The Role of the Cerebellum in Skin-Picking Disorder

Previous research indicated that the cerebellum is involved in psychopathologies with body-focused repetitive behaviors. The present study investigated whether patients with a diagnosis of skin-picking disorder (SPD) also show altered cerebellar structure and function. Structural as well as functional MRI data from 30 SPD patients and 31 controls were analyzed. The fMRI approach compared cerebellar activity and connectivity between the two groups during scratching and caressing of a small skin area on the arm. Relative to controls, SPD patients were characterized by reduced gray matter volumes in the left cerebellar lobules V and VI. During picking (relative to caressing), SPD patients displayed increased activation of the left crus I, which showed enhanced coupling with the left ventrolateral prefrontal cortex (VLPFC). This study provides the first evidence that SPD patients display structural as well as functional abnormalities in specific subregions of the cerebellum related to motor (V) and affective-cognitive functions (VI, crus I). The SPD-related altered cerebellar connectivity with an area implicated in affect control (VLPFC) fits nicely to the model of pathological skin picking as a maladaptive emotion regulation strategy.