Motor inhibition and cognitive flexibility in pathologic skin picking (original) (raw)
Related papers
Motor Inhibition and Cognitive Flexibility in Obsessive-Compulsive Disorder and Trichotillomania
American Journal of Psychiatry, 2006
Problems with inhibiting certain pathological behaviors are integral to obsessive-compulsive disorder (OCD), trichotillomania, and other putative obsessive-compulsive spectrum disorders. The authors assessed and compared motor inhibition and cognitive flexibility in OCD and trichotillomania for the first time, to their knowledge. Method: The Stop-Signal Task and the Intradimensiona/Extradimensional Shift Task were administered to 20 patients with OCD, 17 patients with trichotillomania, and 20 healthy comparison subjects. Results: Both OCD and trichotillomania showed impaired inhibition of motor responses. For trichotillomania, the deficit was worse than for OCD, and the degree of the deficit correlated significantly with symptom severity. Only patients with OCD showed deficits in cognitive flexibility. Conclusions: Impaired inhibition of motor responses (impulsivity) was found in OCD and trichotillomania, whereas cognitive inflexibility (thought to contribute to compulsivity) was limited to OCD. This assessment will advance the characterization and classification of obsessive-compulsive spectrum disorders and aid the development of novel treatments.
Motor inhibition and cognitive flexibility in eating disorder subtypes
Progress in Neuro-psychopharmacology & Biological Psychiatry
Background: Individuals with pathologic skin picking (PSP) often report significant difficulty resisting the urges and drive to engage in picking behavior. Studies have shown significant inhibitory deficiencies (i.e. increased impulsivity) in subjects with other putative obsessive-compulsive spectrum disorders, such as trichotillomania, using objective tests. This study sought to assess motor inhibitory control and aspects of cognitive flexibility in a sample of individuals with PSP. Method: Twenty subjects with PSP (mean age 33.1 ± 14.3 years; 85% female) and 20 healthy controls (mean age 31.6 ± 9.1 years; 85% female) underwent cognitive assessments using the Stop-signal and Intradimensional/Extra-dimensional (ID/ED) set-shift tasks. Groups were matched for age, gender, and education. Results: PSP was associated with significantly impaired stop-signal reaction times but intact ID/ED cognitive flexibility compared to controls. Measures of disease severity in the PSP subjects did not covary significantly with stop-signal performance. Conclusion: The finding of impaired inhibitory control but intact set-shift cognitive flexibility draws remarkable parallels with findings in trichotillomania but differs from obsessive compulsive disorder. These findings have important implications for understanding potential neurobiological dysfunction in PSP, how the disorder should be classified, and suggest new potential treatment directions.
Depression and Anxiety, 2000
In DSM-IV-TR, trichotillomania (TTM) is classified as an impulse control disorder (not classified elsewhere), skin picking lacks its own diagnostic category (but might be diagnosed as an impulse control disorder not otherwise specified), and stereotypic movement disorder is classified as a disorder usually first diagnosed in infancy, childhood, or adolescence. ICD-10 classifies TTM as a habit and impulse disorder, and includes stereotyped movement disorders in a section on other behavioral and emotional disorders with onset usually occurring in childhood and adolescence. This article provides a focused review of nosological issues relevant to DSM-V, given recent empirical findings. This review presents a number of options and preliminary recommendations to be considered for DSM-V:
Child Psychiatry & Human Development, 2012
Body-focused repetitive behavior (BFRB) is an umbrella term for debilitating, repetitive behaviors that target one or more body regions. Despite regularly occurring in youth, there has been limited investigation of BFRBs in pediatric populations. One reason for this may be that there are few reliable and valid assessments available to evaluate the presence, severity and impairment of BFRBs in youth. Given the shift toward evidencebased assessment in mental health, the development and utilization of evidence-based measures of BFRBs warrants increasing attention. This paper examines the available evidence-base for assessments in youth across three BFRB-related disorders: compulsive skin picking, chronic tic disorders and trichotillomania. Based upon present empirical support in samples of youth, recommendations are made for an evidence-based assessment of each condition.
Journal of Behavior Therapy and Experimental Psychiatry, 2012
Background and objectives: Implicit cognitive processes are relevant in understanding the development and maintenance of psychopathology and dysfunctional behaviours. The present study investigated the role of implicit processes in pathological skin picking (PSP). Methods: Using an ApproacheAvoidance Task (AAT), we examined automatic response tendencies towards skin picking-related photographs in a sample of 34 college students who suffered from PSP and participated in a randomized, waiting-list controlled treatment study. Results: In comparison to a control sample (n ¼ 49), PSP patients displayed significantly decelerated reaction times (distraction) in response to photographs of skin irregularities and a tendency to respond with avoidance to photographs of skin irregularities. Both distraction and avoidance in reaction to photographs of skin irregularities were significantly associated with current skin picking severity. Moreover, the strength of distraction in response to skin irregularities predicted unique variance in skin picking severity at post-measurement, over and above the effect of skin picking severity at premeasurement and the effect of treatment condition. For the treatment condition, higher initial distraction predicted better treatment outcome (lower skin picking severity at post-measurement), whereas it predicted symptom deterioration at post-treatment for untreated participants. Limitations: The specific characteristics of PSP patients (mainly female university students) and the relatively small sample size may compromise generalizability of findings. Conclusions: In PSP, affective distraction in response to skin irregularities seems to characterize an important process related to symptom severity as well as treatment susceptibility.