Skin Picking Disorder: Diagnostics, Trigger and Treatment

Manipulating one’s skin is a natural behavior observed in both animals and humans – often serving as a stress-relieving and/or hygienic act (Feusner et al., 2009). However, for some individuals, this behavior escalates into a compulsion they find difficult to resist. This can result in excessive manipulation of the integumentary system (skin, hair, nails), which may cause skin damage, lesions, or hair loss (International Classification of Diseases [ICD-11], World Health Organization [WHO], 2024). The description of such behaviors has historical root. Hippocrates mentioned them as early as 400 BCE: „Next, we must note whether he plucks his hair, scratches or weeps “(Lloyd 1983, p. 100). Compared to well-established mental disorders like anxiety, classified in one of the first versions of ICD-10 (ICD-10-SGB-V Version 1.1; WHO, 1995) and Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association [APA], 1980), body-focused repetitive behaviors (BFRBs) such as dermatillomania (skin picking disorder [SPD], excoriation disorder; DSM-5; APA, 2013) and onychophagia (nail biting; DSM-5, APA, 2013) have only recently been formally recognized in diagnostic manuals. An exception to this is trichotillomania (hair pulling disorder), which was acknowledged as early as DSM-III (APA, 1980). Interest in BFRBs has grown significantly in recent years, as reflected by an increase in research publications (see table 1). Despite this progress, public and professional awareness about BFRBs and their treatment options remain limited (Gallinat et al., 2019; Loftus et al., 2024). More than half of the participants in two studies reported not seeking help for their SPD, citing reasons such as doubts about severity, uncertainty about whom to approach, and concerns over whether medical professionals possess adequate expertise in this area (Gallinat et al., 2019; Tucker et al., 2011). Addressing this gap in professional knowledge and promoting evidence-based treatment strategies represent critical efforts undertaken in this dissertation.