The prevalence of pathologic skin picking in US adults

Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Comprehensive psychiatry (Impact Factor: 2.25). 03/2010; 51(2):183-6. DOI: 10.1016/j.comppsych.2009.04.003
Source: PubMed


Despite increasing recognition of the potentially severe medical and psychosocial costs of pathologic skin picking (PSP), no large-sample, randomized investigation of its prevalence in a national population has been conducted.
Two thousand five hundred and thirteen US adults were interviewed during the spring and summer of 2004 in a random-sample, national household computer-assisted phone survey of PSP phenomenology and associated functional impairment. Respondents were classified for subsequent analysis according to proposed diagnostic criteria.
Of all respondents, 16.6% endorsed lifetime PSP with noticeable skin damage; 60.3% of these denied picking secondary to an inflammation or itch from a medical condition. One fifth to one quarter of those with lifetime PSP not related to a medical condition endorsed tension or nervousness before picking, tension or nervousness when attempting to resist picking, and pleasure or relief during or after picking. A total of 1.4% of our entire sample satisfied our criteria of picking with noticeable skin damage not attributable to another condition and with associated distress or psychosocial impairment. Pickers satisfying these latter criteria differed from other respondents in demographics (age, marital status) and both picking phenomenology and frequency.

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    • "As with the other behavioural addictions in general, the high rates of cooccurrence work in both directions: for example, the reported rates of skin-picking disorder in individuals with OCD range between 8.9% and 24.0% (Cullen et al. 2001;Grant et al., 2006c), which are also markedly higher than community rates (1.4–5.4%) (Hayes et al., 2009;Keuthen et al., 2010). Skinpicking disorder and body dysmorphic disorder (BDD) also often co-occur (Arnold et al., 1998;Phillips, 2005;Grant et al., 2006d) Clinical and epidemiological data indicate that SUDs and behavioural addictions frequently co-occur (Grant et al., 2006a;Lobo and Kennedy, 2009). "
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    ABSTRACT: The term 'addiction' was traditionally used in relation to centrally active substances, such as cocaine, alcohol, or nicotine. Addiction is not a unitary construct but rather incorporates a number of features, such as repetitive engagement in behaviours that are rewarding (at least initially), loss of control (spiralling engagement over time), persistence despite untoward functional consequences, and physical dependence (evidenced by withdrawal symptoms when intake of the substance diminishes). It has been suggested that certain psychiatric disorders characterized by maladaptive, repetitive behaviours share parallels with substance addiction and therefore represent 'behavioural addictions'. This perspective has influenced the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which now has a category 'Substance Related and Addictive Disorders', including gambling disorder. Could other disorders characterised by repetitive behaviours, besides gambling disorder, also be considered 'addictions'? Potential examples include kleptomania, compulsive sexual behaviour, 'Internet addiction', trichotillomania (hair pulling disorder), and skin-picking disorder. This paper seeks to define what is meant by 'behavioural addiction', and critically considers the evidence for and against this conceptualisation in respect of the above conditions, from perspectives of aetiology, phenomenology, co-morbidity, neurobiology, and treatment. Research in this area has important implications for future diagnostic classification systems, neurobiological models, and novel treatment directions.
    No preview · Article · Aug 2015 · European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology
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    • "Picking secondary to substance abuse or psychiatric issues were not directly queried. Parallel to the research criteria for SPD previously used by Keuthen et al. [10], participants were required to endorse lifetime picking resulting in skin damage with picking not attributable to an inflammation or itch from a medical condition. In addition, they had to endorse significant distress attributable to skin picking, missed work or school due to skin picking, or cancelled or avoided important events or social time due to skin picking. "
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    ABSTRACT: Objective The purpose of the study was to examine the prevalence of excoriation (skin picking) disorder (SPD) and associated physical and mental health correlates in a sample of Israeli university students. Methods Five thousand Israeli students were given questionnaires screening for SPD, depression, obsessive-compulsive disorder, body dysmorphic disorder and disruptive, impulse control and conduct disorders. A total of 2176 participants (43.6%) responded and were included in the analysis. Mean age was 25.1±4.8 (range 17-60) years and 64.3% were female. Results 3.03% of students screened positive for SPD with a nearly equal gender distribution (3.0% in females and 3.1% in males). There was a trend towards significantly higher rates of psychiatric problems such as generalized anxiety, compulsive sexual behavior and eating disorders in these students. Within the group of students screening positive for SPD, alcohol intake was higher in male students, while female students perceived themselves as less attractive. No association was found between depression and SPD. A high prevalence rate of skin picking was found within first-degree family members of the participants screening positive for SPD. Conclusions Clinicians and public health officials within university settings should screen for SPD as it is common and associated with psychosocial dysfunction.
    Full-text · Article · Nov 2014 · General Hospital Psychiatry
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    • "Subsequent to the screening interview, eligible participants completed a questionnaire package at home, including the Style of Planning questionnaire (STOP; O'Connor, 2005); Frost Multidimensional Perfectionism Scale (Frost, Marten, Lahart, & Rosenblate, 1990); Symptom Checklist-90-Revised (SCL-90-R; Derogatis, 2000)' and Massachusetts General Hospital Hair-Pulling Scale (MGH-HPS; Keuthen et al., 1995) and analogue SP, NB, and skin-scratching scales. A separate scale for skin-scratching was included because, although skin-scratching is a component of SP (Keuthen, Koran, et al., 2010; Tucker, Woods, Flessner, Franklin, & Franklin, 2011), it is not directly addressed in the SP scale. The questionnaire package included a standard consent form, approved by the institution research ethics committee, for participants to read prior to beginning the questionnaire battery. "
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    ABSTRACT: Body-focused repetitive behaviors (BFRBs) are repetitive, injurious, and non-functional habits that cause significant distress or impairment, including hair-pulling, skin-picking, and nail-biting. The emotion regulation (ER) model suggests that BFRBs are triggered by negative emotions and reinforced by alleviation of unpleasant affect. The frustrated action (FA) model suggests that BFRBs are triggered by and alleviate impatience, boredom, frustration, and dissatisfaction. Individuals with BFRBs are hypothesized to be particularly susceptible to these emotions because they demonstrate maladaptive planning styles characterized by high standards and unwillingness to relax. Objectives The objective of this study was to test these two models. Methods This study compared urge to engage in BFRBs in a BFRB group (n = 24) and a control group (n = 23) in experimental conditions designed to elicit boredom/frustration, stress, and relaxation, respectively. Results The BFRB group reported a significant greater urge to engage in BFRBs than the control group across conditions. Participants in the BFRB group reported a stronger urge to engage in BFRBs in the boredom/frustration condition than in the relaxation condition but not in the stress condition. Finally, the BFRB group presented significantly higher scores on maladaptive planning style, and maladaptive planning style was significantly correlated with difficulties with ER. Limitations Future studies may wish to exclusively use validated mood induction and use more stringent inclusion criteria. Conclusions The results highlight the role of boredom, frustration, and impatience in triggering BFRBs, and support the FA model.
    Full-text · Article · Nov 2014 · Journal of Behavior Therapy and Experimental Psychiatry
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