Self-injurious skin picking: clinical characteristics and comorbidity.
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.


METHODS
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%).


CONCLUSIONS
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.
Wilhelm
S
S
Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, USA. wilhelm@psych.mgh.harvard.edu
Keuthen
N J
NJ
Deckersbach
T
T
Engelhard
I M
IM
Forker
A E
AE
Baer
L
L
O'Sullivan
R L
RL
Jenike
M A
MA
D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000453:epidemiology; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000453:epidemiology; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology; D010555:Personality Inventory; D011569:Psychiatric Status Rating Scales; D016728:Self-Injurious Behavior / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D012867:Skin / Q000293:injuries*; D012871:Skin Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology; D019956:Stereotypic Movement Disorder / Q000175:diagnosis / Q000453:epidemiology