Prevalence of skin picking (excoriation) disorder.
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ABSTRACT:
SUBMITTER: Grant JE
PROVIDER: S-EPMC7115927 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Objective: Excessive calorie intake constitutes a global public health concern, due to its associated range of untoward outcomes. Impulsivity and compulsivity have been linked to dietary intake. However, nothing is known about dietary intake and body-focused repetitive behaviors, despite their classification as obsessive-compulsive related conditions, and high co-morbidity with impulsive and compulsive conditions. Methods: One hundred and ninety six adults with trichotillomania or skin picking disorder were recruited. Dietary intake over the preceding year was quantified using the Dietary Fat and Free Sugar Short questionnaire. Relationships between dietary fat/sugar intake and behaviors were evaluated using regression modeling. Results: Sugar intake was significantly related to higher trans-diagnostic compulsivity (p = 0.011) and higher non-planning impulsivity (p = 0.013) In terms of saturated fat intake, there was no significant relationship to the explanatory variables. A combination high fat/high sugar diet was significantly associated with higher motor impulsivity (p = 0.005). Conclusions: Past-year nutrition appears to be significantly associated with trans-diagnostic impulsivity and compulsivity. The role of poor nutrition in these disorders and related conditions, and its link with impulsivity and compulsivity, requires longitudinal research attention; and clinical work should address not only psychiatric symptoms but also impact of lifestyle of overall health.
| S-EPMC8650212 | biostudies-literature
Project description:ObjectiveSkin picking disorder (SPD) affects up to 5.4% of the population. Less than half of patients are correctly diagnosed and treated. Developing tools to recognize SPD can help professionals and patients alike. This trial aimed to validate the Skin Picking Scale-Revised (SPS-R) for the Brazilian population and assess the psychiatric and dermatological comorbidities of patients with SPD.MethodsBrazilians with a primary diagnosis of SPD, 18 years or older, were recruited from a community sample by media advertising and evaluated by a dermatologist and a psychiatrist. Self-report instruments were used: SPS-R, Dermatology Life Quality Index (DLQI), General Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). Confirmatory factor analysis (CFA) was performed to evaluate the SPS-R, and Pearson correlation (r) was used to assess the relationship between instruments.ResultsOverall, 124 patients were included. The SPS-R demonstrated good internal consistency (Cronbach's coefficient = 0.84). CFA found a good fit to the model according to all indices (?2 = 29.67; degrees of freedom [df] = 19; p = 0.056; root mean square error of approximation [RMSEA] = 0.067; comparative fit index [CFI] = 0.969; non-normed fit index [NNFI] = 0.954). SPS-R correlated with DLQI (r = 0.73), GAD-7 (r = 0.51), and PHQ-9 (r = 0.43). The sample had a high prevalence of psychiatric disorders, mainly generalized anxiety disorder (62.1%) and current (32.3%) and past (37.1%) depressive episodes.ConclusionThe Brazilian version of the SPS-R presents good psychometric properties. The severity of SPD is related to severity of depression, anxiety, and impairment in quality of life.
| S-EPMC9851763 | biostudies-literature
Project description:Skin-picking disorder (SPD) is characterized by repetitive touching and picking of one's skin. The picking is typically experienced as pleasant although this behavior leads to tissue damage. The present functional magnetic resonance imaging (fMRI) study investigated how individuals with SPD react to caress-like touch, which stimulates C-tactile afferents. A standardized touch procedure was used. Seventy females with a primary diagnosis of SPD and 62 healthy females received CT-optimal brushing of their forearms (3 cm/s) and non-optimal brushing (30 cm/s) during an fMRI session. The two types of tactile stimulation were rated according to pleasure, arousal, and urge to pick one's skin. Relative to healthy controls, patients with SPD showed greater activation in parietal regions (supramarginal/angular gyrus) during CT-optimal touch. Moreover, the deactivation of the middle/ inferior frontal cortex displayed by control participants was absent in the SPD group. Being touched was rated as less pleasant, more arousing, and elicited a greater urge to perform skin-picking in participants with SPD. The mentioned frontal and parietal brain regions are sources of attentional control. They are involved in integrating somatosensory information and switching attention between external/internal stimuli. The present study adds to the limited database on the dysfunctional processing of touch in SPD. This study was preregistered on the German Clinical Trials Register (DRKS00022123, June 8th, 2020).
| S-EPMC10786990 | biostudies-literature
Project description:Disorders such as Trichotillomania (TTM) and skin-picking disorder (SPD) are associated with reduced flexibility and increased internally focused attention. While the basal ganglia have been hypothesized to play a key role, the mechanisms underlying learning and flexible accommodation of new information is unclear. Using a Bayesian Learning Model, we evaluated the neural basis of learning and accommodation in individuals with TTM and/or SPD. Participants were 127 individuals with TTM and/or SPD (TTM/SPD) recruited from three sites (age 18-57, 84% female) and 26 healthy controls (HC). During fMRI, participants completed a shape-button associative learning and reversal fMRI task. Above-threshold clusters were identified where the Initial Learning-Reversals BOLD activation contrast differed significantly (p < .05 FDR-corrected) between the two groups. A priori, effects were anticipated in predefined ROIs in bilateral basal ganglia, with exploratory analyses in the hippocampus, dorsolateral prefrontal cortex (dlPFC), and dorsal anterior cingulate cortex (dACC). Relative to HC, individuals with TTM/SPD demonstrated reduced activation during initial learning compared to reversal learning in the right basal ganglia. Similarly, individuals with TTM/SPD demonstrated reduced activation during initial learning compared to reversal learning in several clusters in the dlPFC and dACC compared to HC. Individuals with TTM/SPD may form or reform visual stimulus-motor response associations through different brain mechanisms than healthy controls. The former exhibit altered activation within the basal ganglia, dlPFC, and dACC during an associative learning task compared to controls, reflecting reduced frontal-subcortical activation during initial learning. Future work should determine whether these neural deficits may be restored with targeted treatment.
| S-EPMC8940679 | biostudies-literature
Project description: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. 13-subjects meeting proposed SPD criteria for DSM-5 free from other current psychiatric comorbidities, and 12 healthy comparison subjects underwent MRI with a 3-T system. Between-group comparisons 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 comorbid overlap between SPD and trichotillomania-these disorders likely share overlapping neurobiology.
| S-EPMC3671993 | biostudies-other
Project description:Skin Picking Disorder affects 4% of the general population, with serious quality of life impacts, and potentially life threatening complications. Standard psychoactive medications do not help most patients. Similarly, Mouse Ulcerative Dermatitis (skin lesions caused by excessive abnormal grooming behavior) is very common in widely used inbred strains of mice, and represents a serious animal welfare issue and cause of mortality. Treatment options for Ulcerative Dermatitis are largely palliative and ineffective. We have proposed mouse Ulcerative Dermatitis as a model for human Skin Picking Disorder based on similar epidemiology, behavior, and its comorbidity and mechanistic overlap with hair pulling (trichotillomania). We predicted that mouse Ulcerative Dermatitis would be treated by N-Acetylcysteine, as this compound is highly effective in treating both Skin Picking Disorder and Trichotillomania. Furthermore, we hypothesized that N-Acetylcysteine's mode of action is as a precursor to the production of the endogenous antioxidant glutathione in the brain, and therefore intranasal glutathione would also treat Ulcerative Dermatitis. Accordingly, we show in a heterogenous prospective trial, the significant reduction in Ulcerative Dermatitis lesion severity in mice receiving either N-acetylcysteine (oral administration) or glutathione (intranasal). The majority of mice treated with N-acetylcysteine improved slowly throughout the course of the study. Roughly half of the mice treated with glutathione showed complete resolution of lesion within 2-4 weeks, while the remainder did not respond. These findings are the first to show that the use of N-acetylcysteine and Glutathione can be curative for mouse Ulcerative Dermatitis. These findings lend additional support for mouse Ulcerative Dermatitis as a model of Skin Picking Disorder and also support oxidative stress and glutathione synthesis as the mechanism of action for these compounds. As N-Acetylcysteine is poorly tolerated by many patients, intranasal glutathione warrants further study as potential therapy in Skin Picking, trichotillomania and other body-focused repetitive behavior disorders.
| S-EPMC4500395 | biostudies-literature
Project description:Highlights • Patients with skin-picking disorder (SPD) display reduced neural sensitivity to affective/soft self-touch.• Neurobiological evaluation of a new Soft Touch Training (STT) for SPD patients.• STT increased the pleasantness ratings for (slow/soft) touch administered during fMRI.• STT changed activity/ connectivity in the secondary somatosensory cortex. Background Individuals with skin-picking disorder (SPD) display reduced neural sensitivity to slow/soft touch. This functional magnetic resonance imaging (fMRI) study investigated the effects of Soft Touch Training (STT) on neural correlates of touch processing and SPD symptoms. Method Females with a primary diagnosis of SPD (n = 57) were randomly assigned to receive either four weeks of STT (guided soft brushing of selected skin regions) or Progressive Muscle Relaxation (PMR) training (guided tensing and relaxing of selected muscle regions). The app-assisted intervention consisted of 15-minute daily training sessions at home. Before and after the four-week intervention, the two groups participated in a standardized tactile stimulation procedure during fMRI (affective vs nonaffective touch of the forearm). Intervention-based changes in subjective and neural responses to the tactile stimulation as well as SPD severity were compared between the groups. Results STT increased the pleasantness ratings for (affective) touch administered during fMRI, which was accompanied by decreased activation in the parietal operculum (PO) and supramarginal gyrus (SMG), as well as increased PO-SMG connectivity. These findings possibly reflect normalized affective touch processing due to STT. Both interventions (STT and PMR) reduced SPD severity. Conclusions This study demonstrated that a brief app-assisted touch training can change the experience of receiving touch from others and the associated brain activity and connectivity. Adaptations of the training relating to duration/ frequency of sessions might enhance its effectiveness.
| S-EPMC9668654 | biostudies-literature
Project description:Body-focused repetitive behavior disorders (BFRBs) include Trichotillomania (TTM; Hair pulling disorder) and Excoriation (Skin Picking) Disorder (SPD). These conditions are prevalent, highly heterogeneous, under-researched, and under-treated. In order for progress to be made in optimally classifying and treating these conditions, it is necessary to identify meaningful subtypes. 279 adults (100 with TTM, 81 with SPD, 40 with both TTM and SPD, and 58 controls) were recruited for an international, multi-center between-group comparison using mixture modeling, with stringent correction for multiple comparisons. The main outcome measure was to examine distinct subtypes (aka latent classes) across all study participants using item-level data from gold-standard instruments assessing detailed clinical measures. Mixture models identified 3 subtypes of TTM (entropy 0.98) and 2 subtypes of SPD (entropy 0.99) independent of the control group. Significant differences between these classes were identified on measures of disability, automatic and focused symptoms, perfectionism, trait impulsiveness, and inattention and hyperactivity. These data indicate the existence of three separate subtypes of TTM, and two separate subtypes of SPD, which are distinct from controls. The identified clinical differences between these latent classes may be useful to tailor future treatments by focusing on particular traits. Future work should examine whether these latent subtypes relate to treatment outcomes, or particular psychobiological findings using neuroimaging techniques.
| S-EPMC7610704 | biostudies-literature
Project description: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.
| S-EPMC9483632 | biostudies-literature
Project description:Very little is known about the cognitive functioning of people with body-focused repetitive behaviours and the few existing studies provide mixed findings. The aim of this study was to investigate the interplay between attentional control, negative affectivity, and focused skin picking. We hypothesized that the control of attention is associated with focused style of skin picking and that this relationship is moderated by negative affectivity. The final sample consisted of 273 non-clinical subjects (79% women) aged 18 to 54 years; study variables were assessed using questionnaires. Moderation analysis was conducted, followed by a simple slope analysis, and the Johnson-Neyman technique was used to probe the interaction effect. We found that at the low level of negative affectivity, the relationship between attentional control and focused skin picking is negative, but not at the higher levels of this trait. Interestingly, when negative affectivity reaches very high intensity, the association between attentional control and skin picking becomes positive. This relationship seems to be quite complex and may depend on the way that cognitive abilities are used by the individual, as well as on the stage of cognitive processing that they are applied to. Further studies using behavioural measures of attention are needed to better understand this issue.
| S-EPMC9180320 | biostudies-literature