Skin Picking and Feeling Complete - Is There A Connection?
Most of us have experienced the feeling of wanting something we’re doing to be “just right”. We might want our hair and make-up “just right” or our room arranged “just right”. Most people can reach a place of satisfaction. Sometimes, though, something is “not just right” becomes problematic. That phenomenon is known as “incompleteness” and for people with obsessive-compulsive disorder (OCD) and related disorders like skin picking, it can create problematic behaviors.
This need for “just right” has been observed in and reported by people with skin picking disorder. However, it is not clear just how this phenomenon influences skin picking behaviors. Studies have shown that a specific type of incompleteness, trait incompleteness, is commonly experienced in several obsessive-compulsive and related disorders, including OCD, Tourette’s Syndrome, and trichotillomania. Missing from the research is skin picking and the relationship between trait incompleteness and skin picking. We know that skin picking is related to but not the same as OCD and other related disorders. Just what is incompleteness and what can we learn about its role in skin picking? A new study takes a closer look.
Incompleteness is characterized by the feeling that one’s behaviors and experiences are somehow incomplete or unfinished, leaving a distressing sense of being “not just right”. It is often accompanied by a need to perform some behavior to alleviate the sense of distress or tension until the person feels achieves the sense of “just right”.
Incompleteness is experienced in different ways too. Some incompleteness is experienced in the context of specific situations. This type of incompleteness is known as state incompleteness. It is associated with specific occasions or situations and eases once the “just right” or “close enough” has been achieved. A simple example of this might be when you’re doing your makeup and want it to be “just right”. You’re able to apply it and find a sense of satisfaction with it.
A different and potentially more bothersome type of incompleteness is trait incompleteness. This type of incompleteness is a habitual proclivity towards feelings of incompleteness. It creates a persistent inner sense of dissatisfaction with one’s actions and urges to achieve “just right”. It is this sense of tension and need for relief that is thought to drive repetitive behaviors.
This sense of “not just right” is seen frequently in people with obsessive-compulsive disorder (OCD) and not surprisingly, with skin-picking disorders. However, the mechanisms appear to be different. The act of picking seems to be driven more by the behavior itself and less by obsessive or intrusive thoughts. Once the picking occurs, the urge is satisfied, at least temporarily. With OCD, it is thought that the compulsion to pick is driven by intrusive or obsessive thoughts. Once the picking has occurred, the thoughts remain. These are subtle but important differences that can have significant implications for the diagnosis and skin picking treatment. The new study included a component to examine the influence of obsessive-compulsive symptoms.
In this first-of-its-kind study, the researchers separated the larger study into two distinct components. In the first study, researchers explored whether trait incompleteness was associated with skin picking. They controlled for factors including mood, obsessive-compulsive symptoms, and perfectionism.
In the second component, the researchers examined whether trait incompleteness was associated with the diagnosis of skin picking after controlling for obsessive-compulsive symptoms and mood.
They hypothesized that, based on prior research and clinical data, there would be a significant and unique association between trait incompleteness and skin picking, independent of obsessive-compulsive symptoms.
The findings across the two studies revealed a significant relationship between trait incompleteness and skin picking. This relationship was present even after controlling for other factors such as age, sex, mood, obsessive-compulsive symptoms, and perfectionism. This study is the first to show a direct relationship between trait incompleteness and SPD. This relationship was present in both the non-selected sample and among participants with a diagnosis of skin picking disorder.
The study also examined picking frequency. The frequency of picking was not associated with trait incompleteness. This finding suggests that these sensory experiences may be related to or triggered by the skin picking rather than a habitual proclivity towards skin picking or its severity.
The findings from this study shed new light on the factors underlying skin picking. While it is on the obsessive-compulsive spectrum of disorders, skin picking clearly has its own unique psychological dynamics. These findings may translate to more accurate diagnosis and treatment planning. Given the robust association between skin picking and trait incompleteness, there is a clinical assessment for the presence or risk of heightened trait incompleteness as part of treatment planning for skin picking. The study researchers suggest that clinicians should assess for and monitor traits and state incompleteness as a potential underlying motivation for skin picking and treat this symptom with a cognitive-behavioral approach.
Much more research is needed in this area. These findings highlight the unique diagnostic and clinical factors associated with skin picking. A greater understanding of skin picking offers hope for more effective treatments. Research offers hope.
1. Dieringer, M., Beck, C., Verrel, J., Münchau, A., Zurowski, B., & Brandt, V. (2019). Quality and temporal properties of premonitory urges in patients with skin picking disorder. Cortex, 121, 125-134. https://doi.org/10.1016/j.cortex.2019.08.015
2. Ricketts, E. J., Snorrason, Í., Mathew, A. S., Sigurvinsdottir, E., Ólafsson, R. P., Woods, D. W., & Lee, H. (2021). Heightened sense of incompleteness in excoriation (skin-picking) disorder. Cognitive Therapy and Research, 45(4), 759-766. https://doi.org/10.1007/s10608-020-10201-5
3. Ecker, Willi; Gönner, Sascha (2017): Translated article: Current Status of Research Concerning Incompleteness in Obsessive-Compulsive Disorder. Karger Publishers. Journal contribution. https://doi.org/10.6084/m9.figshare.5048725.v1
4. Summerfeldt, L. J., Kloosterman, P. H., Antony, M. M., & Swinson, R. P. (2014). Examining an obsessive-compulsive core dimensions model: Structural validity of harm avoidance and incompleteness. Journal of Obsessive-Compulsive and Related Disorders, 3(2), 83-94. https://doi.org/10.1016/j.jocrd.2014.01.003