How Do Urges Relate to Skin Picking Behavior?

What you need to know

• People with skin picking disorder experience uncomfortable urges before and during skin picking behaviors
• There is a strong temporal relationship between urge intensity and skin picking events
• Suppressing skin picking weakens the link between urges and behavior but increases overall urge intensity
• Understanding urges may help improve behavioral treatments for skin picking disorder

What is skin picking disorder?

Skin picking disorder, also known as excoriation disorder, is a mental health condition where a person repeatedly picks at their skin, causing tissue damage and significant distress or impairment in their life. It affects about 1-2% of people at some point in their lives. Common picking sites include the face, arms, hands, and legs.

People with skin picking disorder often report feeling unable to control their picking behavior. Many experience an uncomfortable sensation or urge before or during picking episodes. These “premonitory urges” are thought to play an important role in driving and maintaining the picking behavior over time.

Understanding premonitory urges in skin picking

To better understand the nature of premonitory urges in skin picking disorder, researchers conducted a study with 15 participants diagnosed with the condition. They used questionnaires and a real-time computer task to examine several key questions:

1. What types of premonitory urges do people with skin picking experience?
2. How does urge intensity relate to actual picking behavior over time?
3. Can people suppress their picking behavior, and how does this affect urges?

Types of premonitory urges

The study found that people with skin picking disorder experience several types of urges or sensations before or during picking episodes:

• Physical sensations (80% of participants) - Uncomfortable feelings in the skin or body
• Visual “just-right” feelings (80%) - A need for the skin to look a certain way
• Urge-only sensations (80%) - A strong impulse to pick without any specific physical sensation
• Energy build-up (67%) - A feeling of tension that needs to be released
• Feelings of incompleteness (60%) - A sense that something isn’t quite right

These urge experiences show similarities to those reported in related conditions like obsessive-compulsive disorder (OCD) and Tourette syndrome. This may point to some shared mechanisms underlying these disorders.

The temporal relationship between urges and picking

To examine how urges and picking behavior relate over time, participants completed a 20-minute computer task. They continuously rated their urge intensity while being video recorded to capture picking events.

The results showed a strong temporal relationship between urge intensity and skin picking:

• Urge intensity tended to increase before a picking event started
• Urges continued rising during the picking event
• Urge intensity began decreasing even before the picking event ended

This pattern suggests that picking behavior may arise due to increasing urge intensity. The behavior then provides some relief, causing urges to subside. Over time, this could create a cycle that reinforces and maintains the picking habit.

Statistically, changes in urge intensity explained about 23% of the variance in whether picking occurred from moment to moment. This indicates a substantial, though not perfect, link between urges and behavior.

Effects of suppressing skin picking

In a second part of the task, participants were asked to try suppressing their skin picking behavior for 10 minutes. This allowed the researchers to examine whether people could control their picking and how suppression affected urges.

Key findings on suppression:

• Participants achieved over 50% reduction in picking duration and 75% reduction in picking frequency when trying to suppress
• One-third of participants were able to completely stop picking during suppression
• Urge intensity increased overall during suppression compared to free picking
• The temporal relationship between urges and picking weakened during suppression - urge changes only explained about 6% of picking variance

These results suggest that people with skin picking disorder do have some ability to control their behavior, at least in the short term. However, suppressing picking comes with a cost of increased urge intensity.

Interestingly, the typical pattern of urges rising before picking and falling after was disrupted during suppression. Urges sometimes increased and decreased without any picking occurring. This provides support for exposure-based therapies that aim to help patients tolerate urges without engaging in picking.

Implications for treatment

Understanding the relationship between urges and skin picking behavior has important implications for treatment approaches:

1. Targeting urges: Since urges play a key role in driving picking, treatments that help patients manage and tolerate urges may be beneficial. Cognitive-behavioral therapy often includes strategies for coping with urges.

2. Breaking the cycle: The cyclical relationship between urges and picking creates a pattern of negative reinforcement. Treatments can focus on disrupting this cycle, potentially through controlled exposure to urges without picking.

3. Harnessing suppression ability: The finding that patients can suppress picking, at least temporarily, suggests that behavioral control is possible. Therapy may be able to build on this ability while addressing the increased urge intensity that comes with suppression.

4. Customized approaches: Given that patients experience different types of urges, treatments may benefit from being tailored to an individual’s specific urge profile.

5. Transdiagnostic perspective: The similarities in urge experiences across skin picking, OCD, and tic disorders hint at shared mechanisms. Treatments that work for one condition may have potential for others.

Conclusions

• Premonitory urges play an important role in skin picking disorder, showing a clear temporal relationship with picking behavior
• People can suppress their picking to some degree, but this increases overall urge intensity
• Understanding urges may help improve behavioral treatments for skin picking disorder
• More research is needed on long-term suppression effects and neural mechanisms of urges in skin picking

While this study provides valuable insights into the nature of urges in skin picking disorder, it also has some limitations. The sample size was relatively small and consisted mostly of highly educated participants without many other mental health conditions. Future research with larger, more diverse samples will be important to confirm and expand on these findings.

Overall, this research highlights the complex relationship between internal experiences (urges) and observable behaviors (picking) in skin picking disorder. Continued study of these dynamics may lead to more effective treatments that help people break free from the cycle of picking.