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      Visual Triggers of Skin Picking Episodes: An Experimental Study in Self-Reported Skin Picking Disorder and Atopic Dermatitis


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          Skin Picking Disorder (SPD) is a new diagnosis with limited information available about triggers of picking episodes. Itch can be induced via audio-visual stimuli and the effect of contagious itch is stronger for those affected by atopic dermatitis. We examined if picking-related visual stimuli can trigger the urge to pick skin in self-reported SPD. We compared itch and the urge to pick in a sample of AD and/or SPD-affected to controls without either.


          Urge to pick skin and/or scratch when viewing 24 itch-related, picking-related or neutral online pictures was assessed in adult females, who self-report skin-picking (SPD-only, n = 147) and/or atopic dermatitis (AD-only, n = 47; AD+SPD, n = 46) as well as in skin healthy controls (HC, n = 361).


          All participants reported a stronger urge to pick for picking-related pictures compared to neutral content (F[1, 597] = 533.96, p < .001, ηp2 = .472) and more itch for itch-related pictures compared to neutral stimuli (F[1, 597] = 518.73, p < .001, ηp2 = .465). SPD-all (SPD-only & AD+SPD) reported stronger urges to pick for picking-related vs. other stimuli compared to the AD-only and HC group (p < .001, ηp2 = .047). Likewise, AD-all (AD-only & AD+SPD) reported significantly stronger itching for itch-related vs. other stimuli compared to SPD-only and HC (p = .001, ηp2 = .019).


          Analog to visual provocation of itch, the urge to pick can be triggered by visual stimuli. Treatments for SPD and AD may profit from addressing visual stimuli.


          • Contagious itch can be induced with visual stimuli (videos or static pictures).

          • This effect is especially strong in individuals self-reporting atopic dermatitis.

          • The urge to pick can also be induced with visual stimuli (picking-related pictures).

          • This effect is especially strong in individuals self-reporting skin picking disorder.

          • Treatment for skin picking disorder may profit from addressing visual stimuli.

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          Most cited references31

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          Measuring emotion: the Self-Assessment Manikin and the Semantic Differential.

          The Self-Assessment Manikin (SAM) is a non-verbal pictorial assessment technique that directly measures the pleasure, arousal, and dominance associated with a person's affective reaction to a wide variety of stimuli. In this experiment, we compare reports of affective experience obtained using SAM, which requires only three simple judgments, to the Semantic Differential scale devised by Mehrabian and Russell (An approach to environmental psychology, 1974) which requires 18 different ratings. Subjective reports were measured to a series of pictures that varied in both affective valence and intensity. Correlations across the two rating methods were high both for reports of experienced pleasure and felt arousal. Differences obtained in the dominance dimension of the two instruments suggest that SAM may better track the personal response to an affective stimulus. SAM is an inexpensive, easy method for quickly assessing reports of affective response in many contexts.
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            New insights into atopic dermatitis: role of skin barrier and immune dysregulation.

            Atopic dermatitis (AD) is a chronic inflammatory skin disease that is often associated with the development of food allergy and asthma. New insights into AD reveals an important role for structural abnormalities in the epidermis resulting in a leaky epithelial barrier as well as chronic immune activation that contribute to the pathophysiology of this common skin disease. Patients with AD have a predisposition to colonization or infection by microbial organisms, most notably Staphylococcus aureus and herpes simplex virus (HSV). Measures directed at healing and protecting the skin barrier and controlling the immune activation are needed for effective management of AD. Early intervention may improve outcomes for AD as well as reduce the systemic allergen sensitization that may lead to associated allergic diseases in other organs.
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              The Adult Sensory Profile: Measuring Patterns of Sensory Processing


                Author and article information

                Clin Psychol Eur
                Clin Psychol Eur
                Clinical Psychology in Europe
                December 2020
                23 December 2020
                : 2
                : 4
                : e2931
                [a ]Institute of Clinical Psychology and Psychotherapy, University of Cologne , Cologne, Germany
                [2]Philipps-University of Marburg, Marburg, Germany
                Author notes
                Linda Marlen Mehrmann, University of Cologne, Institute of Clinical Psychology and Psychotherapy, Pohligstraße 1, 50969 Cologne, Germany. Phone: 0049-221-470-6854. linda.mehrmann@ 123456uni-koeln.de
                Author information
                Copyright @ 2020

                This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY) 4.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 11 March 2020
                : 03 November 2020
                The authors have no funding to report.
                Research Articles

                skin picking,excoriation disorder,body-focused repetitive behaviors,contagious itch,visual stimuli


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