Clinical characteristics and medical complications of pathologic skin picking

• Published in: General hospital psychiatry Vol. 30; no. 1; pp. 61 - 66
• Main Authors: Odlaug, Brian L., Grant, Jon E.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2008; Elsevier Science
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Biological and medical sciences; Female; Humans; Interview, Psychological; Male; Medical sciences; Mental Disorders; Middle Aged; Miscellaneous; Neurotic excoriation; Obsessive-Compulsive Disorder - complications; Obsessive-Compulsive Disorder - pathology; Pathologic skin picking; Psychiatry; Psychogenic excoriation; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Severity of Illness Index; Skin - injuries; Stereotypic Movement Disorder - complications; Stereotypic Movement Disorder - pathology; United States; United States; Pathologic skin picking; Psychogenic excoriation; Neurotic excoriation; Human; Impulse control disorder; Scar; Clinical form; Infection; Phenomenology; Concomitant disease; Mental disorder; Complication; Diagnosis; Ulceration
• ISSN: 0163-8343; 1873-7714
• DOI: 10.1016/j.genhosppsych.2007.07.009

This study sought to detail the phenomenology and medical consequences of pathologic skin picking (PSP). Sixty subjects (11.7% males) with PSP (mean±S.D.=33.7±11.6 years) were assessed. Subjects seen in a pharmacological study as well as those from an ongoing outpatient longitudinal study comprised this sample. Subjects were assessed for current and lifetime psychiatric comorbidity (using the Structured Clinical Interview for DSM-IV Axis I Disorders), clinical severity (using the Clinical Global Impression — Severity scale) and psychosocial interference due to picking (using the Sheehan Disability Scale). Clinical characteristic data, including time spent picking per day, sites picked and medical complications directly resulting from skin picking behavior, as well as family history, were also obtained. The mean age (±S.D.) of onset for PSP was 12.3±9.6 years. The face was the most common area picked. Subjects reported picking a mean of 107.6 min each day. Scarring, ulcerations and infections were common. Few had ever sought psychiatric treatment for their behavior. Current comorbid Axis I psychiatric conditions were found in 38.3% of the sample. Trichotillomania (36.7%), compulsive nail biting (26.7%), depressive disorder (16.7%) and obsessive–compulsive disorder (15%) were the most common current comorbid conditions. PSP appears to be time consuming and frequently associated with medical complications. Research is needed to optimize patient care for individuals with this behavior.