Clinical characteristics and medical complications of pathologic skin picking

Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN 55454, USA.
General Hospital Psychiatry (Impact Factor: 2.61). 01/2008; 30(1):61-6. DOI: 10.1016/j.genhosppsych.2007.07.009
Source: PubMed

ABSTRACT This study sought to detail the phenomenology and medical consequences of pathologic skin picking (PSP).
Sixty subjects (11.7% males) with PSP (mean+/-S.D.=33.7+/-11.6 years) were assessed. Subjects seen in a pharmacological study as well as those from an ongoing outpatient longitudinal study comprised this sample. Subjects were assessed for current and lifetime psychiatric comorbidity (using the Structured Clinical Interview for DSM-IV Axis I Disorders), clinical severity (using the Clinical Global Impression - Severity scale) and psychosocial interference due to picking (using the Sheehan Disability Scale). Clinical characteristic data, including time spent picking per day, sites picked and medical complications directly resulting from skin picking behavior, as well as family history, were also obtained.
The mean age (+/-S.D.) of onset for PSP was 12.3+/-9.6 years. The face was the most common area picked. Subjects reported picking a mean of 107.6 min each day. Scarring, ulcerations and infections were common. Few had ever sought psychiatric treatment for their behavior. Current comorbid Axis I psychiatric conditions were found in 38.3% of the sample. Trichotillomania (36.7%), compulsive nail biting (26.7%), depressive disorder (16.7%) and obsessive-compulsive disorder (15%) were the most common current comorbid conditions.
PSP appears to be time consuming and frequently associated with medical complications. Research is needed to optimize patient care for individuals with this behavior.

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Available from: Brian Odlaug, Jul 30, 2015
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    • "Females are disproportionately affected by a ratio of 8:1–9:1 (Arnold, Auchenbach, & McElroy, 2001; Flessner & Woods, 2006; Tucker et al., 2011). Although ExD is a distinct psychiatric condition and may occur in the absence of other psychopathology, patients with ExD also exhibit high rates of anxiety disorders (including obsessive-compulsive disorder), mood disorders, eating disorders, and substance use disorders (Arnold et al., 1998; Odlaug & Grant, 2008). Additionally, some studies have found high rates of personality disorders, especially obsessive-compulsive and borderline personality disorders among treatment-seeking individuals with ExD (Lochner, Simeon, Niehaus, & Stein, 2002; Wilhelm et al., 1999). "
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    ABSTRACT: Excoriation disorder (ExD) involves habitual skin picking that causes significant tissue damage and psychosocial impairment. ExD is largely understudied, and efficacious treatments have yet to be established. Preliminary evidence suggests that habit reversal is a promising intervention for ExD and that acceptance and commitment therapy (ACT) techniques may further enhance the efficacy of habit reversal. This report details treatment of ExD in four adults using a combination of habit reversal and ACT, termed acceptance-enhanced behavior therapy (AEBT). Three of four patients experienced a clear decrease in ExD symptoms from pretreatment to posttreatment. Clinical considerations and directions for future research are discussed.
    Cognitive and Behavioral Practice 02/2014; 22(2). DOI:10.1016/j.cbpra.2014.01.008 · 1.33 Impact Factor
    • "The nosological status of SPD and its relationship with other axis I disorders remains unclear. Individuals with SPD report high rates of co-occurring trichotillomania, and first-degree relatives of patients with SPD report high rates of grooming behaviors, including trichotillomania and SPD (Odlaug and Grant, 2008a,b; Wilhelm et al, 1999; Neziroglu et al, 2008). Given this overlapping familiality between SPD and trichotillomania, and that these conditions are associated with pathological habits that are difficult to suppress, it has been suggested that SPD can be viewed as a pathological grooming disorder alongside trichotillomania (Stein et al, 1994; Feusner et al, 2009; Beinvenu et al, 2012). "
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    ABSTRACT: Skin picking disorder (SPD) is characterized by the repetitive and compulsive picking of skin resulting in tissue damage. Neurocognitive findings in SPD implicate difficulty with response inhibition (suppression of pre-potent motor responses). This function is dependent on the integrity of the right frontal gyrus and the anterior cingulate cortices; and white matter tracts connecting such neural nodes. It was hypothesized that SPD would be associated with reduced fractional anisotropy in regions implicated in top-down response suppression, particularly white matter tracts in proximity of the bilateral anterior cingulate and right frontal (especially orbitofrontal and inferior frontal) cortices. Thirteen subjects meeting proposed SPD criteria for DSM-5, and free from other current psychiatric comorbidity, and 12 healthy comparison subjects underwent MRI with a 3-T system. Between-group comparison of imaging data underwent voxelwise analysis with permutation modeling and cluster correction. Fractional anisotropy (measured using diffusion tensor imaging) was the primary outcome measure. Subjects with SPD exhibited significantly reduced fractional anisotropy in tracts distributed bilaterally which included the anterior cingulate cortices.Fractional anisotropy did not correlate significantly with SPD disease severity or depressive or anxiety scores. These findings implicate disorganization of white matter tracts involved in motor generation and suppression in the pathophysiology of SPD, findings remarkably similar to those previously reported in trichotillomania. This study adds considerable support to the notion that-in addition to the phenomenological and co-morbid overlap between SPD and trichotillomania-these disorders likely share overlapping neurobiology.Neuropsychopharmacology accepted article preview online, 29 November 2012; doi:10.1038/npp.2012.241.
    Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 11/2012; 38(5). DOI:10.1038/npp.2012.241 · 7.05 Impact Factor
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    • "Although some preliminary data suggest no differences based on gender [3], other research suggests men with SPD may report more pleasure from the behavior and may pick at areas that are less noticeable to others (legs compared to face) [9]. Studies examining gender differences in trichotillomania, a disorder with phenomenologic and possible neurobiologic similarities to SPD [2] [11] [12], have found that females more commonly have earlier age of onset of behavior, less comorbidity and more disability than males [13]. This study sought not only to examine both the prevalence of SPD in a university sample but also examine the associated emotional and functional consequences of the disorder. "
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    ABSTRACT: Objective: This study sought to examine the prevalence of skin picking disorder (SPD) in a university sample and assess associated physical and mental health correlates. Methods: A 54-item anonymous, voluntary survey was distributed via random email generation to a sample of 6000 university students. Current psychological and physical status was assessed, along with academic performance. Positive screens for SPD were determined based upon individuals meeting full proposed DSM-V criteria. Results: A total of 1916 participants (31.9%; mean age 22.7 ± 5.1; 58.1% female) responded and were included in the analysis. The overall prevalence of SPD was 4.2% (females=5.8%; males=2.0%). SPD was associated with significantly higher lifetime rates of affective, anxiety, eating, substance use and impulse control disorders. Men with SPD had significantly higher BMI ratings and perceived themselves as significantly less attractive to others while women had significantly higher depressive symptoms. Conclusion: SPD is common in both genders and is associated with significant mental and physical health detriments, including higher levels of stress, more psychiatric comorbidity and poorer perceived health. Academic institutions, clinicians and public health officials should be aware of the multimodal presentation of SPD and screen for it in primary care and dermatologic settings.
    General hospital psychiatry 11/2012; 35(2). DOI:10.1016/j.genhosppsych.2012.08.006 · 2.61 Impact Factor
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