title: A systematic review and meta-analysis of psychiatric treatments for excoriation (skin-picking) disorder.
abstract: While individual trials suggest benefit of interventions for excoriation (skin-picking) disorder (ExD), limited systematic evaluation of treatments, or their collective benefit, exists.
  
  
  
  The present study examined the current state of treatments for ExD in a systematic review and meta-analysis and explored potential treatment moderators. Twelve trials were identified for review, including five with a control condition. Of these, nine were eligible to be included in the meta-analysis (three with a control).
  
  
  
  A fixed-effects meta-analysis found a large overall treatment effect size (g=1.13), comprised of large effects for behavioral treatments (g=1.19), lamotrigine (g=0.98) and selective serotonin reuptake inhibitors (g=1.09). Clinician-rated measures did not significantly differ from self-rated measures; however, larger effects were observed on self-rated measures of severity, as compared to impairment [Q(1)=4.63, P=.03]. Treatment type, trial length and trial methodological quality were not significant moderators. For controlled trials, the comparative efficacy of treatments for ExD was in the moderate range (g=0.47).
  
  
  
  Findings suggest that treatment for ExD has benefit; however, the meta-analysis did not provide strong evidence to support any specific treatment or to suggest its unique clinical benefit over control conditions. Overall, there is a lack of study on treatments for ExD and additional randomized controlled trials with inclusion of multiple informants in assessment is needed.
authors.affiliation: Department of Psychology, University of South Florida, Tampa, FL. Electronic address: rselles@mail.usf.edu.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Selles
authors.affiliation: Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: McGuire
authors.affiliation: School of Aging Studies, University of South Florida, Tampa, FL.
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Small
authors.affiliation: Department of Psychology, University of South Florida, Tampa, FL; Department of Pediatrics, University of South Florida, St. Petersburg, FL; Department of Health Policy and Management, University of South Florida, Tampa, FL; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL; Rogers Behavioral Health - Tampa Bay, Tampa, FL; All Children's Hospital - Johns Hopkins Medicine, St. Petersburg, FL.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Storch
mesh_terms: D001521:Behavior Therapy / Q000379:methods*; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000188:drug therapy / Q000628:therapy*; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use*; D006801:Humans; D016728:Self-Injurious Behavior / Q000188:drug therapy / Q000628:therapy*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012867:Skin / Q000293:injuries*
chemical_list: D018691:Excitatory Amino Acid Antagonists; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Behavioral treatment; Excoriation disorder; Pharmacological treatment; Therapy