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It has been a busy 2021 for the BFRB Precision Medicine Initiative! Even with the continuing impacts and restrictions resulting from the coronavirus pandemic, researchers have continued to pursue projects that are contributing to the goals of the BPMI and advancements in treatment of BFRB disorders. The first learnings from this research are now being published and we expect this work to lead to improved treatment outcomes. Some of the scientists in the BPMI gave an in-depth update on this progress at TLC’s virtual conference this past spring. Here are some of the highlights of that update:
When you think about compulsive skin picking, you probably don’t think about addictions, right? After all, Skin Picking Disorder (SPD) is classified as an Obsessive-Compulsive Related Disorder in the DSM5. It was previously classified as an impulse disorder. But not everyone agrees on how to classify SPD and in fact, some research has found that SPD actually shares a number of clinical features with behavioral addictions. Those features include:
• repetitive/compulsive engagement in the behavior despite clearly adverse consequences
• diminished control over the problematic behavior
• urges prior to engagement in the problematic behavior
• pleasant sensations during the behavior
We all avoid things. It’s our go-to when something is unpleasant, or we just don’t want to deal with something. But there’s avoidance and then there’s avoidance – the kind that can create emotional distress. In this SkinPick.com webinar, Dr. Vladimir Miletic talks about emotional avoidance and how avoiding difficult emotions and memories may lead to skin picking behavior.
According to Steven Hayes, the Father of Acceptance and Commitment Therapy, experiential avoidance occurs when a person is unwilling to remain connected to particular private experiences such as body sensations, emotions, or thoughts and takes steps to alter the form or frequency of these events and the contexts in which they occur. Dr. Miletic frames this behavior as the things a person is willing to do to minimize or change their experience so they don’t have to deal with it.
We use avoidance behaviors all the time. Some are relatively benign. Others, like skin picking, can have significant, often unintended, consequences. So, the question is, why do we avoid if we know that it causes problems?
There’s no doubt that the Covid 19 pandemic has been traumatic for many people in so many ways. Seemingly overnight, our world changed. Our way of life changed. The world has seen a level of suffering and loss most of us have not experienced in our lifetimes. While some would argue otherwise, it is safe to say that the pandemic has been a traumatic event on a global scale. To say we were not emotionally prepared to cope with such an event would be an understatement.
With the pandemic, there has been increased attention to those who live with skin-picking and other Body-Focused Repetitive Behaviors (BFRBs), and concern for the effects that this prolonged stressor may have on their symptoms. Eighteen months out, data is sparse but early indicators are that the pandemic is affecting some people who live with skin-picking and other BFRBs. Others have not experienced adverse effects. With the pandemic still in full force, just how this trauma has affected people is still being explored. It will surely be some months, maybe years, before we know the full effects. In the meantime, researchers continue to explore mental health issues and to understand how the pandemic may be affecting people.
If you’ve never heard of Morgellons Disease, you’re not alone. It is a skin disorder that is steeped in controversy and mystery. While first identified in 2002, a similar skin ailment was first mentioned in 1674 in a letter by English physician, Sir Thomas Browne in which he referred to “the Morgellons” and described several children as having a skin disorder characterized in part by “harsh hairs” protruding from their skin. Morgellons is a considered a lay term to describe an unexplained set of symptoms primarily involving the skin. It is not currently recognized as a distinct clinical disorder with established diagnostic criteria that are generally accepted by the medical community. In fact, some clinicians consider it purely a manifestation of a psychiatric disorder. Because Morgellons displays characteristics of other, more well-recognized conditions, it is often not the first consideration for diagnosis. But not everyone in the medical community agrees. And, therein lies the problem. So what do we know about Morgellons Disease and what does it have to do with skin picking? When it comes to diagnosis and treatment, a lot.
Seemingly overnight, the COVID pandemic changed our normal way of life. The resulting lockdowns, shutdowns, and distancing restrictions meant that people were faced with having to find new ways to access everything from basic needs to their jobs, their family, and even their healthcare. Being isolated from others meant being on your own to deal with whatever came about. It’s no surprise that as the pandemic wore on, mental health issues surged. Anxiety and depression rates escalated along with the demand for mental health care. Healthcare providers of all disciplines were left scrambling trying to balance safety with service provision.
If you or a loved one are living with a skin picking disorder, you’ve probably searched for treatments and strategies that can actually help reduce the picking episodes. Current treatments such as dermatologic treatments, behavioral strategies like Habit Reversal, and medications offer some relief but are not particularly effective. In fact, one survey found that about 11% of respondents reported being able to control their behavior. Of the remaining respondents, 48% reported being somewhat successful, and another 42% being unsuccessful. More than 85% of those responding thought that there should be better treatment modalities than what is currently available.
In a recent webinar from Skinpick.com, Dr. Vladimir Miletic discussed the phenomenon known as skin picking “trances.” It’s a behavior that we know happens with people who pick because they talk about their experiences. However, there is surprisingly little information to be found in the literature. Much of what we know about trance picking comes from anecdotal evidence. So, just what do we know about trances? Turns out, quite a bit.
Trance behavior is a prolonged episode of skin picking that is all-consuming. The person becomes singularly focused and completely absorbed in the experience of picking. They can become so engrossed in the picking that they may be completely unaware of what’s happening around them. They may not even realize that they are picking. As a result, the use of competing responses to stop the picking is rather ineffective because they’re not going to attend to it. The focus of the trance is solely on the picking.
What causes a child to develop a body-focused repetitive behavior (BFRB) like skin picking, hair pulling, or nail-biting? It’s the question that every parent of a child with a BFRB asks.
It’s also a question that researchers have asked too. To date, studies have largely focused on adults with BFRBs and the role of factors such as temperament, environment, emotional or medical issues, and even genetics. Those studies suggest that there are certainly biological and environmental influences at play. What isn’t so clear is what factors are at play in the development of BRFBs in children.
It is well established that early childhood experiences and modeling play a key role in a child’s psychological development. Factors such as parental warmth, parenting style, and other parenting behaviors have been linked to the development of maintenance of mental health issues in children. So, it’s not surprising that since BFRBs often emerge in childhood, researchers would be interested in understanding more about how, or if, certain parenting practices can influence the development or maintenance of BFRBs in children. And a new study does just that.
Therapy works. There’s no doubt about that. The data is overwhelmingly positive. There’s no shortage of evidence-based treatments, meaning that their efficacy has been clinically and scientifically verified. But the technical part of therapy is only half of the story.
We also know that therapy doesn’t work for everyone. Much attention has been paid to techniques, treatments, and therapist qualities. However, less attention has been given to perhaps the most important factor of all: the client. The client is the reason for the engagement and the focus of the process. But the therapeutic experience is unique to each person. Things like expectations, commitment, and engagement vary from person to person. Just how these factors affect the person’s experience with therapy and the chances of successful treatment.
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