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Recovery from pathological skin picking and dermatodaxia using a revised decoupling protocol


Moritz, Steffen; Rufer, Michael; Schmotz, Stella (2020). Recovery from pathological skin picking and dermatodaxia using a revised decoupling protocol. Journal of Cosmetic Dermatology, 19(11):3038-3040.

Abstract

Objective

Pathological skin picking (PSP) is characterized by repetitive scratching, biting, and picking of the skin. The disorder is subsumed under the section “obsessive‐compulsive and related disorders” in the DSM‐5. A related body‐focused repetitive disorder, which has received less empirical attention so far, is dermatophagia or dermatodaxia (eating or biting/gnawing of the skin). Habit reversal training (HRT) is regarded as the treatment of choice demonstrating improvement at a medium effect size relative to control conditions.
Methods

The present case report describes a 50‐year‐old man with a lifetime history of PSP and dermatodaxia of the fingertips who stopped excessive nail‐biting approximately 10 years ago using a treatment method known as decoupling. Yet, his PSP and dermatodaxia remained treatment‐refractory after treatment with both decoupling (conventional protocol) and HRT.
Results

Using a revised protocol of decoupling, the man was able to fully stop PSP and dermatodaxia; only the tendency to fidget nervously with his hands remained. The case report describes the revised protocol. Scores on the Skin Picking Scale Revised (SPS‐R) dropped from 15 to 0.
Discussion

The revised decoupling protocol is an easy to use technique that holds promise in this underdiagnosed and undertreated condition. Yet, rigorous randomized controlled studies are needed to ascertain its efficacy.

Abstract

Objective

Pathological skin picking (PSP) is characterized by repetitive scratching, biting, and picking of the skin. The disorder is subsumed under the section “obsessive‐compulsive and related disorders” in the DSM‐5. A related body‐focused repetitive disorder, which has received less empirical attention so far, is dermatophagia or dermatodaxia (eating or biting/gnawing of the skin). Habit reversal training (HRT) is regarded as the treatment of choice demonstrating improvement at a medium effect size relative to control conditions.
Methods

The present case report describes a 50‐year‐old man with a lifetime history of PSP and dermatodaxia of the fingertips who stopped excessive nail‐biting approximately 10 years ago using a treatment method known as decoupling. Yet, his PSP and dermatodaxia remained treatment‐refractory after treatment with both decoupling (conventional protocol) and HRT.
Results

Using a revised protocol of decoupling, the man was able to fully stop PSP and dermatodaxia; only the tendency to fidget nervously with his hands remained. The case report describes the revised protocol. Scores on the Skin Picking Scale Revised (SPS‐R) dropped from 15 to 0.
Discussion

The revised decoupling protocol is an easy to use technique that holds promise in this underdiagnosed and undertreated condition. Yet, rigorous randomized controlled studies are needed to ascertain its efficacy.

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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > Psychiatric University Hospital Zurich > Clinic for Psychiatry, Psychotherapy, and Psychosomatics
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Dermatology
Uncontrolled Keywords:Dermatology
Language:English
Date:1 November 2020
Deposited On:12 Feb 2021 12:43
Last Modified:13 Feb 2021 21:00
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:1473-2130
OA Status:Hybrid
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1111/jocd.13378
PubMed ID:32227431

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