Emotion regulation deficits in skin picking (excoriation) disorder: A systematic review

Abstract

Skin picking disorder (SPD) is a psychiatric condition characterized by repetitive skin picking that results in skin damage, emotional distress, and functional impairment. Emotion regulation is theorized to play a key role in the development and persistence of SPD, yet no prior review has synthesized findings on this relationship. This systematic review evaluates research on emotion regulation in SPD, specifically examining (1) differences in emotion regulation between individuals with SPD and healthy controls, (2) associations between emotion regulation and SPD symptom severity, and (3) links between emotion regulation and picking styles (focused and automatic). Following PRISMA guidelines, a systematic search of PsycINFO, PubMed, and Embase identified 19 studies that met inclusion criteria. Findings indicate that individuals with SPD consistently exhibit greater emotion regulation difficulties compared to healthy controls. Those with SPD also tend to use certain emotion regulation strategies such as cognitive reappraisal less frequently. Results regarding the relationship between emotion dysregulation and overall SPD symptom severity are mixed. Emotion dysregulation is more strongly associated with focused picking (intentional, affect-driven) than with automatic (occurring outside of immediate awareness). These findings underscore the importance of emotion regulation in SPD and suggest that targeting emotion regulation may be beneficial in therapeutic interventions for SPD.