When to Choose Paroxetine Treatment in Skin-Picking Disorder: A Case Report

Skin picking disorder (SPD) characterized by repetitive compulsive scratching in the absence of a primary skin disease is strongly associated with psychiatric comorbidities, including obsessive-compulsive disorder (OCD) and depression (MDD). Selective serotonin reuptake inhibitors (SSRIs) have been used in the treatment of SPD with variable success. Nevertheless, the optimum treatment choice for SPD is an issue for clinicians. This case report presents a 32-year-old female SPD patient treated with four-week paroxetine monotherapy. Based upon the clinical interview and standardized questionnaires, the patient was diagnosed with OCD with depressive features and Skin Picking Disorder. In addition to symptom severity scales, quantitative electroencephalography (qEEG) was also applied. Paroxetine treatment was started (titrated from 5 to 40 mg/day) and doubled each week. After four-week paroxetine monotherapy, OCD symptoms were diminished, and skin lesions were completely regressed leaving solely post inflammatory hyperpigmentation. Post-treatment qEEG assessment also showed a normalization of frontal alpha power and amplitude asymmetry. It can be concluded that if OCD includes SPD with abnormal EEG patterns; then the treatment success using paroxetine will be very high.

Skin Picking in Atopic Dermatitis and Psoriasis Patients: A Single-centre Cross-sectional Study in China

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Nutrition in Skin Picking Disorder and Trichotillomania

Objective: Excessive calorie intake constitutes a global public health concern, due to its associated range of untoward outcomes. Impulsivity and compulsivity have been linked to dietary intake. However, nothing is known about dietary intake and body-focused repetitive behaviors, despite their classification as obsessive-compulsive related conditions, and high co-morbidity with impulsive and compulsive conditions.Methods: One hundred and ninety six adults with trichotillomania or skin picking disorder were recruited. Dietary intake over the preceding year was quantified using the Dietary Fat and Free Sugar Short questionnaire. Relationships between dietary fat/sugar intake and behaviors were evaluated using regression modeling.Results: Sugar intake was significantly related to higher trans-diagnostic compulsivity (p = 0.011) and higher non-planning impulsivity (p = 0.013) In terms of saturated fat intake, there was no significant relationship to the explanatory variables. A combination high fat/high sugar diet was significantly associated with higher motor impulsivity (p = 0.005).Conclusions: Past-year nutrition appears to be significantly associated with trans-diagnostic impulsivity and compulsivity. The role of poor nutrition in these disorders and related conditions, and its link with impulsivity and compulsivity, requires longitudinal research attention; and clinical work should address not only psychiatric symptoms but also impact of lifestyle of overall health.

Pathological Skin Picking: Phenomenology and Associations With Emotions, Self-Esteem, Body Image, and Subjective Physical Well-Being

Pathological skin picking (PSP) refers to the repetitive manipulation of the skin causing wounds, scars, emotional distress, and social impairment. Skin picking disorder was first recognized as a distinct disorder in the DSM-5 and is still understudied in terms of phenomenology, etiology, and associated consequences. However, the body-related pathology suggests that the relation to the own body might be a crucial factor in PSP. Previous studies provided first insights that affected individuals show a more negative body image and lower self-esteem than healthy individuals. The present study sought to investigate skin picking phenomenology, related emotions as well as associations with self-esteem, body image, and subjective physical well-being. The study was conducted as an open online study, and recruitment was generally targeted to individuals of full age and in addition specifically to individuals with PSP. A total of 363 individuals (82.9% female; age: M = 32.6, SD = 13.92) participated and answered various self-report measures. Nearly half of the sample exceeded the cutoff score for pathological skin picking (N = 163; 44.9%). The results suggest that boredom, bodily tension and strong negative feelings often precede PSP episodes. During the episode most individuals seem to experience a loss of control, trance and positive feelings. After the PSP episode, shame, guilt, anger and anger toward themselves are most prominent. As expected, skin picking severity was positively associated with body image disturbances and negatively with self-esteem, and subjective physical well-being. When controlling for depressive symptoms, all associations were reduced, but those with body image disturbances (r = 0.44; p < 0.001), self-esteem (r = −0.27; p < 0.001), subjective physical well-being (r = −0.22; p < 0.001), and peace of mind (r = 0.30; p < 0.01) remained significant. Moreover, greater skin damage due to skin picking was moderately associated with higher body image disturbances. The results indicate that PSP severity is associated with a negative body image and low self-esteem, and suggest that it may be warranted to consider these aspects in the development of future interventions for PSP. However, relations with body image and self-esteem should be examined in longitudinal studies investigating causal relationships between body image, self-esteem and skin picking. Moreover, PSP phenomenology and the role of specific emotions should be investigated in more detail.