Research Paper
Skin picking behaviors: An examination of the prevalence and severity in a community sample

https://doi.org/10.1016/j.janxdis.2009.01.008Get rights and content

Abstract

Body-focused repetitive behaviors such as skin picking have gained recent attention in the psychiatric literature. Prevalence of skin picking has not been well researched and is difficult to estimate; however, consequences of such behaviors can include severe medical complications and impaired social and occupational functioning. Given this, this study examined: (1) the prevalence and severity of skin picking in a nonclinical community sample, and (2) associations between skin picking and other measures of psychological functioning. Three hundred and fifty-four participants completed measures of psychological functioning and skin picking frequency and severity. A total of 62.7% endorsed some form of skin picking and 5.4% reported clinical levels of skin picking and associated distress/impact. Direct associations were found between skin picking and depressive, anxiety, and obsessive–compulsive symptoms, which may support the emotional regulation model of pathological skin picking. To establish proper diagnostic classification of pathological skin picking and optimize treatment planning and outcome, further investigation of functional relationships between skin picking and affective distress is needed.

Section snippets

Participants and procedures

The first author and trained assistants completed confidentiality training modules in social and behavioral research as required for study approval by the Institutional Review Board. Prior to data collection, assistants were familiarized with the study protocol, in which the definition of skin picking was operationalized as any intentional scratching or picking (with fingers or other tools) at normal skin, or skin with minor blemishes, scabs or insect bites, resulting in noticeable injury. The

Prevalence and severity

A total of 62.7% (n = 222) of the sample endorsed some form of skin picking, defined as any picking, rubbing, or scratching with either fingers or tools at skin regardless of being ‘normal’ or ‘irregular.’ The most common sites reported by all participants included the face (41.8% of the total sample, n = 148), cuticles and nails (33.1%, n = 117), arms (22.6%, n = 80), scalp (16.9%, n = 60), and hands and feet (16.1%, n = 57). In the total sample, 11.2% reportedly engaged in clinically significant skin

Discussion

Within a nonclinical community sample, this study examined prevalence rates of skin picking behaviors and correlations with affective distress. Consistent with studies finding that skin picking is relatively common and largely benign (Bohne et al., 2002; Hajcak, Franklin, Simons, & Keuthen, 2006; Keuthen et al., 2000), most participants endorsed the behavior in some form. Body sites most susceptible to skin picking closely matched those referenced in Keuthen et al. (2000), and included the

Acknowledgements

This study was conducted as part of Ms. Hayes’ University of Florida Honors Program requirements. The authors would like to thank David Janicke, Ph.D., Gary R. Geffken, Ph.D., and Megan Demerich for their contributions.

References (55)

  • N.J. Keuthen et al.

    The Skin Picking Impact Scale (SPIS): scale development and psychometric analyses

    Psychosomatics

    (2001)
  • N.J. Keuthen et al.

    Repetitive skin-picking in a student population and comparison with a sample of self-injurious skin-pickers

    Psychosomatics

    (2000)
  • N.J. Keuthen et al.

    Factor analysis of the Massachusetts General Hospital Hairpulling Scale

    Journal of Psychosomatic Research

    (2007)
  • N.J. Keuthen et al.

    The Skin Picking Scale: scale construction and psychometric analyses

    Journal of Psychosomatic Research

    (2001)
  • M.S. Rosenbaum et al.

    The behavioral treatment of neurodermatitis through habit-reversal

    Behaviour Research and Therapy

    (1981)
  • R.M. Stemberger et al.

    Personal toll of trichotillomania: Behavioral and interpersonal sequelae

    Journal of Anxiety Disorders

    (2000)
  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed. text...
  • L. Arnold et al.

    Psychogenic excoriation: clinical features, proposed diagnostic criteria, epidemiology and approaches to treatment

    CNS Drugs

    (2001)
  • L.M. Arnold et al.

    Characteristics of 34 adults with psychogenic excoriation

    Journal of Clinical Psychiatry

    (1998)
  • L.M. Arnold et al.

    An open clinical trial of fluvoxamine treatment of psychogenic excoriation

    Journal of Clinical Psychopharmacology

    (1999)
  • A.T. Beck et al.

    An inventory for measuring clinical anxiety: the Beck Anxiety Inventory

    Journal of Consulting and Clinical Psychology

    (1988)
  • A.T. Beck et al.

    Beck Depression Inventory–II (BDI–II)

    (1996)
  • A. Bohne et al.

    Pathologic hairpulling, skin picking, and nail biting

    Annals of Clinical Psychiatry

    (2005)
  • A. Bohne et al.

    Skin picking in German students: prevalence, phenomenology, and associated characteristics

    Behavior Modification

    (2002)
  • G.A. Christenson et al.

    Characteristics of 60 adult chronic hair pullers

    American Journal of Psychiatry

    (1991)
  • K.L. Croyle et al.

    Subclinical self-harm: range of behaviors, extent, and associated characteristics

    American Journal of Orthopsychiatry

    (2007)
  • B. Dell’Osso et al.

    Epidemiologic and clinical updates on impulse control disorders: a critical review

    European Archives of Psychiatry & Clinical Neuroscience

    (2006)
  • Cited by (177)

    • Self-help for body-focused repetitive behaviors: A randomized controlled trial

      2023, Journal of Obsessive-Compulsive and Related Disorders
    • Case study: Cognitive behavioral therapy for adolescent skin picking disorder

      2023, Handbook of Lifespan Cognitive Behavioral Therapy: Childhood, Adolescence, Pregnancy, Adulthood, and Aging
    • Stimulant use in patients presenting with psychocutaneous disorders

      2022, Journal of the American Academy of Dermatology
    View all citing articles on Scopus
    View full text