Assessing Excoriation (Skin-Picking) Disorder: Clinical Recommendations and Preliminary Examination of a Comprehensive Interview

Abstract

Excoriation (skin-picking) disorder (SPD) is a psychiatric condition with variable clinical presentation. We developed the Diagnostic Interview for Skin Picking Problems (DISP), a semi-structured interview designed to assess (1) DSM-5 criteria for SPD and (2) several clinical features of SPD, including the frequency and duration of picking episodes, and the proportion of time devoted to picking at different body areas. The DISP was administered along with other measures to 120 college students (88% women, average age = 22 years) with suspected skin picking problems (based on their responses to a screening survey). The results showed that the DISP had good inter-rater reliability, test–retest reliability over 1–5 months, and convergent/divergent validity. We also found that participants displayed divergent clinical characteristics depending on the pattern of frequency, duration, and body location of picking episodes (e.g., those who primarily picked at the fingers had a unique clinical presentation). Overall, the findings provide preliminary support for the psychometric properties and clinical utility of DISP. The results also underscore the importance of accurately assessing frequency, duration, and body location of picking episodes.

Prevalence and Correlates of Hair Pulling Disorder and Skin Picking Disorder in an Acute Psychiatric Sample

“…Similarly, evidence suggests that neuroticism is more strongly associated with symptoms of OCD, hoarding disorder, and BDD than with symptoms of HPD and SPD (Keuthen et al, 2015; Watson et al, 2018). Finally, factor analytic studies have consistently shown that self-reported HPD and SPD symptoms load on a shared underlying “grooming” factor in both clinical and nonclinical samples (Hartmann et al, 2020; Maraz et al, 2017), and this grooming factor has been shown to have relatively limited association with negative emotionality (Snorrason et al, 2021, 2022).…”

“…This interview was designed to assess past-month Diagnostic and Statistical Manual of Mental Disorders, 5th Edition ( DSM-5 ) diagnoses of SPD and HPD (Snorrason and Lee, 2022). The interview consisted of separate diagnostic modules for HPD and SPD that were identical except one referred to hair pulling and the other to skin picking.…”