MHM Magazine

Issue 61 | 2022 | MENTAL HEALTH MATTERS | 33 MHM imaging studies that do exist, havesuggested some involvement of the cortico-striatal-thalamic- cortical circuitry, with other regions also appearing to be implicated. Data from different perspectives (animal data, and neurobiological investigations in humans) have also suggested that the dopaminergic system plays a role in SPD. There is evidence from twin and family studies of some heritability, and strong relationships with OCD and the other BFRBDs. Neurobiological investigations have also highlighted preliminary findings of the involvement of a number of interesting candidate genes in SPD, including SAPAP3. Genome-wide association studies have however not yet been undertaken in SPD. IMPACT OF SPD The clinical impact of the disorder is considerable. Individuals with SPD often spend a significant amount of time on repetitive picking and/or camouflaging of skin lesions. This can take up several hours per day in severe cases, leading them to be late for or to miss school, work, appointments, or social activities. There may be various psychosocial sequelae, such as social embarrassment, shame, avoidance of situations or activities where skin lesions can be detected, and loss of productivity in multiple settings. Skin-picking behaviours may also lead to poor self-esteem, anxiety, and depression. Infections, lesions, scarring, and in severe cases, physical disfigurement, are some of the possible medical sequelae of SPD. Moreover, SPD is associated with substantial comorbidity, with trichotillomania being the most common. OCD and body dysmorphic disorder are also more prevalent in people with SPD than in the general population. SCREENING / ASSESSMENT A reliable and valid scale is the 10- item, clinician-administered Yale– Brown Obsessive Compulsive Scale, modified for Neurotic Excoriation (NE-YBOCS), and adapted for DSM- 5. The NE-YBOCS is used to assess the severity of SPD symptoms during the preceding seven days. There are several self-report scales. One of the most widely used instruments for the assessment of SPD is the 8-item, self-report Skin Picking Scale - Revised (SPS-R), a psychometrically sound measure of current SPD severity, with reliable and valid subscales assessing symptom severity and impairment (Snorrason et al., 2012). The Skin Picking Symptom Assessment Scale (SP-SAS) is a 12-item, self- report measure evaluating picking urges, thoughts, and behaviours during the previous week. The SP-SAS has demonstrated good reliability and validity. And finally, the Milwaukee Inventory for the Dimensions of Adult Skin picking (MIDAS) is a 12-item self-report measure with good psychometric qualities, designed to assess "automatic" and "focused" skin- picking. On all of these scales, higher scores reflect greater severity of skin picking symptoms. MYTH OR FACT? MYTH FACT Everyone is stressed or disturbed by their skin-picking behaviours. Not everyone is distressed by skin-picking behaviours. In fact, it’s not uncommon for people to occasionally pick their skin (pimples, scans, healthy skin).  Some people believe that skin- picking is just a nasty habit. The truth is that skin picking may be severely distressing and functionally impairing, and in those instances considered a psychiatric disorder with multiple causes. It can be serious, and is associated with comorbidities, impairment, and reduced quality of life. Skin-picking is a manifestation of OCD. No, SPD is not OCD, but it is an OCRD, and sometimes people may pick to make things symmetrical – which resembles some OCD. Skin-picking is a form of self-harm or non-suicidal self- injury. Although it may be harmful to the picker, it’s not considered a self-harm disorder or non-suicidal self-injury disorder (which is often associated with cutting). SPD results from or is caused by a dermatological condition. SPD may lead to skin problems or may follow after developing acne, but is not in itself caused by dermatological abnormalities. There is no treatment for SPD. There are ways of addressing SPD, including psychoeducation, psychotherapy, and pharmacotherapy. DSM-5 DIAGNOSTIC CRITERIA FOR SPD: ALL OF THE FOLLOWING CRITERIA MUST BE MET 1. Recurrent skin picking that results in skin lesions 2. Repeated attempts to stop the behaviour 3. The symptoms cause clinically significant distress or impairment 4. The symptoms are not caused by a substance or a medical or dermatological condition 5. The symptoms are not better explained by another psychiatric disorder