Recovery from pathological skin picking and dermatodaxia using a revised decoupling protocol

Moritz, Steffen; Rufer, Michael; Schmotz, Stella

doi:10.1111/jocd.13378

Cited by 12 publications

(13 citation statements)

References 12 publications

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“…Also, other body-focused repetitive behaviors have been observed in patients with onychophagia [3,12,18]. Similar to the patient in this report, skin picking may occur [9].…”

Section: Figure 7: Nail Unit Anatomysupporting

confidence: 81%

Nail-Associated Body-Focused Repetitive Behaviors: Habit-Tic Nail Deformity, Onychophagia, and Onychotillomania

Cohen¹

2022

Cureus

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Habit-tic nail deformity, onychophagia (also referred to as nail biting) and onychotillomania (also referred to as nail picking) are body-focused repetitive behaviors that can involve the nails and periungual skin. Patients with habit-tic nail deformity are typically unaware that repeatedly using their nail, often the adjacent index finger, to rub the proximal nail fold and its underlying matrix -usually of one or both of their thumbnails -is the cause of the longitudinal depressed groove that extends along the entire the nail plate. Nail biters usually bite multiple nails -most commonly on the digits of the hands -and the patient is cognizant of their behavior. However, the term onychophagia is a misnomer and onychodaxia would be a more appropriate nomenclature. Nail pickers also often realize that their dystrophic nail results from using other nails or tools to pick, pull, or excessively manicure the affected nail. Individuals with habit-tic nail deformity or onychophagia or onychotillomania may concurrently have other repetitive behaviors involving the skin or the hair or both. Three patients with a nail-associated body-focused repetitive behavior are described who not only presented with dystrophy of their nails but also abnormalities of the adjacent nail apparatus: a 36-year-old woman with habit-tic nail deformity and dermatodaxia, a 64-year-old man with biting of both the nails and the skin, and a 63-year-old man with nail picking and skin picking. The nail dystrophy and concurrent skin biting or skin picking were not the issues that prompted the reported patients to seek evaluation by a physician; the body-focused repetitive behaviors of the nails and skin were incidental findings during their cutaneous examination. The management of nail-associated body-focused repetitive behavior may include non-pharmacologic treatments (such as physical modalities and behavior modifications) and/or pharmacologic agents. The reported woman with habit-tic nail deformity was willing to consider an attempt to modify her repetitive behavior by using paper tape as a physical modality to cover the area on her thumbs that she would unconsciously rub. However, similar to the men in this report with onychophagia and onychotillomania, many of the patients with nail-focused repetitive behaviors do not want to initiate any interventions that might decrease or eliminate their nail condition.

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“…Also, other body-focused repetitive behaviors have been observed in patients with onychophagia [3,12,18]. Similar to the patient in this report, skin picking may occur [9].…”

Section: Figure 7: Nail Unit Anatomysupporting

confidence: 81%

Nail-Associated Body-Focused Repetitive Behaviors: Habit-Tic Nail Deformity, Onychophagia, and Onychotillomania

Cohen¹

2022

Cureus

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“…However, some individuals demonstrated biting off their feet and ankles. Also, some of the patients bite their fingertips or nail folds [1][2][3]7].…”

Section: Discussionmentioning

confidence: 99%

“…Investigation on dermatodaxia has originated from several nations: Germany, Iraq, Saudi Arabia, Switzerland, and the United States of America [1][2][3]5,7,10,11,[14][15][16][17]. However, there is a paucity of published reports of skin biting in the world literature.…”

Section: Discussionmentioning

confidence: 99%

“…At age 40 years, his nail-biting was considerably reduced after he was treated with a method referred to as decoupling; essentially, he would perform exercises using a physical movement to generate a conscious irritant just prior to completing the undesired behavior. However, he would still bite and pick at the skin on his fingertips and nail folds occasionally even causing bleeding; therefore, a revised decoupling protocol (involving exercises that incorporated both an imaginal and a behavioral sequence) was initiated that resulted in eliminating both his skin biting and picking [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…It describes people who habitually bite their skin but do not consume the skin they have bitten. Dermatodaxia can be an isolated body-focused repetitive behavior or occur with other self-induced dermatoses [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Skin Biter: Dermatodaxia Revisited

Cohen¹

2022

Cureus

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Dermatodaxia describes humans who bite their skin. Previously used designations, which are less appropriate, have included chewing pads, wolf-biter, and dermatophagia. Dermatodaxia is a body-focused repetitive behavior and is classified in the category of obsessive-compulsive and related disorders. People who bite their skin may concurrently have other related disorders such as dermatillomania (also referred to as skin picking) affecting their cutaneous integument, trichotillomania (also referred to as hair-pulling) affecting their hair, and/or onychophagia (also referred to as nail-biting) affecting their nails. A man with multiple medical conditions presented for follow-up evaluation of a recently treated superficial skin infection of his abdomen. Cutaneous examination not only showed complete resolution of an abdominal abscess but also dermatodaxia involving his dorsal left index finger; the skin biting site appeared as an asymptomatic lichenified nodule with overlying scaly hyperkeratosis. Additional inquiry confirmed that for several decades he would repeatedly bite this finger. He was aware -and even demonstrated -that his skin biting caused the lesion. He also declined any interventions to alter his behavior. Similar to the patient in this report, dermatodaxia typically presents as an asymptomatic, unilateral, solitary, lichenified, callouslike, thick nodule; however, bilateral involvement or multiple biting sites or both may occur. Lesions typically occur on the forearm, hands, and fingers; on the latter site, they may or may not involve the knuckles. Physical modalities, behavior modifications, and/or pharmacologic agents may be used in the management of dermatodaxia; however, many individuals with dermatodaxia -similar to the reported manare not only aware that the cutaneous lesion is caused by their skin biting but also do not want to entertain the possibility of initiating any intervention that might change or stop their skin biting.

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Habit Reversal Training and Variants of Decoupling for Use in Body-Focused Repetitive Behaviors. A Randomized Controlled Trial

et al. 2022

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Background Behavioral interventions hold promise in improving body-focused repetitive behaviors (BFRBs), such as hair pulling and skin picking. The effect of combining different treatment techniques is currently unknown. Methods In the framework of a randomized controlled crossover trial, 334 individuals with at least one BFRB were allocated either to a waitlist control or to three experimental conditions (1:1:1:1). Participants in the experimental condition received self-help manuals teaching habit reversal training (HRT), decoupling (DC) and decoupling in sensu (DC-is) during a six-week period. Treatment conditions differed only in the order of manual presentation. We examined whether applying more than one technique would lead either to add-on or interference effects. Results The three treatment conditions were significantly superior to the waitlist control group in the improvement of BFRBs according to intention-to-treat analyses at a medium effect size (all p ≤ 0.002, d = 0.52 – 0.54). The condition displaying DC first significantly reduced depressive symptoms (p = 0.003, d = 0.47) and improved quality of life (p = 0.011, d = 0.39) compared to the waitlist control. Those using more techniques concurrently showed the strongest decline in BFRB symptoms, even after controlling for days practiced. Participants rated all manuals favorably, with standard DC and HRT yielding greatest acceptability. Discussion Results tentatively suggest the concurrent application of different behavioral treatments for BFRBs leads to add-on effects. Results were superior when DC was practiced first, with positive effects extending to depressive symptoms and quality of life. Integrating the three techniques into one self-help manual or video along with other treatment procedures (e.g., stimulus control techniques) is recommended.

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Recovery from pathological skin picking and dermatodaxia using a revised decoupling protocol

Cited by 12 publications

References 12 publications

Nail-Associated Body-Focused Repetitive Behaviors: Habit-Tic Nail Deformity, Onychophagia, and Onychotillomania

Nail-Associated Body-Focused Repetitive Behaviors: Habit-Tic Nail Deformity, Onychophagia, and Onychotillomania

Skin Biter: Dermatodaxia Revisited

Habit Reversal Training and Variants of Decoupling for Use in Body-Focused Repetitive Behaviors. A Randomized Controlled Trial

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