Examining Heightened Sense of Incompleteness as a Candidate Endophenotypic Marker for Skin Picking Disorder

Excoriation (skin-picking) disorder (SPD) shares genetic underpinnings with obsessive-compulsive disorder, and the phenomenology of both disorders is characterized by heightened sense of incompleteness or “not just right” experiences. The aim of the study was to examine if a general tendency for heightened sense of incompleteness (trait incompleteness) can serve as an endophenotypic maker of SPD. Individuals with SPD (n=32) and matched healthy controls (n=42) completed two validated self-report measures of trait incompleteness and rated photographs designed to evoke a sense of incompleteness. Additionally, unaffected first-degree relatives of the SPD group (n=18) and the control group (n=22) completed the same set of measures. The results showed that scores on all the trait incompleteness measures were significantly higher in the SPD group compared to the control group. However, the relatives of the SPD group did not show elevated scores on the incompleteness measures, compared to the control relatives. These data suggest that even though trait incompleteness is a correlate of SPD diagnosis, it does not co-segregate with SPD in families and is therefore not a promising candidate endophenotype for SPD

Are Nonclinical Obsessive-Compulsive Symptoms Associated with Bias Toward Habits?

In a sample of student volunteers (N=93), we found that obsessive-compulsive symptoms (although not hoarding) were associated with overreliance on stimulus-response habits at the expense of goal-directed control during instrumental responding. Only checking symptoms were associated with bias toward habits after negative affect was controlled for. Further research is warranted to examine if overreliance on habits represents an aberrant learning process that confers risk for obsessive-compulsive psychopathology

Do daily mood fluctuations activate ruminative thoughts as a mental habit?:Results from an ecological momentary assessment study

It has been suggested that mental habits may underpin a heightened disposition to engage in rumination in response to negative mood. The aim of the current study was to assess the role of habit in the dynamic interplay between affect and ruminative thinking in the flow of daily life experiences. Using mobile ecological momentary assessment, 97 participants recorded affect and rumination ten times daily over six days, after completing measures of trait ruminative brooding and habitual characteristics of negative thinking (e.g. automaticity, lack of conscious awareness, intent and control). Momentary fluctuations in negative (increased) and positive (decreased) affect was prospectively associated with greater rumination-levels at the next sampling occasion. The degree to which affect triggered a subsequent ruminative response was moderated by habitual characteristics of negative thinking in a theoretically consistent way. Stronger temporal pairing of negative affect and rumination was also associated with greater emotional inertia but less carry-over of rumination from one moment to the next. Depression vulnerability may be in the form of rumination being habitually triggered in response to momentary fluctuations in affect, with deleterious effect on mood. The findings may have clinical implications, as targeting the habitual nature of rumination might help reduce depression vulnerability

Validation and psychometric properties of the Polish version of the Skin Picking Scale-Revised

The Skin Picking Scale-Revised (SPS-R) is an 8-item self-report measure of skin picking behaviors. It includes two subscales related to skin picking symptom severity and picking-related impairments. The study aimed to assess the psychometric properties of the Polish version of the SPS-R in a sample of adults reporting skin picking. The sample of 764 participants was recruited from the general population through an online survey. Among them, 159 meet the criteria of pathological skin picking applied in the original SPS-R validation study, and 57 endorsed all of the DSM-5 criteria for excoriation disorder. The SPS-R was back-translated into Polish. Factor structure, reliability, convergent and divergent validity, and diagnostic accuracy were assessed. Confirmatory factor analyses revealed a two-factor structure of the scale. High internal consistency and convergent and divergent validity were confirmed for the total score as well as for the subscales. High prognostic ability of the SPS-R total score was also demonstrated using ROC analysis: ≥5 was accepted as an optimal cut-off point for distinguishing skin picking sufferers from healthy controls. The Polish version of the SPS-R shows good psychometric properties and appears to be a reliable measure of skin picking symptoms and picking-related impairment

Body-Focused Repetitive Behaviors and Non-Suicidal Self-Injury: A Comparison of Clinical Characteristics and Symptom Features

Body-focused repetitive behaviors (BFRBs) and non-suicidal self-injury (NSSI) are recognized as distinct categories in the DSM-5. However, definitions and assessment of NSSI sometimes encompasses behaviors similar to BFRBs, and little data exist about their clinical differences. The current study examined clinical characteristics and symptom features associated with NSSI vs. BFRBs. The current sample included 1523 individuals who endorsed moderate to severe NSSI (n = 165) or BFRBs: hair pulling group (n = 102), skin picking group (n = 216), nail picking group (n = 253), nail biting group (n = 487), and cheek biting group (n = 300). Responders were asked to complete questionnaires on clinical features relevant for BFRBs and NSSI. NSSI and BFRBs had significant differences on several clinical features. Individuals in the NSSI group were more likely than individuals with BFRBs to report engaging in the behavior for social-affective reasons (i.e., to get out of doing something, or receive attention from others). Individuals in the NSSI group were also more likely to engage in the behavior to regulate tension and feelings of emptiness, and to experience relief during the act. In contrast, individuals in the BFRB groups were more likely to engage in the behavior automatically without reflective awareness, to reduce boredom, or to fix appearance. The NSSI group obtained significantly higher scores on questionnaires assessing stress, anxiety, depression, and harm avoidance. Overall, the results showed several notable differences between NSSI and BFRBs that are consistent with clinical literature and definitions of these problems in the DSM-5

The Bergen 4-day treatment for panic disorder: adapting to COVID-19 restrictions with a hybrid approach of face-to-face and videoconference modalities

Background The Bergen 4-day treatment (B4DT) is a concentrated exposure-based therapy that has been shown to be effective in the treatment of anxiety disorders. The current study sought to examine the effectiveness of B4DT for panic disorder (PD), when delivered with a combination of face-to-face sessions and videoconferencing. Methods Treatment was delivered to 50 patients from April 2020 to May 2021. Because of regulations during the pandemic, a significant portion of the treatment was conducted via videoconference. The primary outcome measure was the clinician-rated Panic Disorder Severity Scale (PDSS), and secondary measures included patient-rated symptoms of panic disorder, agoraphobia, generalized anxiety, depression, and treatment satisfaction. Changes in symptom levels over time were estimated using multilevel models. Results Patients showed a significant reduction in clinician-rated symptoms of panic disorder (Measured by PDSS) from before treatment to post treatment (d = 2.18) and 3-month follow-up (d = 2.01). At three months follow-up 62% of patients were classified as in remission, while 70% reported a clinically significant response. We also found a reduction in symptoms of depression and generalized anxiety, and the patients reported high satisfaction with the treatment. Conclusion The current study suggests that B4DT delivered in a combination of videoconference and face-to-face meetings may be a useful treatment approach. As the study is uncontrolled, future studies should also include more strictly designed investigations.publishedVersio

‘Wanting’ and ‘liking’ skin picking: A validation of the Skin Picking Reward Scale

Background and Aims Excoriation (skin-picking) disorder (SPD) is often conceptualized as a behavioral addiction in which aberrant reward processing may play an important role. The current study sought to develop a self-report instrument – the Skin Picking Reward Scale (SPRS) – that measures how strongly skin picking is ‘liked’ (i.e., the degree of pleasurable feelings while receiving the reward) and ‘wanted’ (i.e., the degree of the motivation to seek the reward). Methods We administered the SPRS to individuals who endorsed excessive skin picking in online surveys and examined the scale’s factor structure (Studies 1 and 2). We then asked individuals with documented pathological skin picking to complete the SPRS and other relevant questionnaires on two occasions one week apart (Study 3). Results Exploratory (Study 1; n = 330) and confirmatory (Study 2; n = 144) factor analyses consistently supported a two-factor structure reflecting the ‘liking’ and ‘wanting’ constructs. Results from Study 3 (N = 36) indicated that the Wanting and the Liking scales had adequate internal consistency and test–retest reliability. Additionally, consistent with predictions, the Wanting scale, but not the Liking scale, was associated with picking urges the following week, greater cue-reactivity, and more picking-related routines/habits. Discussion These initial findings suggest that SPRS is a psychometrically sound measure of ‘wanting’ and ‘liking’ in pathological skin picking. The SPRS may facilitate research on reward processing anomalies in SPD and serve as a useful clinical instrument (e.g., to identify those at risk for cue-induced relapse)

A Latent Profile Analysis of Age of Onset in Pathological Skin Picking

Background Pathological Skin Picking (PSP) may begin at any age, but the most common age of onset is during adolescence. Age of onset is a potentially useful clinical marker to delineate subtypes of psychiatric disorders. The present study sought to examine empirically defined age of onset groups in adults with PSP and assess whether groups differed on clinical characteristics. Method Participants were 701 adult respondents to an internet survey, who endorsed recurrent skin picking with tissue damage and impairment. Latent profile analysis (LPA) was conducted to identify subtypes of PSP based on age of onset. Then subgroups were compared on demographic and clinical characteristics. Results The best fitting LPA model was a two-class solution comprised of a large group with average age of onset in adolescence (n = 650; 92.9% of the sample; Mean age of onset = 13.6 years) and a small group with average onset in middle adulthood (n = 50; 7.1% of the sample; Mean age of onset = 42.8 years). Relative to the early onset group, the late onset group reported significantly less focused picking, less skin picking-related impairment, lower rates of co-occurring body-focused repetitive behaviors, and trends towards reduced family history of PSP. Individuals in the late onset group also reported increased rates of comorbid depression, anxiety and posttraumatic stress disorder, and were more likely to report that initial picking onset seemed related to or followed depression/anxiety and physical illness. Conclusion Findings suggest the presence of two distinct PSP age of onset groups: (1) an early onset group with average onset in adolescence, clinical characteristics suggestive of greater picking-related burden and familiality, and a profile more representative of the general PSP population; and (2) a late onset group with average onset in middle adulthood, increased co-occurring affective and trauma conditions, and initial onset associated with or following other mental health and physical problems. Future replication is needed to assess the validity and clinical utility of these subgroups