The problem with picking: Permittance, escape and shame in problematic skin picking

Area of Science:

• Psychology
• Dermatology
• Mental Health

Background:

• Problematic skin picking (SP), classified as excoriation disorder in DSM-5, is poorly understood.
• SP is characterized by a compulsive urge to pick skin, leading to significant psychosocial distress.
• A qualitative perspective is needed to explore the lived experience of SP.

Purpose of the Study:

• To present a rare qualitative perspective on the lived experience of problematic skin picking.
• To prioritize participants' voices and sense-making in understanding SP.
• To explore the phenomenology of problematic skin picking.

Main Methods:

• An in-depth qualitative study involving 17 UK-based participants who self-identified with problematic SP.
• Online recruitment with flexible interview modalities (IM, phone, email, Skype) to maximize comfort and accessibility.
• Thematic analysis of interview transcripts to identify key themes.

Main Results:

• Three novel themes emerged: cognitions/circumstances driving SP, dissociative "zoning out" during SP for escape/relief, and feelings of shame regarding perceived judgment by others.
• Participants described how environmental factors and internal cognitions influenced their picking behavior.
• The experience of shame and distress related to the visibility of SP was a significant finding.

Conclusions:

• The study offers in-depth insights into the phenomenology of problematic skin picking.
• Environmental factors, cognitions, distress, and shame are crucial considerations for therapeutic interventions.
• Understanding the complexity of SP and the need for individualized treatment approaches is highlighted.