Skin Picking Disorder Case Study

Skin Picking Disorder (SPD) is known as repetitive and compulsive picking of skin which may lead to tissue damage.1Due to phenomenological and neurobiological similarities with Obsessive-Compulsive Disorder (OCD), SPD has recently been classified under obsessive–compulsive and related disorders title in DSM-5.2Subjects with SPD display more OCD and other OC spectrum disorders compared to ones without SPD.3 Stress, anxiety, boredom, feelings of tiredness or anger have been found to be possible triggers for SPD.4,5 Subjective difficulties in emotion regulation might predict picking behavior independent from depression and anxiety.6 Various investigations demonstrated that individuals SPD had a high frequency of previous traumatic events

She reported that she experienced some rape-related posttraumatic stress disorder (PTSD) symptoms such as flashbacks, hyperarousal, hypervigilance, nightmares and reexperiencing traumatic event since three years. Along the next ten years following her delivery, despite several attempts for psychiatric treatments, no significant improvement was observed in her picking behaviour. Morever, her SP exacerbated after a sexual assault three years ago. She failed to decrease or stop skin picking resulting in skin lesions. She reported feeling an intense sense of loss of control and tension prior to SP. She also reported experiencing relief a majority of the time. She had no dermatological or infectious etiologies of the SP. Dermatological consultation, and laboratory investigations of thyroid, liver, and kidney functions were normal. We could not obtain her skin biopsy since she refused it to be done. She had also no past history of any OCD-related disorders or Impulse Control Disorders (ICD). She had not previously used any substance or other medications which might cause SP behaviour. She reported that she had severe conflicts during childhood and adolescence with her father who had rigid and authoritarian temperament characteristics. Her pregnancy was planned and she well-prepared herself for her baby. Prior to her pregnancy, she did not experience any pysical or sexual abuse. In the inpatient unit, on the basis of current psychiatric examination, she received the diagnoses of SPD, Posttraumatic Stress Disorder (PTSD), and major depression. Initially, 50 mg/day of sertralin and 50 mg/day of lamotrigine were started and both drugs were increased to 100 mg/day one week