Reducing Skin Picking via Competing Activities (original) (raw)
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Research in Developmental Disabilities, 2010
Skin-picking is a type of self-injurious behavior involving the pulling, scratching, lancing, digging, or gouging of one's own body. It is associated with social impairment, and increased medical and mental health concerns. While there are several reports showing that skin-picking is common in individuals with developmental disabilities, knowledge about effective treatment approaches is sparse. We therefore reviewed studies involving the treatment of chronic skin-picking in individuals with developmental disabilities. Systematic searches of electronic databases, journals, and reference lists identified 16 studies meeting the inclusion criteria. These studies were evaluated in terms of: (a) participants, (b) functional assessment procedures and results, (c) intervention procedures, (d) results of the intervention, and (e) certainty of evidence. Across the 16 studies, intervention was provided to a total of 19 participants aged 6-42 years. Functional assessment procedures included direct observations, analog functional analyses, and functional assessment interviews. The most commonly identified function was automatic reinforcement. Treatment approaches included combinations of differential reinforcement, providing preferred items and activities stimuli (e.g., toys), wearing protective clothing (e.g., helmets or gloves), response interruption and redirection, punishment, and extinction. Improvements in behavior were reported in all of the reviewed studies. Suggestions for future intervention research are offered.
Skin Picking Phenomenology and Severity Comparison
The Primary Care Companion to The Journal of Clinical Psychiatry, 2008
Prim Care Companion J Clin Psychiatry 2008;10(4) 307 PSYCHIATRIST.COM ited existing literature about the theoretical and phenomenological aspects of this behavior. In our clinical experience, as a behavior, skin picking can range greatly in its severity, level of interference, degree of pathology, and functionality. Moreover, skin picking is often a cause of substantial distress and embarrassment for many individuals. Unfortunately, many patients with skin picking often fail to report it, believing it to be unrelated to therapeutic issues. Consequently, skin picking often goes undiagnosed and thus untreated. Therefore, the purpose of the present study is 2-fold. First, unlike patients in previous psychiatric studies, individuals in the present sample had forms of skin picking that ranged from mild to severe. Therefore, the authors examined whether individuals with mild skin picking differed in their presentation of picking behavior (e.g., emotional experiences related to the picking) from individuals with severe skin picking. It is important to study the broad spectrum of skin picking because the knowledge obtained may be helpful in understanding the course of this behavior as well as assist in preventing the exacerbation of picking once it begins. Furthermore, the distinction between mild and severe skin picking may also help in the resolution of existing diagnostic categorization issues around this symptom as well as help generate more efficacious treatment recommendations.
Psychosomatics, 2000
The prevalence of skin-picking and its associated characteristics were documented in a nonclinical sample of 105 college students. Subjects completed a self-report skin-picking inventory and several paper-and-pencil scales. Students who endorsed skin-picking were compared to a clinical sample of self-injurious skin-pickers (n)13ס reported on previously. Of the student subjects, 78.1% (n)28ס endorsed some degree of skin-picking and four subjects satisfied criteria for severe, self-injurious picking. Student subjects significantly differed from the clinical sample of selfinjurious skin-pickers in the duration, focus, and extent of picking, techniques used, reasons for picking, associated emotions, and picking sequelae.
Journal of Anxiety Disorders, 2011
The current study examined the characteristics of pathological skin picking (PSP) in a population-based sample. Participants were recruited through several online resources for PSP and related conditions to complete a web-based survey assessing the functional and topographical phenomenology, physical and psychosocial impact, treatment utilization, and associated psychopathology of PSP. A total of 1663 participants consented, of whom 760 were over 18 and met study criteria for PSP. Results showed considerable heterogeneity in picking methods, body sites, and function (e.g., regulation of emotional, sensory, and cognitive states). Participants generally reported moderate psychosocial and physical impact from picking and tended to perceive available treatment as poor in quality. Severity of associated symptoms of psychopathology (depression, anxiety, and stress) was comparable to severity levels found in previous samples of persons with trichotillomania and obsessive-compulsive disorder. Severity of PSP was a statistically significant predictor of overall impairment after controlling for depression and anxiety symptoms. Results suggest that PSP is a significant public health concern in need of further rigorous investigation.
Old Habits Die Hard: Treating a Woman With a 20-Year Severe Case of Skin Picking Disorder
Clinical Case Studies, 2011
This article describes the course of treatment for a 55-year-old woman presenting with a particularly challenging case of skin picking disorder. Treatment consisted of five phases (psychoeducation, habit-reversal training, cognitive training, exposure, and relapse prevention), over an 11-month period, in which each new phase built on to the previous phase. Digital photos of wounds resulting from skin picking were also taken during treatment. Several sources of information (continuous self-monitoring, rating scales, self-report, photos) indicated significant treatment gains, especially following Phases 3 and 4. Several challenges were encountered, most notably designing exposure-based techniques that were tailored to match the client's needs and content of symptoms. Several treatment implications are discussed, including tailoring manualized treatments, managed care concerns, and suggestions for clinicians and supervisors. Taken together, this study adds to the scant literature on treatment of skin picking in older, typically developing adults.
The Skin Picking Scale-Revised: Factor structure and psychometric properties
Journal of Obsessive-Compulsive and Related Disorders, 2012
The Skin Picking Scale (SPS; ) is a 6-item self-report measure of skin picking disorder (SPD) severity. The current study reports on a psychometric evaluation of a revised eight-item version of the scale (the Skin Picking Scale-Revised; SPS-R). Participants were 652 responders to an Internet survey who met criteria for SPD. Exploratory and confirmatory factor analyses revealed two factors, one assessing impairment and the other symptom severity (4 items each). Both factors demonstrated high internal consistency and convergent/concurrent and discriminant validity. Potential advantages of the SPS-R compared to the original version include elimination of an ambiguous item, improved psychometric properties (e.g. clearer factor structure), and a more comprehensive assessment of the SPD symptom profile.
Clinical Case Studies, 2011
Skin picking is common in individuals with Prader-Willi Syndrome (PWS) but few treatment studies exist. This study reports the successful functional behavioral assessment (FBA) and treatment of skin picking in a 16-year-old female with PWS. A treatment package based on FBA results consisted of differential reinforcement for alternative and incompatible behavior, selfevaluation of progress, and reinforcement for weekly progress and participation in treatment. Pictures of wounds resulting from skin picking were taken during treatment. A total of 30 pictures were randomly selected and shown in a random order to 16 individuals unfamiliar with the study. The individuals then rated severity of the wounds displayed in the pictures. Pearson's c 2 was used to assess changes in the ratings of severity during the course of treatment, and significant results indicate improvement over the course of intervention, c 2 (1) = 246.6, p < .001. This study adds to the very small literature on treatment of skin picking in people with PWS.