JMIR Publications

ABSTRACT

Background:

Skin picking disorder (SPD) is an understudied mental illness that is classified in the category of body-focused repetitive behavior disorders (BFRBDs). Literature suggests that pathological skin picking is strongly integrated into the daily lives of affected individuals and may involve a high degree of variability in terms of episode characteristics, frequency, and intensity. However, existing data on the phenomenology of SPD are limited and typically involve retrospective assessments which may fail to accurately capture the variability of behavior.

Objective:

The objective of the present study was to investigate skin picking in the daily lives of individuals suffering from SPD by using ecological momentary assessment (EMA). The first aim focused on the description of skin picking patterns (e.g., characteristics, intensity, and distribution of episodes and urges) and the second aim was to explore differences in characteristics and patterns between automatic and focused skin picking.

Methods:

Participants were recruited online and underwent an online screening, a diagnostic telephone interview, and a comprehensive online self-report questionnaire before participating in an EMA protocol. The latter included ten consecutive days with 7 pseudo-random time contingent assessments per day between 8am and 10pm. The EMA questionnaire assessed the current skin picking urge, occurrence of the behavior, and a detailed assessment of the episodes’ characteristics (e.g., length, intensity, consciousness) if applicable.

Results:

The final sample consisted of 57 participants, who completed at least 70 % of the scheduled assessments (94.7 % female, mean age: M = 29.3; SD = 6.77). In total, participants completed 3,758 EMAs and reported 1,467 skin picking episodes. The results showed that skin picking occurred frequently (M = 2.57; SD = 1.12 episodes per day and person) in relatively short episodes (1-30 min) and it was distributed quite evenly throughout the day and across different days of the week. Focused and automatic episodes were relatively balanced across all reported episodes (focused episodes: 54.9 %) and over the course of the day. The analyses showed statistically significant differences between self-reported triggers for the two styles. Visual and tactile cues, and the desire to pick the skin were more important for the focused style, while boredom and concentration problems were more prominent in automatic skin picking (SMD = 0.31-0.82).

Conclusions:

The current results contribute to an enhanced understanding of the phenomenology of SPD using a more rigorous assessment methodology. Our findings underscore that picking can impact affected persons multiple times throughout their daily life. Clinical Trial: German Clinical Trials Register: DRKS00025168