For many of us, the pores and skin is just a boundary – a barrier between us and the world. However for many who stay with body-focused repetitive behaviours (BFRBs) reminiscent of skin-picking, hair-pulling, or nail-biting, the pores and skin can change into the very website of emotional wrestle.
BFRBs are a bunch of situations characterised by repetitive and hard-to-control selecting, pulling, biting, or in any other case manipulating the physique leading to harm to the tissue. BFRBs are sometimes misunderstood as a ‘unhealthy behavior’, regardless of being recognised as a part of the spectrum of obsessive–compulsive and associated problems (American Psychiatric Affiliation, 2013). BFRBs have an effect on an estimated 2-5% of individuals (Snorrason et al., 2012) and are related to disgrace, emotional dysregulation, and appreciable practical impairment. But we nonetheless know comparatively little in regards to the mechanisms that maintain these behaviours going or how they relate to the way in which people expertise their our bodies.
Interoception – our potential to sense inside bodily alerts reminiscent of heartbeat, pressure or discomfort – has not too long ago gained consideration as a possible consider situations involving emotion-regulation difficulties (Khalsa et al., 2018). This contains rising work on affective (C-tactile) contact, which performs a task in calming and social-emotional processing (McGlone et al., 2014). In skin-picking dysfunction (SPD), people usually report urges, discomfort or “not-just-right” sensations previous selecting episodes, and reduction or grounding afterwards (Snorrason et al., 2010). These observations have prompted researchers to discover whether or not interoception, together with affective contact, might play a task within the onset, upkeep or regulation of BFRBs.
On this weblog, we summarise and critically consider a current systematic assessment by Kłosowska et al. (2025), which synthesises the small however rising proof base on interoception in SPD. We additionally replicate on what these findings would possibly imply for follow and for individuals dwelling with BFRBs.
What’s the position of bodily sensations and affective contact in relation to skin-picking dysfunction? This systematic assessment synthesises the proof in relation to how we interpret inside bodily alerts.
Strategies
5 databases have been searched utilizing phrases referring to skin-picking dysfunction (SPD) and interoception to determine quantitative research exploring how individuals with SPD sense and interpret bodily alerts. Articles have been included in the event that they have been peer-reviewed, revealed in English, included a validated measure of at the very least one facet of interoception (a modality or a dimension), and included a validated measure or DSM-5/ICD-11 prognosis of SPD. Gray literature was excluded, in addition to research that explored skin-picking within the context of a special situation. quotation chasing was additionally used to make sure that related research weren’t missed.
Recognized articles have been double screened by two researchers, earlier than related knowledge was extracted. To account for the heterogeneity of research designs and measures, the crew assessed methodological high quality utilizing the Combined Strategies Appraisal Software standards.
Outcomes
9 articles based mostly on eight totally different samples have been included on this systematic assessment, with knowledge from a complete of 1,338 individuals. Nearly all of individuals have been feminine, with imply ages starting from 23.87 to 34.32 years. Most research in contrast people with skin-picking dysfunction (SPD) or SPD signs to wholesome controls. 5 research have been quasi-experimental, one was a randomised managed trial, one used an intensive longitudinal design, and one was cross-sectional.
A number of totally different interoceptive modalities have been explored in relation to SPD, together with:
- Visceral alerts: One research discovered that compared to wholesome controls, people with SPD signs confirmed considerably decrease cardiac interoceptive accuracy after controlling for potential confounders. Additionally they discovered that greater interoceptive accuracy within the SPD group was related to a decrease chance of skin-picking throughout the subsequent measurement interval (OR = 0.10, 95% CI [0.02 to 0.44], p = .002).
- Affective contact: Out of 4 articles based mostly on three research, one discovered a optimistic average correlation between skin-picking urges throughout affective (C-tactile) contact and SPD symptom severity, and two discovered that people with SPD rated contact (C-tactile and non-C-tactile) as considerably much less nice and extra arousing , with the next urge to skin-pick in response to the touch. An experimental research additionally discovered that the severity of SPD signs decreased from baseline to post-training after receiving both Mushy Contact Coaching or Progressive Muscle Leisure.
- Ache: Three research explored altered ache processing in people with SPD. Two research discovered no important variations in ache tolerance between people with SPD and wholesome controls and between people with SPD, trichotillomania, or wholesome controls. A ultimate research discovered that people with average or excessive SPD signs reported considerably much less optimistic have an effect on and larger arousal from electrocutaneous pulses compared to wholesome controls, however there have been nonetheless no important variations in ache scores.
- Itch: One research discovered that people with SPD reported a considerably greater urge to itch in response to itch-related and picking-related stimuli compared to wholesome controls, in addition to the next urge to select in response to itch-related stimuli.
One additional research investigated interoceptive sensibility, which is a person’s perceived sensitivity to bodily sensation. They discovered that individuals with SPD had decrease emotional consciousness scores compared to wholesome controls, and that greater physique listening scores have been related to lowered perceived management over skin-picking episodes within the subsequent measurement interval. This was the one included research that explored an interoceptive dimension reasonably than a modality.
Throughout 9 research, there seems to be an rising sample between disturbances in interoception (the interpretation of inside bodily alerts) and skin-picking behaviours in people with Pores and skin Selecting Dysfunction.
Conclusions
Based mostly on the findings from this systematic assessment, Kłosowska and colleagues conclude that there’s preliminary proof to point a relationship between skin-picking and disrupted interoception, highlighting a possible mechanism that might contribute to or assist keep SPD. Nonetheless, with solely 9 articles recognized, nothing is conclusive and rather more analysis is required. Because the authors state:
Agency medical suggestions can’t but be made […] advancing analysis on interoceptive processes in skin-picking dysfunction (SPD) may facilitate the event of novel interventions, addressing the present shortage of accessible therapies.
Whereas the findings of this systematic assessment spotlight an fascinating space future intervention, a lot additional analysis on interoception in Pores and skin Selecting Dysfunction is required earlier than this may be explored.
Strengths and limitations
There are a number of strengths to this systematic assessment, together with the very fact that it’s the first systematic synthesis of interoception in skin-picking dysfunction (SPD), mapping out a extremely under-explored space and providing a transparent overview of what’s at present recognized. This endeavour is useful for clinicians and researchers in understanding what the present evidence-base is, and what gaps in data stay. A rigorous methodology was additionally used, with the protocol pre-registered and the assessment reported in accordance with PRISMA tips, which aids methodological transparency and the reliability of the information. The authors used a well-known, broad definition of interoception that captured a number of dimensions, which will increase the chance that every one related research have been recognized and included. Lastly, most research have been rated as having a comparatively low danger of bias, growing the reliability of the findings; nonetheless, there have been queries in relation to choice, reporting, and omitted-variable bias.
Nonetheless, there are limitations to the assessment itself and the included research. First, the proof base is extraordinarily small, together with 9 articles performed by 4 totally different analysis teams. Not solely does this imply that there are limits to the statistical energy of those findings and generalisability, however there may be additionally the potential for investigator bias, which the authors acknowledge; nonetheless, that is usually unavoidable in such an under-researched space. Moreover, it’s tough to straight examine the totally different research as there was lots of methodological heterogeneity, which is why a meta-analysis was not performed. This reduces the reliability of the conclusions drawn, therefore why the authors are so tentative. Lastly, the exclusion of gray literature may imply that related analysis was not included, reminiscent of research which can be at present beneath peer-review and haven’t but been revealed. In just a few years’ time, it might be fascinating to undertake an up to date systematic assessment to see how a lot the proof base has expanded.
Because the very first systematic assessment investigating interoception in relation to Pores and skin Selecting Dysfunction, this paper helpfully maps the present proof base for researchers and clinicians. Nonetheless, with small pattern sizes and excessive heterogeneity, findings are nonetheless preliminary.
Implications for follow
Given the early levels of this proof, any medical implications from this systematic assessment must be drawn cautiously. Nonetheless, there are some fascinating areas for future consideration, together with:
- Exploring bodily cues as a part of evaluation: For some people with skin-picking dysfunction (SPD), bodily sensations might precede skin-picking episodes. Clinicians would possibly gently discover these sensations as a part of a broader formulation, with out assuming they function in the identical method for everybody.
- Supporting emotion regulation and physique consciousness: Given wider help for the idea that skin-picking is related to emotional regulation (Khalsa et al., 2018) and the discovering from one research on this assessment that people with SPD display decrease emotional consciousness, clinicians may take into account interventions that strengthen emotion regulation or secure, compassionate physique consciousness. Nonetheless, research have but to check interoception-focused interventions for SPD straight, that means such approaches must be thought of exploratory reasonably than evidence-based.
- Affective contact as a possible future space of curiosity: Preliminary findings on affective contact elevate fascinating questions on sensory consolation and dysregulation in SPD. Whereas these outcomes are too restricted to tell medical interventions, they spotlight the potential significance of sensory components in understanding how people soothe or regulate inside states.
- Trauma- and neurodiversity-informed follow: Some individuals with SPD might have heightened sensitivity to sensory cues or discomfort with interpersonal contact. The place related, clinicians might take into account a trauma- and neurodiversity-informed strategy, starting with client-led exploration of sensations and making certain any methods involving contact prioritise consent, consolation and emotional security.
For me (Marta), as each a researcher and lived-experience advocate, the findings from this systematic assessment really feel deeply validating. For years, attachment-based and emotion-regulation fashions of BFRBs have been overshadowed by behavioural and neurobiological explanations. But the rising science of interoception and affective contact gives a language many people recognise intuitively — security, connection, and reduction by way of the pores and skin. Our earliest experiences of care are communicated by way of contact, and empirical work more and more helps this hyperlink: insecure attachment predicts altered sensitivity to affective contact (Krahé et al., 2018) and better BFRB severity (Isibor, 2025; Shen, 2024). Though preliminary, this implies that contact and attachment kind a shared sensory–emotional system that underpins how we regulate misery. Seeing interoception and affective-touch analysis spotlight these similar pathways, brings each scientific validation and private recognition.
These findings additionally resonate with my medical work and my position as a dad or mum of neurodivergent kids. I see day by day how sensory experiences form emotional regulation; generally soothing, generally overwhelming. For some individuals with SPD, bodily cues reminiscent of pressure, irritation, or a “build-up” of discomfort precede selecting; for others, contact itself will be dysregulating. Trauma histories, sensory sensitivities, and neurodiversity can all affect how the physique is felt and the way security is signalled. Which means that any future sensory-based approaches should stay client-led, mild, non-compulsory, and grounded in consent.
Total, these findings invite cautious optimism. The proof is just not but sturdy sufficient to information medical follow, but it surely encourages curiosity in regards to the physique’s position in self-soothing. Beneath many repetitive behaviours might lie a physique attempting to control itself; and the pores and skin, removed from being the enemy, might be a part of the answer.
Whereas additional analysis is required earlier than interventions concentrating on interoception will be thought of for skin-picking, these findings present meals for thought relating to the position of emotional regulation and physique consciousness inside follow.
Assertion of pursuits
Marta has lived expertise of Physique-Targeted Repetitive Behaviours and has co-authored analysis on this space. She can be concerned in advocacy and psychoeducational work referring to BFRBs. No different conflicts of curiosity to declare.
Marta used AI help (OpenAI GPT-5) for structuring this weblog. All writing and reflections are her personal.
Edited by
Dr Nina Higson-Sweeney.
Hyperlinks
Main paper
Kłosowska, J., Żegleń, M., Badzińska, J., & Prochwicz, Okay. (2025). Interoception abnormalities and skin-picking dysfunction: Systematic assessment and narrative synthesis of preliminary proof. Neuroscience & Biobehavioral Opinions, 106349. https://doi.org/10.1016/j.neubiorev.2025.106349
Different references
American Psychiatric Affiliation. (2013). Diagnostic and statistical handbook of psychological problems (fifth ed.).
Isibor, M. (2025). Emotion regulation as a mediator of the affiliation between attachment safety and skin-picking dysfunction symptom severity. Attachment: New Instructions in Psychotherapy and Relational Psychoanalysis, 19(1), 54–69. https://doi.org/10.33212/att.v19n1.2025.54
Khalsa, S. S., Adolphs, R., Cameron, O. G., Davenport, P. W., Feinstein, J. S., Feusner, J. D., … Zucker, N. (2018). Interoception and psychological well being: A roadmap. Organic Psychiatry: Cognitive Neuroscience and Neuroimaging, 3(6), 501–513. https://doi.org/10.1016/j.bpsc.2017.12.004
Krahé, C., von Mohr, M., Gentsch, A., Man, L., Vari, C., Nolte, T., & Fotopoulou, A. (2018). Sensitivity to CT-optimal, affective contact relies on grownup attachment fashion. Scientific Stories, 8(1), 14544. https://doi.org/10.1038/s41598-018-32865-6
McGlone, F., Wessberg, J., & Olausson, H. (2014). Discriminative and affective contact: Sensing and feeling. Neuron, 82(4), 737–755. https://doi.org/10.1016/j.neuron.2014.05.001
Shen, T. (2024). A correlation research of attachment and body-focused repetitive behaviour in non-treatment-seeking individuals. Lecture Notes in Schooling Psychology and Public Media, 47. https://doi.org/10.54254/2753-7048/47/20240894
Snorrason, I., Belleau, E. L., & Woods, D. W. (2012). How associated are hair pulling dysfunction (trichotillomania) and pores and skin selecting dysfunction? A assessment of proof for comorbidity, similarities and shared etiology. Scientific Psychology Overview, 32(7), 618-629. https://doi.org/10.1016/j.cpr.2012.05.008
Snorrason, Í., Smári, J., & Olafsson, R. P. (2010). Emotion regulation in pathological pores and skin selecting: Findings from a non-treatment in search of pattern. Journal of Conduct Remedy and Experimental Psychiatry, 41(3), 238-245. https://doi.org/10.1016/j.jbtep.2010.01.009
