Comorbidity of psychiatric and dermatologic disorders with skin picking disorder and validation of the Skin Picking Scale Revised for Brazilian Portuguese

Objective: Skin picking disorder (SPD) affects up to 5.4% of the population. Less than half of patients are correctly diagnosed and treated. Developing tools to recognize SPD can help professionals and patients alike. This trial aimed to validate the Skin Picking Scale-Revised (SPS-R) for the Brazilian population and assess the psychiatric and dermatological comorbidities of patients with SPD. Methods: Brazilians with a primary diagnosis of SPD, 18 years or older, were recruited from a community sample by media advertising and evaluated by a dermatologist and a psychiatrist. Self-report instruments were used: SPS-R, Dermatology Life Quality Index (DLQI), General Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). Confirmatory factor analysis (CFA) was performed to evaluate the SPS-R, and Pearson correlation (r) was used to assess the relationship between instruments. Results: Overall, 124 patients were included. The SPS-R demonstrated good internal consistency (Cronbach's coefficient = 0.84). CFA found a good fit to the model according to all indices (χ2 = 29.67; degrees of freedom [df] = 19; p = 0.056; root mean square error of approximation [RMSEA] = 0.067; comparative fit index [CFI] = 0.969; non-normed fit index [NNFI] = 0.954). SPS-R correlated with DLQI (r = 0.73), GAD-7 (r = 0.51), and PHQ-9 (r = 0.43). The sample had a high prevalence of psychiatric disorders, mainly generalized anxiety disorder (62.1%) and current (32.3%) and past (37.1%) depressive episodes. Conclusion: The Brazilian version of the SPS-R presents good psychometric properties. The severity of SPD is related to severity of depression, anxiety, and impairment in quality of life. Clinical trial registration: ClinicalTrials.gov, NCT04731389

The Spanish version of the Skin Picking Impact Scale (SPIS) and its Short form (SPIS-S)

ABSTRAC Introduction: The Skin Picking Impact Scale (SPIS) is a self-report rating scale that assess the psychosocial impact of excoriation disorder. In this study the SPIS was translated into Spanish and its reliability was measured. Similarly, its short version (SPIS-S) has been translated and tested. Methodology: The recruitment has been performed through a survey launched on social media. All subjects were older than18 years and self-reported being diagnosed with an excoriation disorder. 281 individuals were rated for the validation analysis. SPIS has been translated into Spanish and validated through an exploratory and confirmatory factorial analysis. Participants have been also scored with the Skin Picking Scale-Revised (SPS-R). Results: On factor at the exploratory factorial analysis has a raw eigenvalue greater than 1, with 65.5% of total variance. The confirmatory analysis confirmed that the scale is one-dimensional. Cronbach's alpha also confirmed a good internal consistency (α=0.934 for the SPIS and α=0.882 for the SPIS-S). Scores between the two scales (SPIS and the SPS-R) have shown a good convergence (r=0.592, p<0.0001). Conclusion: The Spanish version of SPIS and its short version show good psychometric properties and adequately reproduce the one-dimensional model of the original English version.

RESUMEN Introducción: la Skin Picking Impact Scale (SPIS) es una escala autoaplicada de que evalúa el impacto psicosocial del trastorno de excoriación. En este estudio se tradujo la SPIS al español y se midió su confiabilidad. Asimismo, se tradujo y se evalúo su versión corta (SPIS-S). Metodología: el reclutamiento se realizó a través de una encuesta distribuida a través de redes sociales. Todos los sujetos participantes fueron mayores de 18 años e informaron haber sido diagnosticados con trastorno de excoriación. 281 individuos calificaron para el análisis de validación. La SPIS fue traducida al español y validada a través de análisis factorial exploratorio y análisis factorial confirmatorio. Los participantes también fueron evaluados con la versión revisada de la Skin Picking Scale - Revised (SPS-R). Resultados: en el análisis factorial exploratorio, un valor tenía un valor propio bruto mayor que 1, con 65,5 % de la varianza total. El análisis confirmatorio determinó que la escala es unidimensional. El alfa de Cronbach también confirmó una buena consistencia interna (α = 0,934 para la SPIS y α = 0,882 para la SPIS-S). Las puntuaciones entre las dos escalas (SPIS y SPS-R) mostraron una buena convergencia (r = 0,592, p <0,0001). Conclusión: la versión en español de la SPIS y de su versión abreviada muestran buenas propiedades psicométricas y reproducen adecuadamente el modelo unidimensional de la versión original en inglés.

Transtorno de escoriação: diagnóstico e intervenção - uma revisão sistemática / Skin picking: diagnosis and intervention - a systematic review of literature

O Transtorno de Escoriação é o ato repetitivo e compulsivo de provocar lesões na própria pele, sendo caracterizado como patológico quando é recorrente, o que causa desconforto e por diversas vezes gera sensação de culpa pela lesão, podendo gerar sofrimento psíquico significativo além de afetar direta e indiretamente a relação do indivíduo com si próprio e com o outro. O método para esta pesquisa foi a partir de uma revisão sistemática da literatura, com base na estratégia PRISMA, o que permitiu realizar uma coleta ampla e variada de diversos trabalhos realizados nesta temática, tanto na literatura nacional quanto internacional. Enquanto resultados, constatou-se que o transtorno possui maior predominância em mulheres, podendo também ser apresentado em indivíduos com outras comorbidades. Verificou-se também a necessidade de se refletir sobre este transtorno de um ponto de vista interdisciplinar, no qual a Psicologia pode contribuir significativamente com os aspectos subjetivos dos sujeitos acometidos por este transtorno.

Excoriation Disorder is the repetitive and compulsive act of causing injuries to the skin itself, being used as pathological when it is recurrent, or what causes discomfort and often causes the injury because of the injury, using the psychological suffering even more after the use and indirectly an individual's relationship with himself and with another. The method for this research was a systematic review of the literature, based on the PRISMA strategy, which made it possible to carry out a wide and varied collection of various works carried out on this theme, both in national and international literature. While the results, we found that the disorder is more prevalent in women, it can also be exhibited in other comorbidities. There was also a need to reflect on this disorder from an interdisciplinary point of view, no psychology can contribute to the subjective aspects of individuals affected by this disorder.

Caracterización fenomenológica de las conductas repetitivas impulsivas orientadas hacia el cuerpo y el trastorno por excoriación en estudiantes universitarios / Phenomenological characterization of body-focused repetitive impulsive behaviours and excoriation disorder in college students

Resumen Introducción: Las conductas repetitivas impulsivas orientadas hacia el cuerpo (CRIOC) se caracterizan por el rascado, mordido y/o remoción de uñas, pelos y piel, pudiendo llegar a constituir un desorden mental. El trastorno por excoriación (TE) o dermatilomanía ha sido recientemente incorporado como desorden específico al DSM-5 como parte del espectro obsesivo-compulsivo. Su fenomenología describe una conducta reactiva a la ansiedad, seguida de tensión psíquica progresiva y luego placentera al realizarla, finalizando muchas veces en culpa. Se ha reportado una mayor incidencia de TE en estudiantes universitarios, sin embargo, los estudios en Latinoamérica son escasos. Objetivos: Establecer la frecuencia y las características fenomenológicas de las CRIOC y del TE en población universitaria. Métodos: Se realizó un estudio transversal mediante la aplicación de un cuestionario de autorreporte sobre aspectos relacionados con el TE en estudiantes universitarios. Resultados: 440 estudiantes fueron incluidos. Un 22,2% sintió siempre o casi siempre el impulso de rascar su piel hasta lesionarse; 13,2% ejecutó estas acciones varias veces al día y 4,3% desplegó mucho esfuerzo en resistirlas. Los afectos más frecuentemente asociados fueron culpa, vergüenza, arrepentimiento y autorreproche. Un 24,1% creyó que estos comportamientos fueron anormales y 6,1% que constituyeron una patología. Según criterios DSM-5 y establecidos por los autores, se hallaron cuatro casos compatibles con TE (0,91%), al descartar patologías psiquiátricas y médicas comórbidas. Conclusión: Aunque las CRIOC fueron frecuentes en población universitaria, la frecuencia de TE fue similar a la de la población general, describiendo una fenomenología característica congruente con la reportada por la literatura.

Introduction: Body-focused repetitive impulsive behaviors (BFRIB) are characterized by skin, nail and hair removing, scratching and/or biting, that configurate a mental disorder in some cases. Excoriation disorder (ED) or dermatillomania has been recently added as a specific disorder in DSM-5 obsessive-compulsive spectrum. Its phenomenology describes a behavior that emerges from anxiety, followed by a progressive psychic tension and then a pleasurable sensation, concluding in many times in guilt. Evidence has reported a greater incidence of ED in college students; however, studies in Latin America are scarce. Objective: To establish frequence and phenomenological features of BFRIB and ED in college students. Methods: We performed a cross-sectional study through the application of a self-administered questionnaire about ED aspects in college students. Results: 440 students were included; 22.2% felt always or almost always the impulse to scratch their skin until they were injured; 13.2% made these actions many times a day and 4.3% deployed considerable efforts in resisting them. Most frequent reported affects were guilt, shame, repentance, and self-reproach; 24.1% thought these behaviors were abnormal and 6.1% considered they constitute a pathology. According to DSM-5 and authors' criteria, four cases of ED were found (0.91%), when psychiatric and medical comorbidities were discarded. Conclusion: Although BFRIB were frequent in college students, dermatillomania frequency was similar to general population. A characteristic phenomenology was described, similar to the evidence reported one.