Implicit processes in pathological skin picking: Responses to skin irregularities predict symptom severity and treatment susceptibility

Background and objectivesImplicit cognitive processes are relevant in understanding the development and maintenance of psychopathology and dysfunctional behaviours. The present study investigated the role of implicit processes in pathological skin picking (PSP).MethodsUsing an Approach–Avoidance Task (AAT), we examined automatic response tendencies towards skin picking-related photographs in a sample of 34 college students who suffered from PSP and participated in a randomized, waiting-list controlled treatment study.ResultsIn comparison to a control sample (n = 49), PSP patients displayed significantly decelerated reaction times (distraction) in response to photographs of skin irregularities and a tendency to respond with avoidance to photographs of skin irregularities. Both distraction and avoidance in reaction to photographs of skin irregularities were significantly associated with current skin picking severity. Moreover, the strength of distraction in response to skin irregularities predicted unique variance in skin picking severity at post-measurement, over and above the effect of skin picking severity at pre-measurement and the effect of treatment condition. For the treatment condition, higher initial distraction predicted better treatment outcome (lower skin picking severity at post-measurement), whereas it predicted symptom deterioration at post-treatment for untreated participants.LimitationsThe specific characteristics of PSP patients (mainly female university students) and the relatively small sample size may compromise generalizability of findings.ConclusionsIn PSP, affective distraction in response to skin irregularities seems to characterize an important process related to symptom severity as well as treatment susceptibility.

► We examine the role of implicit processes in pathological skin picking (PSP).
► We assess automatic responses to skin irregularities in PSP patients and controls.
► PSP patients display distraction and avoidance in response to skin irregularities.
► Distraction by skin irregularities uniquely predicts symptom severity at post-measurement.
► Responses to skin irregularities seem relevant in severity and maintenance of PSP.