MHM Magazine

32 | MENTAL HEALTH MATTERS | Issue 1 | 2022 MHM be regarded as separate entities, or whether they are different manifestations of the same underlying tendency, is yet to be determined. Diagnostic criteria of SPD include recurrent picking of skin, resulting in skin lesions, repeated attempts to decrease or stop the behaviour, and significant distress or impairment in social, occupational, or other important domains of functioning. It may be assumed that inclusion of SPD in the diagnostic manuals have led to growing scientific attention and vice versa. Skin-picking behaviours often resemble a grooming ritual where the person initially scans their skin - either visually by looking into the mirror, or with their hands, in an attempt to identify sites to be picked. The goal of picking is usually to smoothen the skin or to make it “perfect”, by removing blemishes, scabs, loose skin, or bumps. This often has the opposite effect however, with picking resulting in bruising, bleeding, disfigurement, infection, and in some cases, permanent tissue damage. Notably, people pick from anywhere on their bodies, most commonly facial skin, followed by the hands, fingers, arms, and legs, and most have multiple picking sites. Skin-pickers may also pick from healthy skin and minor skin irregularities. Generally, people use their fingers or fingernails to pick or squeeze their skin, but more than half of skin-pickers also use implements such as tweezers or pins whilst picking. People who pick may have a range of behaviours associated with skin-picking, for example, finding a particular scab, picking at it in a specific way, and examining, playing, and/or mouthing or swallowing the scab once it’s picked. Some people report their picking occurs out of awareness (automatic picking), whereas others pick their skin more intentionally while being aware of these episodes (focused picking), and some report both types of picking (mixed). “Automatic” picking includes picking in situations in which an individual is engaged in a sedentary activity, such as watching television or reading. “Focused” picking may happen when the picker consciously picks in response to an urge or perhaps a negative emotion, or in an attempt to correct perceived imperfections. Finally, people who pick, report multiple skin-picking triggers , which may vary from individual to individual, and commonly include negative emotions such as stress, anger, and anxiety. Sedentary activities (as noted above), boredom and feeling tired are also associated with picking. EPIDEMIOLOGY SPD is a relatively common mental health condition. In a recent epidemiologically representative community sample of 10,169 people, it was found that SPD had a point prevalence of 2.1%, and lifetime prevalence of ~3.1%. This rate is similar to that found in previous community-recruited samples with much smaller sample sizes. Interestingly, in comparison to other disorders with similar prevalence such as OCD, it has received very little research study. Females more often present with SPS than males (but the ratio is more even than in the case of trichotillomania where the majority of hair-pullers are female). SPD occurs at any age, but skin- picking behaviours typically start adolescence, coinciding with the onset of puberty. Dermatological conditions such as acne or eczema may trigger the onset of SPD. HOW DOES IT WORK? WHAT ARE THE CAUSES OF SPD? In the neuropsychologic literature, motor impulsivity has been suggested to be involved in SPD, like OCD. The very few brain Author Lanchon, 2017-08-09, Image: "Excoriation disorder affecting face” (https://en.wikipedia.org/wiki/File :Excoriation_disorder_affecting_face.jpg) This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 License. Author User:Sexyboricuapr, Unknown, Image: "Dermatophagia” (https://commons.wikimedia.org/wiki/ File:Dermatophagia_2014-03-29_21-50. jpg). This file is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.