Interoception, emotion regulation strategies and skin-picking behaviors – Results of an intensive longitudinal study

Compulsive skin-picking is associated with emotion regulation difficulties, whose origins remain unclear. Interoception, plays an important role in effective emotion regulation. This study examined the relationship between interoception, emotion regulation strategies, and skin-picking in 136 individuals (85% women, aged 18-41), including 71 engaging in skin-picking and 65 psychologically healthy controls. We were interested in between-group differences in maladaptive and adaptive emotion regulation and aspects of interoception as well as associations of the latter with skin-picking symptoms and use of emotion regulation strategies. At baseline, we assessed habitual emotion regulation strategies (rumination, suppression, distraction, engagement, arousal control, reappraisal) and Interoceptive Sensibility (e.g., emotional awareness, body listening, self-regulation, noticing) through self-report questionnaires. Moreover, Interoceptive Accuracy (IAc) was measured via a Heartbeat Counting Task. Additionally, Ecological Momentary Assessment (EMA) over seven days was used to register use of emotion regulation strategies and the occurrence and severity of skin-picking episodes during that period. At baseline, the skin-picking group exhibited lower IAc, emotional awareness, and higher habitual use of rumination than control group. Lower IAc was associated with higher odds of reporting skin-picking episodes assessed during EMA. Body listening correlated with a reduced sense of control over skin-picking during EMA. In total sample, self-regulation was related to lower odds of using rumination during EMA and noticing with less use of cognitive reappraisal. The study highlights the complex relationship between interoception, emotion regulation, and skin-picking, offering new insights into the mechanisms underlying skin picking disorder.