Few issues encourage concern in college students as reliably as exams. Until you’re one of many blissful few who a) have a photographic reminiscence or b) benefit from the thrill of all of it (I’m advised these folks exist), assessments are inherently tense, and none extra so than remaining college examinations. In my friendship group alone, throughout Finals, one particular person developed insomnia, one other stopped stomaching strong meals, and another person satisfied themselves they’d failed all the pieces. All of us had our idiosyncratic methods of coping, starting from exemplary (exercising usually) to mildly regarding (day by day ‘crying breaks’). Different methods have been shared, reminiscent of attempting to get sufficient sleep. Nonetheless others have been much less seen – and probably much less intentional.
At some point, throughout peak examination season, I walked into the library and was struck by the variety of folks biting their nails or choosing at their pores and skin. I had lately learnt of body-focused repetitive behaviours (BFRBs), a catch-all time period for such behaviours which, after they trigger harm and impairment or misery regardless of efforts to cease, warrant a scientific prognosis (American Psychiatric Affiliation, 2013). One instance is pores and skin choosing (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). Nonetheless, according to my observations within the library, one influential idea views BFRBs together with skin-picking as a method to handle emotion (Roberts et al., 2013). Accordingly, a current systematic evaluation 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 folks to handle their emotions.
Strategies
The authors searched three databases for printed 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 targeted (intentional) in comparison with computerized (unconscious) choosing (Walther et al., 2009).
Individuals have been adults throughout the vary of SPD severity (i.e., nonclinical, subclinical and scientific ranges); phenomena associated to emotion regulation (e.g., misery tolerance, experiential avoidance and alexithymia) have been additionally included. The evaluation didn’t embody any gray literature or non-English-language papers; the researchers additionally didn’t seek the advice of consultants within the discipline, however they did search reference lists for added related research.
The authors used the JBI Essential Appraisal Guidelines (Munn et al., 2023; Porritt et al., 2014) to critically appraise the standard of included research, which have been all reported as top quality.
Outcomes
Nineteen papers have been included within the systematic evaluation, with pattern sizes starting from 18-285 individuals. Of those, 9 research confirmed that SPD sufferers (and BFRB samples generally) had increased ranges of emotion dysregulation in comparison with wholesome controls. Folks with pores and skin choosing additionally:
- Had extra bother understanding (i.e., figuring out and describing) their feelings and have been much less tolerant of psychological misery
- Had been much less more likely to distance themselves from struggling than controls, implying that they could develop into trapped by troublesome 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 folks with problematic skin-picking might battle to know, tolerate and handle their emotions, which might contribute to SPD.
If folks with SPD battle to control their feelings, sturdy emotions might have an effect on their behaviour in a different way to controls. Accordingly, three research discovered that SPD sufferers battle to manage impulses, pursue targets and cope adaptively when experiencing troublesome feelings. By way of particular methods, these with skin-picking could also be significantly impaired at cognitive reappraisal (pondering in a different way in regards to the emotional scenario) somewhat than expressive suppression (hiding their emotions), however this discovering doesn’t at all times replicate. There may be 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 towards 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 fully unrelated to expressive suppression and at finest weakly associated to cognitive reappraisal. Though emotion regulation might not predict skin-picking generally, 5 research revealed that emotion regulation and associated constructs persistently predicted targeted choosing; associations with computerized pores and skin choosing have been weak or nonsignificant, and associations with emotion regulation methods have been inconclusive. Therefore, emotion regulation issues (however not essentially reappraisal or suppression) could also be significantly associated to a sure sort of skin-picking somewhat than SPD generally.
Pores and skin-picking sufferers appear to have bother understanding, tolerating and regulating feelings, and should battle to suppose in a different way about emotion-provoking occasions.
Conclusions
Total, the systematic evaluation helps the position 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).
Nonetheless, 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’s really a distinction between targeted and computerized choosing.
Though folks with and with out skin-picking differ when it comes to emotion regulation, the severity of emotion dysregulation shouldn’t be related to the severity of skin-picking.
Strengths and limitations
A power of the systematic evaluation included its complete search technique spanning three educational databases along with quotation looking primarily based on the reference lists of accessible papers. Nonetheless, the search was restricted to printed 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 evaluation dangers overestimating the affiliation between emotion regulation and SPD. As many results have 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 consultants who might concentrate on further unpublished or presently ongoing work. Together with non-English language research would additional enhance the comprehensiveness of the evaluation, as we threat lacking key research in any other case.
The authors did, nonetheless, use a standardised guidelines to guage the methodological rigour of included papers and transparently reported the outcomes of this evaluation. As all have been of sufficiently top quality, we could be assured of their findings. To additional enhance transparency and openness, the researchers might have offered key statistics and precision estimates for all research, which might assist the reader come to their very own impartial and absolutely knowledgeable conclusions in regards to the power of the relationships noticed.
The informativeness of any evaluation is essentially restricted by that of the research included. Right here, most research have been cross-sectional (carried out at one time level), so it’s unclear whether or not emotion regulation predicts pores and skin choosing over time or vice versa. Future work ought to reply this question by following up individuals longitudinally. It will even be helpful to research whether or not the findings generalise to younger folks, who have been excluded from the present evaluation. Certainly, the sampling technique of the evaluation might not have been superb: along with skin-picking samples, the authors included sufferers with BFRBs extra broadly. Though we’ve causes to imagine completely different BFRBs will not be dissimilar (Moritz et al., 2023), it could 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 apply
Though extra analysis is required to verify the present findings, the evaluation has vital scientific implications. Firstly, if emotion dysregulation contributes to SPD, a promising remedy avenue might contain educating purchasers to higher handle their feelings. As highlighted by the authors, dialectical behaviour remedy (DBT) and acceptance and dedication remedy (ACT) explicitly goal emotional processing and should due to this fact assist to alleviate skin-picking (see this weblog for a evaluation of rising therapies together with DBT and ACT). DBT and ACT are presently under-researched in SPD so, earlier than incorporating them into scientific apply, we first want to check whether or not they successfully cut back signs and the way they evaluate to therapies with out emotional components.
Furthermore, as folks with and with out skin-picking reliably differ when it comes to emotion regulation, the authors highlighted how emotion processing deficits might assist determine folks weak to growing SPD. Longitudinal analysis should affirm whether or not that is certainly potential; if that’s the case, we might present at-risk people with focused help to stop problematic skin-picking. Furthermore, if enhancing emotional processing reduces this threat, the findings would help the case for educating emotion regulation in faculties (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 cut back the struggling attributable to SPD.
The proof additionally opens up thrilling avenues for future work. Alongside the necessity for longitudinal research, it could 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 purchasers appear significantly impaired at cognitive reappraisal (somewhat than expressive suppression), future work ought to first affirm this discovering after which evaluate the impact of focusing on completely different emotion regulation methods on skin-picking signs. Furthermore, current analysis has questioned the excellence between targeted and computerized BFRBs, highlighting that they could not comprise really distinct subtypes (Grant & Chamberlain, 2021). The sphere thus first must make clear whether or not it’s significant to delineate between targeted and computerized skin-picking and, if that’s the case, set up extra conclusively whether or not emotion dysregulation is especially central to one in all these subtypes.
So, have been my fellow college students actually choosing 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 definitely makes for a greater story. Sadly, although, even when people with skin-picking battle to control 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 watch for 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 Chopping has no conflicts of curiosity to reveal with respect to the content material of this weblog put up.
Edited by
Dr Nina Higson-Sweeney.
Hyperlinks
Main paper
Kathryn E. Barber, & Jacklynn M. Fitzgerald. (2025). Emotion regulation deficits in pores and skin choosing (excoriation) dysfunction: A scientific evaluation. 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 issues: 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 evaluation 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). Computerized and targeted 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 faculties: Translating analysis into apply with the RULER method 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 chance of bias of quantitative analytical research: Introducing the imaginative and prescient for important appraisal inside JBI systematic evaluations. 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 varied kinds 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 evaluations: 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 Evaluate, 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 Choosing (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
