severity. The current study reveals a high occurrence of skin picking compared to the general population. The results indicate an association between skin picking severity and attentional impulsiveness. Further research is needed to investigate the differentiation of skin picking and self-harm in more detail.
Collapse
Affiliation(s)
- Christina Gallinat
- University Hospital Heidelberg, Center for Psychotherapy Research, Heidelberg, Germany
| | - Markus Moessner
- University Hospital Heidelberg, Center for Psychotherapy Research, Heidelberg, Germany
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, University Antwerp, Antwerp, Belgium
| | - Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| |
Collapse
|
36
|
Abstract
Skin-picking disorder, also known as excoriation disorder or psychogenic skin excoriations, is an obsessive-compulsive and related disorder that is classified with other body-focused repetitive-behavior disorders in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Skin-picking disorder is associated with significant comorbidity and psychosocial dysfunction. The disorder has a female predominance across studies, and the average age of onset is variable but commonly in adolescence and adulthood. A full clinical and dermatologic examination and multidisciplinary approach is important in the diagnosis of this condition. There is no specific or recommended treatment option, but cognitive-behavioral therapy, particularly habit-reversal therapy and acceptance and commitment therapy have shown promise. Various pharmacological interventions have also been described to treat this condition in case reports and open and controlled trials. Specific classes of agents implemented include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors, antipsychotics, and glutaminergic-modulating agents. SSRIs and N-acetylcysteine have been shown to be the most effective of the pharmacological interventions.
Collapse
Affiliation(s)
- Mohammad Jafferany
- Central Michigan University College of Medicine, 3201 Hallmark Court, Saginaw, MI, 48603, USA.
| | - Arsh Patel
- Central Michigan University College of Medicine, 3201 Hallmark Court, Saginaw, MI, 48603, USA
| |
Collapse
|
37
|
Brown C, Shahab R, Collins K, Fleysher L, Goodman WK, Burdick KE, Stern ER. Functional neural mechanisms of sensory phenomena in obsessive-compulsive disorder. J Psychiatr Res 2019; 109:68-75. [PMID: 30508745 PMCID: PMC6347462 DOI: 10.1016/j.jpsychires.2018.11.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/02/2018] [Accepted: 11/20/2018] [Indexed: 11/24/2022]
Abstract
Sensory phenomena (SP) are aversive or uncomfortable sensations that accompany and/or drive repetitive behaviors in obsessive-compulsive disorder (OCD). Although SP are associated with significant distress and may respond less well to standard treatments than harm-related obsessions, little is known about their underlying neurobiology. The present study used functional magnetic resonance imaging (fMRI) to measure brain functioning related to severity of SP during a "body-focused" videos task designed to elicit activation in sensorimotor brain regions. Regression analysis examined the relationship between severity of SP and activation during task using permutation analysis, cluster-level corrected for multiple comparisons (family-wise error rate p < 0.05). The distribution of SP severity was not significantly different from normal, with both high- and low-severity scores represented in the OCD sample. Severity of SP was not correlated with other clinical symptoms in OCD including general anxiety, depression, or harm avoidance. When viewing body-focused videos, patients with greater severity of SP showed increased activity in the mid-posterior insula, a relationship that remained significant when controlling for other clinical symptoms, medication status, and comorbidities. At uncorrected thresholds, SP severity was also positively related to somatosensory, mid orbitofrontal, and lateral prefrontal cortical activity. These data suggest that SP in OCD are dissociable from other symptoms in the disorder and related to hyperactivation of the insula. Future work examining neural mechanisms of SP across different disorders (tics, trichotillomania) as well as with other imaging modalities will be needed to further understand the neurobiology of these impairing symptoms.
Collapse
Affiliation(s)
- Carina Brown
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Rebbia Shahab
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Katherine Collins
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lazar Fleysher
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wayne K Goodman
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | | | - Emily R Stern
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA.
| |
Collapse
|
38
|
Ricketts EJ, Snorrason Í, 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] [Abstract] [Key Words] [MESH Headings] [Grants] [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.
Collapse
Affiliation(s)
- Emily J Ricketts
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA, United States of America.
| | - Ívar Snorrason
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, United States of America; Department of Psychiatry, Columbia University Medical Center, New York, NY, United States of America
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States of America
| | - Jennifer R Alexander
- Department of Psychology, Marquette University, Milwaukee, WI, United States of America
| | - Hardian Thamrin
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Christopher A Flessner
- Department of Psychological Sciences, Kent State University, Kent, OH, United States of America
| | - Martin E Franklin
- Children's Hospital of Philadelphia, University of Pennsylvania, United States of America; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Philadelphia, PA, United States of America
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, WI, United States of America
| |
Collapse
|
39
|
Abstract
OBJECTIVE Evidence suggests that skin picking disorder (SPD) could be a prevalent condition associated with comorbidity and psychosocial dysfunction. However, just a few studies have assessed the prevalence and correlates of SPD in samples from low- and middle-income countries. In addition, the impact of SPD on quality of life (QoL) dimension after multivariable adjustment to potential confounders remains unclear. METHODS Data were obtained from a Brazilian anonymous Web-based research platform. Participants provided sociodemographic data and completed the modified Skin Picking-Stanford questionnaire, the Hypomania Checklist (HCL-32), the Patient Health Questionnaire-9 (PHQ-9), the Fagerström Test for Nicotine Dependence, Alcohol Use Disorder Identification Test (AUDIT), Symptom Checklist-90-Revised inventory (SCL-90R), early trauma inventory self report-short form, and the World Health Organization quality of life abbreviated scale (WHOQOL-Bref). Associations were adjusted to potential confounders through multivariable models. RESULTS For our survey, 7639 participants took part (71.3% females; age: 27.2±7.9 years). The prevalence of SPD was 3.4% (95% CI: 3.0-3.8%), with a female preponderance (P<0.001). In addition, SPD was associated with a positive screen for a major depressive episode, nicotine dependence, and alcohol dependence, as well as suicidal ideation. Physical and psychological QoL was significantly more impaired in participants with SPD compared to those without SPD, even after adjustment for comorbidity. CONCLUSIONS In this large sample, SPD was a prevalent condition associated with co-occurring depression, nicotine, and alcohol dependence. In addition, SPD was independently associated with impaired physical and psychological QoL. Public health efforts toward the early recognition and treatment of SPD are warranted.
Collapse
|
40
|
Aldahadha B. The psychometric properties of perfectionism scale and its relation to depression and anxiety. COGENT PSYCHOLOGY 2018. [DOI: 10.1080/23311908.2018.1524324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Basim Aldahadha
- Counseling and Special Education, Mutah University, Al-Karak Mutah University, College of Educational Sciences, Al-Karak, Jordan
| |
Collapse
|
41
|
Akarsu S, Ozbagcivan O, Ilknur T, Semiz F, Inci BB, Fetil E. Xerosis cutis and associated co-factors in women with prurigo nodularis. An Bras Dermatol 2018; 93:671-679. [PMID: 30156616 PMCID: PMC6106662 DOI: 10.1590/abd1806-4841.20187127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/20/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Current data regarding the associated factors of prurigo nodularis are still uncertain, except for atopic predisposition. OBJECTIVES The purposes of this study were to (1) determine the frequencies of xerosis and other accompanying diseases of female patients with prurigo nodularis; (2) compare the demographic, clinical and accompanying disease characteristics by grouping these patients according to whether they have associated xerosis (who were subsequently subgrouped as atopic or non-atopic) or not. METHODS In this retrospective descriptive study, 80 females with PN were categorized according to the accompanying diseases (dermatological, systemic, neurological, psychogenic, mixed, or undetermined origin). RESULTS A total of 45 associated co-factors including dermatological in 63 (78.8%), systemic in 57 (71.3%), psychological in 33 (41.3%) and neurological co-factors in 14 (17.5%) of all patients with prurigo nodularis were detected. Xerosis was observed in 48 (60%) patients (non-atopic co-factors in 66.7% of them). The ratio of patients with mixed co-factors, dermatological+systemic co-factors and dermatological+systemic+psychological co-factors were found to be significantly higher in patients with xerosis compared to those without xerosis. STUDY LIMITATIONS Our study has certain limitations such as the absence of an age-matched control group, absence of follow-up data and the fact that the diagnosis of xerosis has not been based on objective methods. CONCLUSIONS Xerosis has been identified in more than half of the patients with PN and it has been determined that in most patients xerosis is associated especially with diabetes mellitus and other conditions related to prurigo nodularis.
Collapse
Affiliation(s)
- Sevgi Akarsu
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| | - Ozlem Ozbagcivan
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| | - Turna Ilknur
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| | - Fatma Semiz
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| | - Burcu Bahar Inci
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| | - Emel Fetil
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| |
Collapse
|
42
|
Initial psychometrics, outcomes, and correlates of the Repetitive Body Focused Behavior Scale: Examination in a sample of youth with anxiety and/or obsessive-compulsive disorder. Compr Psychiatry 2018; 81:10-17. [PMID: 29195104 DOI: 10.1016/j.comppsych.2017.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/27/2017] [Accepted: 11/04/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Body-Focused Repetitive Behaviors (BFRBs), including skin-picking, hair-pulling, and nail-biting, commonly occur in youth, even at elevated/problematic levels, and are associated with a number of other psychiatric symptoms. The present study examined the internal consistency of a brief screening tool for BFRBs as well as the prevalence, severity, and correlates of BFRBs in a sample of youth with a primary anxiety or obsessive-compulsive disorder (OCD). METHODS Ninety-three youth-parent dyads presenting for treatment for anxiety or OCD completed study measures including the Repetitive Body Focused Behavior Scale - Parent (RBFBS), which includes subscales for skin-picking, hair-pulling, and nail-biting, as well as a number of additional clinician-, parent-, and child-rated scales. RESULTS The RBFBS demonstrated good to excellent internal consistency. BFRBs were endorsed in 55% of youths, with elevated levels in 27%. Skin-picking was the most common BFRB (38%), followed by nail-biting (34%) and hair-pulling (4%). Youth with BFRBs, as compared to those without, were rated as more avoidant by their parents. Among those with BFRBs, more avoidant tendencies, anxiety sensitivity, and child-rated panic, separation, and generalized anxiety symptoms were associated with elevated BFRB severity. BFRBs were equally common but more likely to be elevated among youth with a primary anxiety, than OCD, diagnosis. DISCUSSION Results provide initial support for the RBFBS as a brief screening tool for the three common BFRBs. In addition, the results suggest avoidant tendencies and physical manifestations of distress may be particularly relevant to the escalation of BFRB symptoms in youth.
Collapse
|
43
|
Alexander JR, Houghton DC, Bauer CC, Lench HC, Woods DW. Emotion regulation deficits in persons with body-focused repetitive behavior disorders. J Affect Disord 2018; 227:463-470. [PMID: 29156359 DOI: 10.1016/j.jad.2017.11.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/07/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Conceptualizations of emotion dysregulation (ED) and body-focused repetitive behavior disorders (BFRBDs) imply that ED may be a central component of BFRBDs as well as a factor that distinguishes BFRBDs from non-impairing, subclinical body-focused repetitive behaviors (BFRBs). The current study empirically tested these observations. METHODS One hundred thirty-eight undergraduates (of 1900 who completed a screening survey) completed self-report measures assessing four emotion regulation (ER) deficits hypothesized to underlie ED (alexithymia, maladaptive emotional reactivity, experiential avoidance, and response inhibition when distressed); 34 of these participants had BFRBDs, 64 had subclinical BFRBs, and 42 were unaffected by BFRBs. RESULTS Results indicated that participants with BFRBDs reported higher levels of maladaptive emotional reactivity, experiential avoidance, and response inhibition when distressed than participants with subclinical BFRBs and participants unaffected by BFRBs. These results held even when controlling for comorbidity and total number of reported BFRBs. Participants did not differ on alexithymia. LIMITATIONS Limitations of the current study include the BFRB groups' different distributions of BFRB types (e.g., hair pulling versus skin picking), the sample's demographic uniformity, and the fact that negative affectivity was not controlled when exploring BFRB group differences on ER deficits. Future research should improve on these limitations. CONCLUSIONS The current results suggest that ED is a factor that differentiates BFRBDs from subclinical BFRBs. Such results may be useful for generating hypotheses regarding mechanisms responsible for BFRBs' development into BFRBDs. Furthermore, these results may provide insight into factors that explain the efficacy of more contemporary behavioral treatments for BFRBDs.
Collapse
Affiliation(s)
- Jennifer R Alexander
- Department of Psychology, Marquette University, Cramer Hall, 317, 604 N., 16th St., Milwaukee, WI 53233, USA; Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX 77840, USA.
| | - David C Houghton
- Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX 77840, USA.
| | - Christopher C Bauer
- Department of Psychology, Marquette University, Cramer Hall, 317, 604 N., 16th St., Milwaukee, WI 53233, USA; Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX 77840, USA.
| | - Heather C Lench
- Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX 77840, USA.
| | - Douglas W Woods
- Department of Psychology, Marquette University, Cramer Hall, 317, 604 N., 16th St., Milwaukee, WI 53233, USA; Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX 77840, USA.
| |
Collapse
|
44
|
Harries MD, Chamberlain SR, Redden SA, Odlaug BL, Blum AW, Grant JE. A structural MRI study of excoriation (skin-picking) disorder and its relationship to clinical severity. Psychiatry Res 2017; 269:26-30. [PMID: 28918268 PMCID: PMC5604737 DOI: 10.1016/j.pscychresns.2017.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 01/01/2023]
Abstract
Excoriation (skin-picking) disorder (SPD) shares symptomology with other obsessive-compulsive and related disorders. Few studies, however, have examined the neurological profile of patients with SPD. This study examined differences in cortical thickness and basal ganglia structural volumes between 20 individuals with SPD and 16 healthy controls using magnetic resonance imaging (MRI). There were no significant differences in demographic variables (age, gender, education and race) between groups. All subjects completed a structural MRI scan and completed a battery of clinical assessments focusing on SPD symptom severity, depression and anxiety symptoms, and quality of life. No statistically significant differences in basal ganglia (caudate, putamen, and nucleus accumbens) structural volumes were found between groups. In individuals with SPD, increasing impulsiveness correlated positively with increased cortical thickness in the left insula, and skin picking severity correlated negatively with cortical thickness in the left supramarginal gyrus and a region encompassing the right inferior parietal, right temporal and right supramarginal gyrus. This study suggests similarities and differences exist in symptomology between SPD and the other obsessive-compulsive and related disorders. Additional neuroimaging research is needed to better delineate the underlying neurobiology of SPD.
Collapse
Affiliation(s)
- Michael D Harries
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841S. Maryland Avenue, MC3077, Chicago, IL 60637, United States.
| | | | - Sarah A Redden
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841S. Maryland Avenue, MC3077, Chicago, IL 60637, United States
| | - Brian L Odlaug
- Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark; H. Lundbeck A/S, Valby, Denmark
| | - Austin W Blum
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841S. Maryland Avenue, MC3077, Chicago, IL 60637, United States
| | - Jon E Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841S. Maryland Avenue, MC3077, Chicago, IL 60637, United States
| |
Collapse
|
45
|
Krooks JA, Weatherall AG, Holland PJ. Review of epidemiology, clinical presentation, diagnosis, and treatment of common primary psychiatric causes of cutaneous disease. J DERMATOL TREAT 2017; 29:418-427. [DOI: 10.1080/09546634.2017.1395389] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- J. A. Krooks
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - A. G. Weatherall
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
- ClearlyDerm Center for Dermatology, Boca Raton, FL, USA
| | - P. J. Holland
- Psychiatry and Neurology Department, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| |
Collapse
|
46
|
Grant JE, Chamberlain SR. Clinical correlates of symptom severity in skin picking disorder. Compr Psychiatry 2017; 78:25-30. [PMID: 28779593 PMCID: PMC5584660 DOI: 10.1016/j.comppsych.2017.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 06/24/2017] [Accepted: 07/01/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Skin picking disorder (SPD) remains poorly understood with limited data regarding its underlying pathophysiology and appropriate treatment choices. One approach to refining our treatment of SPD might be to better understand the range of illness severity and the clinical associations with severity. METHODS 125 adults aged 18 to 65 with a primary, current DSM-5 diagnosis of SPD were assessed for the severity of their picking, using the Skin Picking Symptom Assessment Scale, and related mental health symptoms. To identify clinical and demographic measures associated with variation in disease severity, we utilized the statistical technique of partial least squares (PLS). RESULTS Greater SPD symptom severity was associated with higher Barratt attentional impulsiveness and motor impulsivity, higher Eysenck impulsivity, higher state anxiety/depression, having a current anxiety disorder, and having a lifetime substance use disorder. CONCLUSIONS The present analysis is, to our knowledge, the most complete assessment of clinical variables and their relationship to illness severity in a sample of adults with SPD. Aspects of impulsivity and anxiety are both strongly associated with worse illness severity, and functional disability, in SPD. Treatment approaches should incorporate these as possible treatment targets when developing new treatment approaches to this disorder.
Collapse
Affiliation(s)
- Jon E. Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA,Corresponding author at: Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 3077, Chicago, IL 60637, United States.Department of Psychiatry & Behavioral NeuroscienceUniversity of ChicagoPritzker School of Medicine5841 S. Maryland Avenue, MC 3077ChicagoIL60637United States
| | - Samuel R. Chamberlain
- Department of Psychiatry, University of Cambridge, Cambridge and Peterborough NHS Foundation Trust (CPFT), UK
| |
Collapse
|
47
|
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] [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.
Collapse
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
| |
Collapse
|
48
|
Abstract
Excoriation (skin-picking) disorder (SPD) is a disabling, under-recognized condition in which individuals repeatedly pick at their skin, leading to noticeable tissue damage. There has been no examination as to whether individuals with SPD have different pain thresholds or pain tolerances compared to healthy counterparts. Adults with SPD were examined on a variety of clinical measures including symptom severity and functioning. All participants underwent the cold pressor test. Heart rate, blood pressure, and self-reported pain were compared between SPD participants (n=14) and healthy controls (n=14). Adults with SPD demonstrated significantly dampened autonomic response to cold pressor pain as exhibited by reduced heart rate compared to controls (group x time interaction using repeated ANOVA F=3.258, p<0.001). There were no significant differences between the groups in terms of overall pain tolerance (measured in seconds), recovery time, or blood pressure. SPD symptom severity was not significantly associated with autonomic response in the patients. In this study, adults with SPD exhibited a dampened autonomic response to pain while reporting pain intensity similar to that reported by the controls. The lack of an autonomic response may explain why the SPD participants continue a behavior that they cognitively find painful and may offer options for future interventions.
Collapse
|
49
|
Gallinat C, Keuthen NJ, Stefini A, Backenstrass M. The assessment of skin picking in adolescence: psychometric properties of the Skin Picking Scale-Revised (German version). Nord J Psychiatry 2017; 71:145-150. [PMID: 27885889 DOI: 10.1080/08039488.2016.1259427] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Skin picking disorder has received growing attention since the release of DSM-5, yet there are no evidence-based assessment instruments for adolescent samples. AIM The present study examines the psychometric properties of the Skin Picking Scale-Revised (SPS-R, German version) in adolescents. METHODS A total of 76 adolescents (96% female) completed the SPS-R, the Clinical Psychological Diagnostic System (KPD-38), and a questionnaire assessing demographics and clinical characteristics online. RESULTS The SPS-R had high internal consistency (α = 0.89) and significant small-to-medium correlations with reduced competence skills, psychological impairment, general life satisfaction, social support, and social problems on the KPD-38. Similar to prior findings for adults, an exploratory factor analysis suggested a two-factor model for the SPS-R in adolescents. Group comparisons failed to show significant differences on SPS-R scores between participants with and without dermatological conditions. CONCLUSIONS The current results suggest that the SPS-R can be useful in adolescent samples as a reliable and valid instrument for the assessment of skin picking severity. Future research investigating scale validity and factor structure in a clinical sample of adolescent skin pickers is warranted.
Collapse
Affiliation(s)
- Christina Gallinat
- a Center for Psychotherapy Research , University Hospital Heidelberg , Heidelberg , Germany
| | - Nancy J Keuthen
- b Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School , Boston , MA , USA
| | - Annette Stefini
- c General Psychiatry , University Hospital Heidelberg , Heidelberg , Germany
| | - Matthias Backenstrass
- d Institute of Clinical Psychology, Hospital Stuttgart , Stuttgart , Germany.,e Institute of Psychology, Department of Clinical Psychology and Psychotherapy , Heidelberg University , Heidelberg , Germany
| |
Collapse
|
50
|
Lochner C, Roos A, Stein DJ. Excoriation (skin-picking) disorder: a systematic review of treatment options. Neuropsychiatr Dis Treat 2017; 13:1867-1872. [PMID: 28761349 PMCID: PMC5522672 DOI: 10.2147/ndt.s121138] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Although pathological skin-picking has been documented in the medical literature since the 19th century, it has only recently been included as a distinct entity in psychiatric classification systems. In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition and the proposed International Classification of Diseases, Eleventh Revision, excoriation (skin-picking) disorder (ED), also known as neurotic excoriation, psychogenic excoriation, or dermatillomania), is described as recurrent picking of skin, leading to skin lesions and significant distress or functional impairment. ED is listed as one of the obsessive-compulsive and related disorders, given its overlap with conditions such as trichotillomania (hair-pulling disorder). Arguably, its inclusion and delineation in the diagnostic nomenclature will lead to increased awareness of the condition, more research, and ultimately in treatment advances. This systematic review aims to provide readers with an up-to-date view of current treatment options for ED. A MEDLINE search of the ED treatment literature was conducted to collate relevant articles published between 1996 and 2017. The findings indicate that a number of randomized controlled trails on ED have now been published, and that current management options include behavioral therapy (habit reversal or acceptance-enhanced behavior therapy), and medication (selective serotonin reuptake inhibitors or N-acetyl cysteine).
Collapse
Affiliation(s)
- Christine Lochner
- SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, South Africa
| | - Annerine Roos
- SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, South Africa
| | - Dan J Stein
- SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| |
Collapse
|