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Self-Injurious Skin Picking: Clinical Characteristics and Comorbidity
Abstract
BACKGROUND: Repetitive skin picking, a self-injurious behavior that may cause severe tissue damage, has received scant empirical attention. The authors examined the demographics, phenomenology, and associated psychopathology in a series of 31 subjects with this problem. METHOD: Subjects were administered the Structured Clinical Interview for DSM-IV for Axis I and Axis II disorders. They also completed several mood questionnaires and a new self-report inventory designed to assess phenomenology, triggers, cognitions, emotions, and consequences associated with skin picking. RESULTS: The mean age at onset on self-injurious skin picking was 15 years, and the mean duration of illness was 21 years. All subjects picked at more than one body area, and the most frequent sites of skin picking were pimples and scabs (87%). The most common comorbid Axis I diagnoses were obsessive-compulsive disorder (OCD; 52%), alcohol abuse/dependence (39%), and body dysmorphic disorder (32%). Forty-eight percent (N = 15) of the subjects met criteria for at least one mood disorder, and 65% (N = 20) for at least one anxiety disorder. The most common Axis II disorders were obsessive-compulsive personality disorder (48%) and borderline personality disorder (26%). CONCLUSION: Self-injurious skin picking is a severe and chronic psychiatric and dermatologic problem associated with high rates of psychiatric comorbidity. It may be conceptualized as a variant of OCD or impulse-control disorder with self-injurious features and may, in some cases, represent an attempt to regulate intense emotions.
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From Internet-delivered acceptance-based behavior therapy for trichotillomania and skin-picking disorder in a psychiatric setting: A feasibility trial (2022) · cites this paper as Wilhelm et al., 1999
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Metadata
- Authors
- Wilhelm, S., Keuthen, N. J., Deckersbach, T., Engelhard, I. M., Forker, A. E., Baer, L., O'Sullivan, R. L., & Jenike, M. A.
- Affiliations
- Harvard University (US)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 1999-07-15
- Volume
- 60
- Issue
- 7
- Pages
- 454-459
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W1972662442
- Cited by
- 252
- References
- 0
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 9 · 2023: 8 · 2022: 11 · 2021: 9 · 2020: 12 · 2019: 12 · 2018: 8 · 2017: 22 · 2016: 11 · 2015: 14 · 2014: 5 · 2013: 11 · 2012: 15
- FWCI
- 10.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- dermatillomania, obsessive-compulsive disorder, psychiatric comorbidity, obsessive-compulsive personality disorder, borderline personality disorder, impulse control disorders, mood disorders, anxiety disorders, body dysmorphic disorder, alcohol abuse, emotion regulation, phenomenology
- MeSH terms
- Adolescent, Adult, Alcoholism, Anxiety Disorders, Mental Disorders, Female, Humans, Disruptive, Impulse Control, and Conduct Disorders, Male, Middle Aged, Obsessive-Compulsive Disorder, Personality Disorders, Personality Inventory, Psychiatric Status Rating Scales, Skin, Skin Diseases, Somatoform Disorders, Comorbidity, Self-Injurious Behavior, Stereotypic Movement Disorder, Mood Disorders
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