Skin picking in a non-clinical sample of young Polish adults. Prevalence and characteristics
Introduction
Picking, digging, and squeezing one's skin are common human behaviors that in most cases do not reach the level of pathology. However, some individuals pick their skin so frequently, intensely, or repetitively that it leads to visible tissue damage, significant distress, and impaired daily functioning. Skin picking is considered to be a psychological disorder in such cases [1], [2], [3].
Skin picking behaviors have been described in the medical literature since the 19th century [4]; however, skin picking disorder (SPD) was only recently included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a distinct psychiatric condition [5]. According to the DSM-5, the diagnostic criteria of SPD are recurrent skin picking resulting in skin lesions, repeated attempts to decrease or stop skin picking, and clinically significant distress or impairment in social, occupational, or other important areas of functioning caused by picking. Skin picking that meets the DSM-5 criteria of SPD cannot be attributable to the psychological effects of substance abuse or other medical conditions and cannot be better explained by the symptoms of another mental disorder [5].
Numerous studies have demonstrated that skin picking behaviors are quite common in the general population and occur along a continuum from mild to severe forms. Hayes et al. [2] examined a community sample of 354 adults in the United States (US) and found that 62.7% of the participants reported some form of skin picking; severe skin picking with associated distress or functional impairments was reported by 5.4% of the sample. Another large community study by Keuthen et al. [6] found that the prevalence rate of severe skin picking was 1.4% among 2513 US adults who were studied in a telephone survey [6]. Very recently, Leibovici et al. [7] reported that 5.4% of the Israeli adult population meets the current diagnostic criteria of SPD.
Previous studies also revealed a relatively high prevalence of skin picking among young adults. The prevalence rate of any form of skin picking behavior was 78.1% in a sample of university students in a US study [8], and slightly higher prevalence rates (87.8%) were found in Turkish [1] and in German (91.7%) student populations [9]. Recurrent skin picking causing distress or significant functional impairment was reported by 3.8% to 4.2% of students in the US [8], [10]; a similar prevalence rate (4.6%) was found among students in Germany [9], whereas a Turkey study reported the occurrence of severe skin picking among 2.04% of a university sample [1]. More recently, Leibovici et al. [7] found that 3.03% of Israel university students fulfilled the diagnostic criteria of SPD, whereas Siddiqui et al. [11] reported the prevalence rate of SPD in a sample of Pakistan students as high as 9%. Several studies indicate that there is a predominance of women among individuals who report severe skin picking [3], [12], [13], [14]; however, studies on non-clinical samples have not confirmed that women pick their skin more frequently than men do [1], [9].
Community studies clearly indicate that pathological skin picking is a universal behavior that occurs in various countries with similar prevalence. However, detailed analysis of the data obtained in different surveys indicates that some characteristics of picking episodes, the factors triggering picking, and the inclination to seek treatment may vary across age cohorts and cultures [1], [9], [11], [15], [16], [17], [18]. Unfortunately, apart from a few studies [1], [7], [9], [11], [16], [15], most of the data about skin picking were gathered from American adults, and there is a lack of data from other countries, including European countries. To date, no studies have examined the prevalence of skin picking behaviors in a Polish population. Hence, the aim of our study was to fill this gap by investigating skin picking frequency in a non-clinical sample of Polish young adults. Since, in Poland, SPD is not commonly recognized as a psychological disorder, and other disorders affecting dermatological conditions such as trichotillomania have already been found to be recognized and treated inadequately by dermatologists [19], we expect that Polish young adults with skin picking may differ from those from other countries in terms of their awareness of the psychological nature of that behavior, as well as in terms of the inclination to seek psychological help due to skin picking.
Our study also investigated the basic characteristics of skin picking episodes, the effect of skin picking on daily functioning, and the study participants' inclination to seek treatment for skin picking. Moreover, we gathered detailed information about the emotions that are experienced before, during, and after picking episodes. Our analysis also examined gender differences in skin picking characteristics. Given a lack of knowledge on the prevalence in the Polish sample, our study was exploratory with no specific hypothesis stated.
Section snippets
Participants
A total sample of 534 participants took part in the study voluntarily after providing informed consent. The study was approved by the local ethics committee. All the respondents were high school students and university students from various faculties of the Pedagogical University and the University of Technology in Krakow, Poland. Of the 534 participants, 356 (66.67%) were women, and 178 (33.33%) were men.
The age of the participants ranged from 16 to 46 years (mean = 21.33, SD = 3.39). The mean age
Skin picking severity
Of the 534 participants, 246 (46.07%) reported that they picked their skin at least occasionally during the week before the study. Among those who confirmed skin picking, 166 (67.48%) were women and 80 (32.52%) were men; the women did not report picking significantly more frequently than men (χ2(1) = 0.03, p < 0.87, Φ = 0.01). Of those who reported skin picking, 195 (36.52% of the total sample; 79.26% of skin pickers) admitted that they picked their skin to an extent that it caused visible skin
Discussion
The results of our study demonstrated that skin picking is a common behavior among young Polish adults. Nearly half of the participants (46%) reported some forms of skin picking, and 41 (7.67%) of them met the diagnostic criteria for skin picking disorder (SPD) [5]. These results indicate that the prevalence rate of occasional, non-pathological forms of picking was lower in our Polish sample than the prevalence rate found in other student and community samples (62.75–91.7%) [1], [2], [8], [9].
Conflicts of interest
The authors declare that they have no conflicts of interest concerning this article.
Role of funding source
None.
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2019, Journal of Obsessive-Compulsive and Related DisordersCitation Excerpt :Individuals affected by this condition manipulate their skin repetitively (e.g., scratching, squeezing, picking, rubbing) and are unable to stop the behavior, even though the behavior leads to skin damage, scars, and psychosocial impairment (APA, 2013). Results about point prevalence rates are heterogeneous across different studies and vary between 3.4% and 7.7% (Bohne, Wilhelm, Keuthen, Baer, & Jenike, 2002; Hayes, Storch, & Berlanga, 2009; Leibovici et al., 2015; Machado et al., 2018; Prochwicz, Kałużna-Wielobób, & Kłosowska, 2016). The lifetime prevalence is estimated at 1.4% (APA, 2013) with a higher occurrence in females (APA, 2013; Hayes et al., 2009; Machado et al., 2018).