Cognitive-behavior therapy for self-injurious skin picking. A case series

Self-injurious skin picking is characterized by repetitive, ritualistic, or impulsive skin picking that leads to tissue damage and causes significant distress or impairment in daily functioning. Little is known about effective behavioral or cognitive-behavioral treatments for self-injurious skin picking. As described by Azrin and colleagues, habit reversal is a promising behavioral treatment for modifying nervous habits or tics. To the authors' knowledge, only one case series currently exists in the literature that shows self-injurious skin picking, in the absence of an underlying dermatological condition or without psychiatric comorbidity, can be successfully treated with habit reversal. In the current article, the authors describe the implementation and outcome of cognitive-behavior therapy for three patients with severe self-injurious skin picking, two of which had psychiatric comorbidity.