Pathological Skin Picking: Phenomenology and Associations With Emotions, Self-Esteem, Body Image, and Subjective Physical Well-Being

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.

Discriminative and Affective Processing of Touch: Associations with Severity of Skin-picking

“…As an alternative, more intense tactile stimulation (skin-picking) may be chosen to fulfill the same function. In line with this hypothesis are clinical observations which indicate that a majority of patients with SPD describe their skin-picking as soothing; a term that is typically used to describe the effects of soft touch (Gallinat et al, 2021). To the best of our knowledge, the role of touch experiences and attitudes toward (soft) touch has not been examined in samples with subclinical/clinical SPD.…”

“…It becomes more frequent in times of emotional distress. Negative feelings (e.g., frustration, anger, boredom) are typical triggers of skin-picking, which helps to reduce tension and is experienced as soothing (Bohne et al, 2002 ; Gallinat et al, 2021 ). In this sense, skin-picking can be seen as part of an adaptive effort to manage negative affective states (Neff et al, 2011 ; Snorrason et al, 2010 ).…”

Appearance-related concerns in individuals with pathological skin picking—a comparison with individuals with dermatological conditions and skin-healthy controls

“…In addition to the stressful experience that it is difficult to stop skin picking and to experience a lack of understanding from their social environment as well as from health care professionals [e.g., dermatologists; ( 18 – 20 )], those affected often also suffer from the visible consequences of the behavior, for example scabs or scars. To avoid skin blemishes or to cover or treat skin picking wounds, many affected people undergo various cosmetic procedures (e.g., dermabrasion, laser therapy) and use camouflaging make-up ( 21 , 22 ).…”

Brain mechanisms for processing caress-like touch in skin-picking disorder

“…Individuals with SPD typically pick at minor skin irregularities (e.g., pimples, calluses, scabs), which are identified by visual inspection and tactile checking (repetitive touching). Picking episodes are often preceded by negative affective or somatic states (e.g., feelings of anger, and bodily tension) [ 3 ]. During these episodes, most patients experience the picking as pleasant since it leads to a reduction of tension, and is perceived as soothing or calming, or even meditative/trance-like [ 3 , 4 ].…”

“…Picking episodes are often preceded by negative affective or somatic states (e.g., feelings of anger, and bodily tension) [ 3 ]. During these episodes, most patients experience the picking as pleasant since it leads to a reduction of tension, and is perceived as soothing or calming, or even meditative/trance-like [ 3 , 4 ]. The positive valence of skin-picking episodes is surprising since the excessive manipulation of the skin causes tissue damage which would generally be experienced as unpleasant.…”