Skin picking disorder (SPD) is a mental health disorder on the OCD spectrum that belongs to a group of disorders known as Body-Focused Repetitive Behaviors (BFRBs). SPD is characterized by repetitive and compulsive picking at the skin causing damage to the skin.
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What causes someone to develop SPD and other BFRBs, like hair pulling, isn’t entirely clear. Research suggests that genetics may play a role. Skin picking, like other BFRBs, is more common in people who have family members with SPD, or related disorders such as OCD (obsessive-compulsive disorder) or another BFRB.
There is some evidence that suggests SPD is a neurological disorder, caused by underdeveloped motor-inhibitory control. Inhibitory control is an important element of executive function that allows for the suppression of actions and resistance to interference from irrelevant stimuli. Problems with inhibitory control have been found to be related to structural issues in the brain.
Emotional issues such as anxiety and depression are strongly correlated with skin picking. Even hormonal issues and impulsivity have been associated with skin picking.
Just who might be likely to develop a skin picking disorder is unclear. Is there a “type” of a person or certain traits that someone might have that makes them more likely to pick? Researchers are asking that question too.
There have been very few studies exploring personality and BFRBs. Most of the studies have focused primarily on people with trichotillomania. One of the few studies that have looked at skin picking and personality found that people with skin picking share certain personality traits such as reward dependence or harm avoidance. Just how personality traits influence the manifestation of BFRBs is unclear.
How do personality traits contribute to the clinical presentation of skin picking or hair pulling? What can that mean for the treatment? A new study takes a closer look at the role of personality features and their clinical associations to both skin picking and hair pulling.
A personality trait is defined as a relatively stable, and enduring internal characteristic that is evident in and inferred from a person’s behaviors, attitudes, feelings, and habits. Personality features are known to be associated in many ways with individual differences in emotional responses. It is thought that this association could be one of the mediating factors between personality traits and the development of mental health disorders.
While there are many personality traits, it is generally recognized that there are five main traits commonly referred to as the Big Five or the Five-Factor Model. This model is the most accepted personality theory today.
These Big Five traits are:
These traits are not “either/or”. Rather, each trait represents a continuum of expression. A person can be anywhere along the continuum for each of the traits. For example, when measuring Agreeableness, a person would not be considered purely hostile or completely agreeable or trusting. They would fall somewhere in between. Just where that is is highly individualized.
It is thought that personality traits are at least partially inherited but that they are heavily influenced by one’s environment and experiences. These traits are relatively stable over the course of one’s lifetime and are known to play a role in certain life situations. Neuroticism, in particular, is strongly associated with mental health issues such as depression and schizophrenia. Not surprisingly, neuroticism has also been associated with hair-pulling behavior.
Unlike earlier studies, this new study specifically focused on adults with skin picking disorder, hair-pulling disorder, or both. It was hypothesized that people with trichotillomania or skin picking disorder would have high neuroticism scores and that higher scores would correlate with greater symptom severity.
Data were collected to assess personality along the Big Five domains using a valid and reliable assessment tool. In addition to questionnaires and interviews, participants underwent neurocognitive testing to assess response inhibition and decision-making abilities. This testing was included because the inhibitory response and decision-making abilities have been associated with BFRBs.
The findings supported the study’s hypothesis. Higher levels of neuroticism were significantly related to both hairs pulling and skin picking severity, as well as anxiety, depression, and perceived stress. Neuroticism is conceptually related to the experience of negative affect and self-doubt.
Introversion was also significantly associated with BFRBs and symptom severity. Introversion was significantly associated with higher skin picking severity, as well as with worse mood and higher levels of perceived stress.
Lack of conscientiousness was significantly associated with more depressive symptoms, more impulsivity, and higher perceived stress in both hair pulling and skin picking. This is in keeping with other research.
No differences were found between those with BFRBs and the control group for either openness or agreeableness.
So, is there a “type” of personality that is more likely to develop a BFRB? Not exactly.
These findings suggest that personality may play a significant role in the development and progression of BFRBs for people who have a certain set of personality traits. The fact that neuroticism is a trait associated with many psychiatric disorders suggests that this trait may be a vulnerability marker.
The study authors suggest that it may be helpful to utilize treatments that focus on strengthening these personality factors by addressing negative effects, improving conscientiousness, and increasing extroversion. Therapeutic approaches such as mindfulness-based cognitive therapy, cognitive behavior therapy, or metacognitive therapy may be useful to address specific needs.
While more studies of personality traits and BFRBs are needed, these findings suggest that personality plays a significant role in BFRBs and highlight the importance of considering individual differences in treatment planning. Just what the role of personality is and what interventions might be most helpful remains to be discovered. What is clear is that treatments should be sensitive to and adaptable to the individual and their unique presentation.
Understanding how personality may contribute to picking or hair pulling can improve understanding of these disorders and support the development of more effective treatments. Findings like these offer hope for the future and for improving the lives of those living with BFRBs.
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