Few issues encourage worry in college students as reliably as exams. Until you’re one of many joyful few who a) have a photographic reminiscence or b) benefit from the thrill of all of it (I’m informed these individuals exist), assessments are inherently nerve-racking, and none extra so than remaining college examinations. In my friendship group alone, throughout Finals, one particular person developed insomnia, one other stopped stomaching stable meals, and another person satisfied themselves they’d failed every part. All of us had our idiosyncratic methods of coping, starting from exemplary (exercising usually) to mildly regarding (day by day ‘crying breaks’). Different methods had been shared, similar to making an attempt to get sufficient sleep. Nonetheless others had been much less seen – and presumably much less intentional.
In the future, throughout peak examination season, I walked into the library and was struck by the variety of individuals biting their nails or selecting at their pores and skin. I had lately learnt of body-focused repetitive behaviours (BFRBs), a catch-all time period for such behaviours which, once they trigger injury and impairment or misery regardless of efforts to cease, warrant a medical analysis (American Psychiatric Affiliation, 2013). One instance is pores and skin selecting (excoriation) dysfunction (SPD), which happens in roughly 3.5% of most of the people (Farhat et al., 2023). Regardless of its widespread nature, little is known about what causes or maintains SPD (e.g. this weblog discusses interoception as a doubtlessly related issue). Nevertheless, in step with my observations within the library, one influential principle views BFRBs together with skin-picking as a method to handle emotion (Roberts et al., 2013). Accordingly, a latest systematic evaluate by Barber and Fitzgerald (2025) has explored the connection between emotion regulation and SPD in additional element.
Physique-focused repetitive behaviours, together with hair-pulling, skin-picking and nail-biting, have been linked to emotion dysregulation and could also be a manner for individuals to handle their emotions.
Strategies
The authors searched three databases for revealed English-language research that explored whether or not:
- emotion regulation differed in grownup SPD sufferers in comparison with wholesome controls,
- emotion regulation difficulties predicted SPD severity, or
- the impact of emotion regulation on centered (intentional) in comparison with automated (unconscious) selecting (Walther et al., 2009).
Individuals had been adults throughout the vary of SPD severity (i.e., nonclinical, subclinical and medical ranges); phenomena associated to emotion regulation (e.g., misery tolerance, experiential avoidance and alexithymia) had been additionally included. The evaluate didn’t embrace any gray literature or non-English-language papers; the researchers additionally didn’t seek the advice of specialists within the subject, however they did search reference lists for extra related research.
The authors used the JBI Crucial Appraisal Guidelines (Munn et al., 2023; Porritt et al., 2014) to critically appraise the standard of included research, which had been all reported as prime quality.
Outcomes
Nineteen papers had been included within the systematic evaluate, with pattern sizes starting from 18-285 individuals. Of those, 9 research confirmed that SPD sufferers (and BFRB samples usually) had larger ranges of emotion dysregulation in comparison with wholesome controls. Individuals with pores and skin selecting additionally:
- Had extra hassle understanding (i.e., figuring out and describing) their feelings and had been much less tolerant of psychological misery
- Have been much less more likely to distance themselves from struggling than controls, implying that they might develop into trapped by tough feelings that they expertise as extra insupportable than the overall inhabitants
- (In a single research) exhibited extra experiential avoidance (an inclination to keep away from emotion-provoking experiences) than these with out.
Total, these research suggest that individuals with problematic skin-picking might wrestle to grasp, tolerate and handle their emotions, which might contribute to SPD.
If individuals with SPD wrestle to manage their feelings, sturdy emotions might have an effect on their behaviour in a different way to controls. Accordingly, three research discovered that SPD sufferers wrestle to regulate impulses, pursue targets and cope adaptively when experiencing tough feelings. When it comes to particular methods, these with skin-picking could also be significantly impaired at cognitive reappraisal (pondering in a different way concerning the emotional state of affairs) relatively than expressive suppression (hiding their emotions), however this discovering doesn’t all the time replicate. There’s additionally some controversy about whether or not people with skin-picking have much less emotional consciousness, readability and acceptance than controls, with completely different research offering proof for and in opposition to this risk. Total, though emotion regulation does appear reliably impaired in SPD, it therefore stays unsure how precisely this deficit manifests when it comes to ideas and actions.
Considerably surprisingly, though these with and with out SPD have completely different emotion regulation profiles, emotion dysregulation doesn’t reliably correlate with skin-picking or BFRB severity. Research supporting such a correlation are contradicted by others failing to take action; including to this confusion, experiential avoidance seems to foretell SPD signs while misery tolerance doesn’t. Moreover, when it comes to particular methods, skin-picking severity appears utterly unrelated to expressive suppression and at finest weakly associated to cognitive reappraisal. Though emotion regulation might not predict skin-picking usually, 5 research revealed that emotion regulation and associated constructs constantly predicted centered selecting; associations with automated pores and skin selecting had been weak or nonsignificant, and associations with emotion regulation methods had been inconclusive. Therefore, emotion regulation issues (however not essentially reappraisal or suppression) could also be significantly associated to a sure sort of skin-picking relatively than SPD usually.
Pores and skin-picking sufferers appear to have hassle understanding, tolerating and regulating feelings, and will wrestle to suppose in a different way about emotion-provoking occasions.
Conclusions
Total, the systematic evaluate helps the function of emotion dysregulation and associated components (e.g., misery tolerance, alexithymia, experiential avoidance) in problematic skin-picking, implying that emotion regulation might play a job within the onset or upkeep of SPD.
These findings align with the emotion regulation mannequin of BFRBs, which views skin-picking as a manner for people to handle intense emotional states (Roberts et al., 2013).
Nevertheless, some key questions stay unanswered, together with why emotion regulation doesn’t reliably predict SPD severity, how particular emotion regulation methods relate to skin-picking and whether or not there may be actually a distinction between centered and automated selecting.
Though individuals with and with out skin-picking differ when it comes to emotion regulation, the severity of emotion dysregulation is just not related to the severity of skin-picking.
Strengths and limitations
A power of the systematic evaluate included its complete search technique spanning three tutorial databases along with quotation looking primarily based on the reference lists of accessible papers. Nevertheless, the search was restricted to revealed research in peer-reviewed journals and might due to this fact have missed related papers. As journals are much less more likely to publish nonsignificant findings, the evaluate dangers overestimating the affiliation between emotion regulation and SPD. As many results had been already fairly small, the conclusions made should therefore stay tentative.
Future work ought to mitigate the hazard of publication bias by increasing the search to incorporate gray literature. It will even be useful to seek the advice of with specialists who might concentrate on further unpublished or presently ongoing work. Together with non-English language research would additional enhance the comprehensiveness of the evaluate, as we danger lacking key research in any other case.
The authors did, nevertheless, use a standardised guidelines to guage the methodological rigour of included papers and transparently reported the outcomes of this evaluation. As all had been of sufficiently prime quality, we will be assured of their findings. To additional enhance transparency and openness, the researchers might have supplied key statistics and precision estimates for all research, which might assist the reader come to their very own unbiased and totally knowledgeable conclusions concerning the power of the relationships noticed.
The informativeness of any evaluate is basically restricted by that of the research included. Right here, most research had been cross-sectional (performed at one time level), so it’s unclear whether or not emotion regulation predicts pores and skin selecting over time or vice versa. Future work ought to reply this question by following up individuals longitudinally. It will even be helpful to analyze whether or not the findings generalise to younger individuals, who had been excluded from the present evaluate. Certainly, the sampling technique of the evaluate might not have been best: along with skin-picking samples, the authors included sufferers with BFRBs extra broadly. Though we now have causes to imagine completely different BFRBs will not be dissimilar (Moritz et al., 2023), it will have been useful to discover whether or not emotion regulation patterns differ between these teams.
Though there seems to be a relationship between emotion dysregulation and skin-picking, it’s unclear which comes first and whether or not there’s a causal affiliation between the 2.
Implications for observe
Though extra analysis is required to verify the present findings, the evaluate has essential medical implications. Firstly, if emotion dysregulation contributes to SPD, a promising therapy avenue might contain educating shoppers to raised handle their feelings. As highlighted by the authors, dialectical behaviour remedy (DBT) and acceptance and dedication remedy (ACT) explicitly goal emotional processing and will due to this fact assist to alleviate skin-picking (see this weblog for a evaluate of rising therapies together with DBT and ACT). DBT and ACT are presently under-researched in SPD so, earlier than incorporating them into medical observe, we first want to check whether or not they successfully scale back signs and the way they examine to therapies with out emotional components.
Furthermore, as individuals with and with out skin-picking reliably differ when it comes to emotion regulation, the authors highlighted how emotion processing deficits might assist establish individuals weak to creating SPD. Longitudinal analysis should verify whether or not that is certainly doable; if that’s the case, we might present at-risk people with focused help to stop problematic skin-picking. Furthermore, if bettering emotional processing reduces this danger, the findings would help the case for educating emotion regulation in colleges (Hoffmann et al., 2020). Though the proof base is arguably too preliminary to tell coverage at current, the findings trace at potential future interventions which might assist scale back the struggling attributable to SPD.
The proof additionally opens up thrilling avenues for future work. Alongside the necessity for longitudinal research, it will be attention-grabbing to discover whether or not incorporating emotion regulation expertise in remedy for sufferers with SPD improves outcomes over and above present therapies. As shoppers appear significantly impaired at cognitive reappraisal (relatively than expressive suppression), future work ought to first verify this discovering after which examine the impact of concentrating on completely different emotion regulation methods on skin-picking signs. Furthermore, latest analysis has questioned the excellence between centered and automated BFRBs, highlighting that they might not comprise actually distinct subtypes (Grant & Chamberlain, 2021). The sphere thus first must make clear whether or not it’s significant to delineate between centered and automated skin-picking and, if that’s the case, set up extra conclusively whether or not emotion dysregulation is especially central to certainly one of these subtypes.
So, had been my fellow college students actually selecting their pores and skin in an try to alleviate examination anxiousness? Or was I simply sensitised to BFRBs, lately having learnt about these behaviours? The previous actually makes for a greater story. Sadly, although, even when people with skin-picking wrestle to manage their feelings, this doesn’t essentially imply skin-picking helps them to take action. It might even be making issues worse. All I can do is anticipate extra analysis and hope to be forgiven for spinning this neat and tidy (albeit barely deceptive) anecdote within the interim.
If emotion dysregulation is an element sustaining skin-picking, constructing emotion regulation expertise in remedy might assist to cut back signs and alleviate struggling.
Assertion of pursuits
Daisy Slicing has no conflicts of curiosity to reveal with respect to the content material of this weblog publish.
Edited by
Dr Nina Higson-Sweeney.
Hyperlinks
Major paper
Kathryn E. Barber, & Jacklynn M. Fitzgerald. (2025). Emotion regulation deficits in pores and skin selecting (excoriation) dysfunction: A scientific evaluate. Journal of Affective Problems, 388, 119500. https://doi.org/10.1016/j.jad.2025.119500
Different references
American Psychiatric Affiliation (2013). Diagnostic and statistical guide of psychological problems: DSM-V. American Psychiatric Affiliation.
Farhat, L. C., Reid, M., Bloch, M. H., & Olfson, E. (2023). Prevalence and gender distribution of excoriation (skin-picking) dysfunction: A scientific evaluate and meta-analysis. Journal of Psychiatric Analysis, 161, 412–418. https://doi.org/10.1016/j.jpsychires.2023.03.034
Grant, J. E., & Chamberlain, S. R. (2021). Automated and centered hair pulling in trichotillomania: Legitimate and helpful subtypes? Psychiatry Analysis, 306, 114269. https://doi.org/10.1016/j.psychres.2021.114269
Hoffmann, J. D., Brackett, M. A., Bailey, C. S., & Willner, C. J. (2020). Instructing emotion regulation in colleges: Translating analysis into observe with the RULER strategy to social and emotional studying. Emotion, 20(1), 105–109. https://doi.org/10.1037/emo0000649
Isibor, M., & Higson-Sweeney, N. (2025). Contained in the urge: Interoception, affective contact, and the rising science of skin-picking dysfunction. The Psychological Elf.
Munn, Z., Stone, J.C., Aromataris, E., Klugar, M., Sears, Okay., Leonardi-Bee, J., Barker, T.H. (2023). Assessing the danger of bias of quantitative analytical research: Introducing the imaginative and prescient for important appraisal inside JBI systematic opinions. JBI Proof Synthesis, 21(3), 467–471. https://doi.org/10.11124/jbies-22-00224.
Moritz, S., Penney, D., Mißmann, F., Snorrason, I., & Schmotz, S. (2023). Similar however completely different? Phenomenological variations amongst numerous sorts of body-focused repetitive behaviors. Annals of Scientific Psychiatry, 35(4), 252–259. https://doi.org/10.12788/acp.0123
Porritt, Okay., Gomersall, J., Lockwood, C., 2014. JBI’S systematic opinions: Research choice and demanding appraisal. American Journal of Nursing, 114(6), 47–52. https://doi.org/10.1097/01
Roberts, S., O’Connor, Okay., & Bélanger, C. (2013). Emotion regulation and different psychological fashions for body-focused repetitive behaviors. Scientific Psychology Overview, 33(6), 745–762. https://doi.org/10.1016/j.cpr.2013.05.004n
Sampson, C. (2018). Is third-wave CBT good worth?. The Psychological Elf.
Walther, M. R., Flessner, C. A., Conelea, C. A., & Woods, D. W. (2009). The Milwaukee Stock for the Dimensions of Grownup Pores and skin Selecting (MIDAS): Preliminary growth and psychometric properties. Journal of Conduct Remedy and Experimental Psychiatry, 40(1), 127–135. https://doi.org/10.1016/j.jbtep.2008.07.002
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