Evaluating the role of Approach-Avoidance Training on action-tendencies in individuals with skin-picking disorder: A preliminary randomized experiment

Background and aimsPathological skin-picking (PSP) or excoriation disorder is a destructive behavior that affects 1-2% of the general population. The purpose of this pilot study was to evaluate the effect of a computerized behavior modification task on action-tendencies (i.e., approach or avoidance) in adults with PSP. We aimed to modify these action-tendencies by having participants with PSP complete the Approach-Avoidance Training (AAT) task, using a joystick to simulate an approach (=pull) or avoidance (=push) response.MethodForty-five participants diagnosed with PSP were randomized to one of three training conditions: (1) Avoidance Training (AvT; n = 15), (2) Approach Training (ApT; n = 15), or (3) Placebo Training (PT; n = 15). We hypothesized that after training, those in the AvT would have the greatest reduction in behavioral approach (i.e., their overall reaction time [RT] to approach pictures of irregular skin stimuli).ResultsResults of the pre-training assessment task revealed a positive correlation between behavioral approach to irregular skin stimuli and skin-picking severity as assessed by the Skin Picking Scale-Revised (SPS-R). After training, a lower behavioral approach and urges to pick were found in the AvT and PT groups, while those in the ApT reported higher behavioral approach and urges to pick. At two-week follow-up, no significant changes on the SPS-R were reported between groups.DiscussionOur preliminary data suggest that the AAT is a promising avenue of research to develop as a cognitive intervention to address an excessive behavioral approach tendency that characterizes skin-picking problems.

Complexities in Obsessive Compulsive and Related Disorders

Obsessive-compulsive and related disorders (OCRDs) have received considerable attention over the past two decades, culminating with the inclusion of a new classification category of “Obsessive-Compulsive and Related Disorders” in the DSM-5. This group of conditions includes obsessive-compulsive disorder along with two newly minted conditions (hoarding disorder and excoriation disorder) and others previously classified as somatoform disorders (body dysmorphic disorder) and impulse control disorders (hair-pulling disorder). In addition, other conditions that are not discussed in the DSM-5 have received attention, such as misophonia and orthorexia nervosa. The implications for research on these conditions, as well as their relations with one another, are significant since their aggregation is based on putative central mechanisms with limited empirical support to date. Indeed, the past decades have seen a dramatic surge in research on OCRDs across several domains, including clinical phenomenology, assessment, and psychological therapies. With these issues in mind, this comprehensive text addresses recent advances in the field of OCRDs, highlighting psychosocial theoretical and intervention approaches. As researchers and clinicians will be increasingly focused on this topic in light of the changes to DSM-5, this book is a timely addition to the literature in guiding clinicians in advances in OCRDs that will impact their practice.

Excoriation Disorder

Excoriation disorder, which is characterized by recurrent and impairing skin picking, has been included as a distinct diagnosis in the most recent version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The move to include excoriation disorder as a separate diagnosis in the DSM-5 was largely due to increasing awareness of its prevalence and the potential for significant impairment and distress. This chapter discusses the nature, clinical presentation, and potential etiological determinants of excoriation disorder. In addition to the nature of symptoms, contemporary approaches to assessment and treatment, including behavioral and pharmacological, are highlighted. The chapter concludes with a discussion of future directions for research.

Dissociative Experiences Mediate the Relationship Between Traumatic Life Events and Types of Skin Picking. Findings From Non-clinical Sample

Aim: Skin-picking (excoriation) disorder is considered as a form of maladaptive coping methods used by individuals who have difficulties in applying more adaptive strategies. Skin-picking development has been suggested to be preceded by traumatic life events. Dissociative symptoms have been reported as experienced by skin-picking sufferers during picking episodes. The purpose of the study was to examine whether the link between trauma and automatic type of skin-picking is mediated by the frequency of dissociative experiences, and whether the COVID-19 pandemic conditions have changed this relationship in any way.Methods: The study sample consisted of 594 adults (76% women) aged from 18 to 60. Traumatic life events, dissociative experiences, and types of skin-picking (focused vs. automatic) were assessed with self-report questionnaires. Mediation analyses and multigroup path analyses were carried out.Results: Dissociative experiences partially mediated the link between traumatic events and both types of skin-picking. The model was robust considering the conditions in which survey was filled out (pre-pandemic vs. pandemic).Conclusions: Traumatic life events and dissociative experiences are associated with both automatic and focused skin-picking regardless of pandemic conditions. Further studies are needed to understand mechanisms underlying the relationship between dissociation and skin-picking styles.

Neurocognitive And Dysfunctional Belief Candidate Endophenotypes Of Obsessive-Compulsive And Related Disorders

Background: The current dissertation examined neurocognitive and dysfunctional belief candidate endophenotypes (CEs) across the obsessive compulsive spectrum to elucidate general versus specific factors. This study included CEs from two etiological perspectives well established in the literature. Secondary analyses examined several CEs multidimensionally and examined the relationship between CEs and of QOL. Methods: A total of 77 participants took part in this study, divided into four groups; OCD (n = 21), Hoarding Disorder (HD; n = 16), Grooming Disorders which included both Trichotillomania and Excoriation Disorder (GD; n = 18), and control participants (n = 22). Participants completed a clinical interview and battery of neurocognitive tasks and questionnaires. Results: Those with HD performed worse than controls on measures of response inhibition and set-shifting. OCD continued to predict significant variance in number sequencing. Examination of dysfunctional belief CEs revealed specificity of Responsibility/Threat beliefs and Importance/Control of Thoughts beliefs to OCD. Perfectionism/Intolerance of Uncertainty appear to be broad CEs; however, differing specificity emerged depending on the measure utilized to measure the construct. Self-report indecision revealed specificity to OCD and HD. Differing patterns of QOL impairments emerged across the spectrum. A better understanding of CEs specificity has implications for diagnostic classification, etiology, course, and treatment.

Neurocognitive And Dysfunctional Belief Candidate Endophenotypes Of Obsessive-Compulsive And Related Disorders

Background: The current dissertation examined neurocognitive and dysfunctional belief candidate endophenotypes (CEs) across the obsessive compulsive spectrum to elucidate general versus specific factors. This study included CEs from two etiological perspectives well established in the literature. Secondary analyses examined several CEs multidimensionally and examined the relationship between CEs and of QOL. Methods: A total of 77 participants took part in this study, divided into four groups; OCD (n = 21), Hoarding Disorder (HD; n = 16), Grooming Disorders which included both Trichotillomania and Excoriation Disorder (GD; n = 18), and control participants (n = 22). Participants completed a clinical interview and battery of neurocognitive tasks and questionnaires. Results: Those with HD performed worse than controls on measures of response inhibition and set-shifting. OCD continued to predict significant variance in number sequencing. Examination of dysfunctional belief CEs revealed specificity of Responsibility/Threat beliefs and Importance/Control of Thoughts beliefs to OCD. Perfectionism/Intolerance of Uncertainty appear to be broad CEs; however, differing specificity emerged depending on the measure utilized to measure the construct. Self-report indecision revealed specificity to OCD and HD. Differing patterns of QOL impairments emerged across the spectrum. A better understanding of CEs specificity has implications for diagnostic classification, etiology, course, and treatment.