Abstract
To examine the nature and psychosocial correlates of skin-picking behavior in youth with Prader-Willi Syndrome (PWS). Parents of 67 youth (aged 5–19 years) with PWS were recruited to complete an internet-based survey that included measures of: skin-picking behaviors, the automatic and/or focused nature of skin-picking, severity of skin-picking symptoms, anxiety symptoms, developmental functioning, symptoms of inattention, impulsivity, and oppositionality, and quality of life. Results indicated that skin-picking was endorsed in 95.5% of youth. Direct associations of moderate strength were found between skin-picking severity and symptoms of anxiety, inattention, oppositionality, developmental functioning, and quality of life. Other descriptive data, such as areas picked, cutaneous factors, antecedents, and consequences related to skin-picking are reported. The prevalence and consequences associated with skin-picking in PWS indicate a greater need for clinician awareness of the behavior and interventions tailored to meet the needs of this population.
Similar content being viewed by others
Notes
Data regarding country of origin for participants was not collected.
Further information about this study can be provided upon request by the second author.
References
Prader A, Labhart A, Willi H (1956) Ein Syndrom vom Adipositas, Kleinwuchs Kryptorchismus und Oligophenie nach myatonieartigem Zustand im Neugeborenalter. Schweizerische Medicinische Wochwenschrift 86:12601
Cassidy S, Schwartz S (1998) Prader-Willi and Angelman syndromes: disorders of genomic imprinting. Medicine 77:140–151
Holm VA, Cassidy SB, Butler M, Hanchett JM, Greenswag LR, Whitman BY, Greenberg R (1993) Prader-Willi syndrome: consensus diagnostic criteria. Pediatrics 91:398–402
Cassidy SB (1997) Prader-willi syndrome. J Med Genet 34:917–923
Dykens EM, Kasari C (1997) Maladaptive behavior in children with Prader–Willi syndrome, Down syndrome, and nonspecific mental retardation. Am J Ment Retard 102:228–237
Dykens EM, Leckman JF, Cassidy SB (1996) Obsessions and compulsions in Prader-Willi syndrome. J Child Psychol Psychiatry 37:995–1002
Dykens EM, Shah B (2003) Psychiatric disorders in Prader-Willi syndrome: epidemiology and management. CNS Drugs 17:167–178
Cassidy SB, Forsythe M, Heeger S, Nicholls RD, Schork N, Benn P, Schwartz S (1997) Comparison of phenotype between patients with Prader- Willi syndrome due to deletion 15q and uniparental disomy 15. Am J Med Genet 68:433–440
Stein DJ, Keating J, Zar HJ, Hollander E (1994) Survey of the phenomenology and pharmacotherapy of compulsive and impulsive-aggressive symptoms in Prader-Willi Syndrome. J Neuropsychiatry Clin Neurosci 6:23–29
Symons FJ, Butler MG, Sanders MD, Feurer ID, Thompson T (1999) Self-injurious behavior and Prader-Willi syndrome: Behavioral forms and body locations. Am J Ment Retard 104:260–269
Dimitropoulos A, Feurer ID, Butler MG, Thompson T (2001) Emergence of compulsive behavior and tantrums in children with Prader-Willi syndrome. Am J Ment Retard 106:39–51
Günay-Aygün M, Schwartz S, Heeger S, O’Riordan MA, Cassidy SB (2001) The changing purpose of Prader-Willi syndrome clinical diagnostic criteria and proposed revised criteria. Pediatrics 108:E92
Dimitropoulos A, Blackford J, Walden T, Thompson T (2006) Compulsive behavior in Prader-Willi syndrome: examining severity in early childhood. Res Dev Disabil 27:190–202
State MW, Dykens EM, Rosner B, Martin A, King BH (1999) Obsessive compulsive symptoms in Prader-Willi and “Prader-Willi-like” patients. J Am Acad Child Adolesc Psychiatry 38:329–334
Wigren M, Hansen S (2003) Rituals and compulsivity in Prader–Willi syndrome: profile and stability. J Intellect Disabil Res 47:428–438
Clarke DJ, Waters J, Corbett JA (1989) Adults with Prader-Willi syndrome: Abnormalities of sleep and behaviour. J R Soc Med 82:21–24
Dykens EM, Hodapp RM, Walsh K, Nash LJ (1992) Adaptive and maladaptive behavior in Prader-Willi Syndrome. J Am Acad Child Adolesc Psychiatry 31:1131–1136
Bienvenu OJ, Samuels JF, Riddle MA, Hoehn-Saric R, Liang KY, Cullen B, Grados MA, Nestadt G (2000) The relationship of obsessive-compulsive disorder to possible spectrum disorders: results of a family study. Biol Psychiatry 48:287–293
Richter MA, Summerfeldt L, Antony MM, Swinson RP (2003) Obsessive-compulsive spectrum conditions in obsessive-compulsive disorder and other anxiety disorders. Depress Anxiety 8:118–127
Stein DJ, Hollander E (1992) Dermatology and conditions related to obsessive-compulsive disorder. J Am Acad Dermatol 26:237–242
Stein DJ, Hutt CS, Spitz JL, Hollander E (1993) Compulsive picking and obsessive-compulsive disorder. Psychosomatics 34:177–181
Whitman BY, Accardo P (1987) Emotional symptoms in Prader-Willi syndrome adolescents. Am J Med Genet 28:897–905
Thornton L, Dawson KP (1990) Prader-Willi syndrome in New Zealand: A survey of 36 affected people. N Z Med J 103:97–98
Didden R, Korzilius H, Curfs LMG (2007) Skin-picking in individuals with Prader-Willi Syndrome: Prevalence, functional assessment, and its comorbidity with compulsive and self-injurious behaviors. J Appl Res Intellect Disabil 20:409–419
Neziroglu F, Rabinowitz D, Breytman A, Jacofsky M (2008) Skin picking phenomenology and severity comparison. Prim Care Companion J Clin Psychiatry 10:306–312
Arnold LM, McElroy SL, Mutasim DF, Dwight MM, Lamerson CL, Morris EM (1998) Characteristics of 34 adults with psychogenic excoriation. J Clin Psychiatry 59:509–514
Wilhelm S, Keuthen NJ, Deckersbach T, Engelhard IM, Forker AE, Baer L, O’Sullivan RL, Jenike MA (1999) Self-injurious skin picking: clinical characteristics and comorbidity. J Clin Psychiatry 60:454–459
Flessner C, Woods D (2006) Phenomenological characteristics, social problems, and the economic impact associated with chronic skin picking. Behav Modif 30:944–963
Keuthen NJ, Deckersbach T, Wilhelm S, Hale E, Fraim C, Baer L, O’Sullivan RL, Jenike MA (2000) Repetitive skin-picking in a student population and comparison with a sample of self-injurious skin-pickers. Psychosomatics 41:210–215
O’Sullivan RL, Phillips KA, Keuthen NJ, Wilhelm S (1999) Near-fatal skin picking from delusional body dysmorphic disorder responsive to fluvoxamine. Psychosomatics 40:79–81
Flessner CA, Busch AM, Woods DW, Heideman P (2008) Acceptance-enhanced behavior therapy for trichotillomania and chronic skin picking: exploring the effects of component sequencing. Behav Modif 32:579–594
Twohig MP, Woods DW (2001) Habit Reversal as a treatment for chronic skin picking in typically developing adult male siblings. J Appl Behav Anal 34:217–220
Teng EJ, Woods DW, Twohig MP (2006) Habit reversal as a treatment for chronic skin picking: a pilot investigation. Behav Modif 30(4):411–422
Hayes SL, Storch EA, Berlanga L (2009) Skin picking behaviors: an examination of the prevalence and severity in a community sample. J Anxiety Disord 23:314–319
Keuthen NJ, Wilhelm S, Deckersbach T, Engelhard IM, Forker AE, Baer L, Jenike MA (2001) The skin picking scale: scale construction and psychometric analysis. J Psychosom Res 50:337–341
Walther MW, Flessner CA, Conelea CA, Woods DW (2009) The Milwaukee dimensions of adult skin picking scale: initial development and psychometric properties. J Behav Ther Exp Psychiatry 40:127–135
Nauta MH, Scholing A, Rapee RM, Abbott M, Spence SH, Waters A (2004) A parent-report measure of children’s anxiety: psychometric properties and comparison with child-report in a clinic and normal sample. Behav Res Ther 42:813–839
Swanson JM (1992) School-based assessments and interventions for ADD students. K.C. Publications, Irvine, CA
Stevens J, Quittner AL, Abikoff H (1998) Factors influencing elementary school teachers’ rating ADHD and ODD behaviors. J Clin Child Adolesc Psychol 27:406–414
Wolraich ML, Greenhill LL, Pelham W, Swanson J, Wilens T, Palumbo D, Atkins M, McBurnett K, Bukstein O, August G (2001) Randomized, controlled trial of OROS methylphenidate once a day in children with attention-deficit/hyperactivity disorder. Pediatrics 108:883–892
Steele M, Weiss M, Swanson J, Wang J, Prinzo RS, Binder CE (2006) A randomized, controlled, effectiveness trial of OROS-methylphenidate compared to usual are with immediate-release methylphenidate in attention deficit-hyperactivity disorder. Can J Clin Pharmacol 13:e50–e62
Roman T, Polanczyk G, Zeni C, Genro J, Rohde LA, Hutz M (2006) Further evidence of the involvement of alpha-2A-adrenergic receptor gene (ADRA2A) in inattentive dimensional scores of ADHD. Mol Psychiatry 11:8–10
McGrew S, Malow BA, Henderson L, Wang L, Song Y, Stone WL (2007) Developmental and behavioral questionnaire for autism spectrum disorders. Pediatr Neurol 37:108–116
Varni J, Seid M, Kurtin P (2001) PedsQL 4.0: Reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care 39:800–812
Varni JW, Burwinkle T, Seid M, Skarr D (2003) The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr 3:329–341
Varni JW, Seid M, Rode CA (1999) The PedsQL measurement model for the pediatric quality of life inventory. Med Care 37:126–139
Bastiaansen D, Koot H, Ferdinand R, Verhulst F (2004) Quality of life in children with psychiatric disorders: self-, parent, and clinician report. J Am Acad Child Adolesc Psychiatry 43:221–230
Barrett PM (1988) Evaluation of cognitive-behavioral group treatments for childhood anxiety disorders. J Clin Child Psychol 27:459–468
Flannery-Schroeder EC, Kendall PC (2000) Group and individual cognitive-behavioral treatments for youth with anxiety disorders: a randomized clinical trial. Cognit Ther Res 24:251–278
Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill J, Ginsburg GS, Rynn MA, McCracken J, Waslick B, Iyengar S, March JS, Kendall PC (2008) Cognitive-behavioral therapy, sertraline and their combination for children and adolescents with anxiety disorders: acute phase efficacy and safety. N Engl J Med 359:2753–2766
Wood J, Drahota A, Sze K, Har K, Chiu A, Langer D (2009) Cognitive behavioural therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial. J Child Psychol Psychiatry 50:224–234
Arnold LM, Auchenbach MB, McElroy SL (2001) Psychogenic excoriation, clinical features, proposed diagnostic criteria, epidemiology and approaches to treatment. CNS Drugs 15:351–359
Lewin AB, Piacentini J, Flessner CA, Woods DW, Franklin ME, Keuthen NJ, Moore P, Khanna M, March JS, Stein DJ, The TLC-SAB (2009) Depression, anxiety, and functional impairment in children with trichotillomania. Depress Anxiety 26:521–527
Wetterneck CT, Woods DW, Norberg M, Begotka AM (2006) The social and economic impact of trichotillomania: results from two nonreferred samples. Behav Interventions 21:97–109
Pediatric OCD Treatment Study Team (2004) Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: The Pediatric OCD Treatment Study randomized controlled trial. JAMA 292:1969–1976
Storch EA, Geffken GR, Merlo LJ, Mann G, Duke D, Munson M, Adkins J, Grabill KM, Murphy TK, Goodman WK (2007) Family-based cognitive-behavioral therapy for pediatric obsessive-compulsive disorder: comparison of intensive and weekly approaches. J Am Acad Child Adolesc Psychiatry 46:469–478
Storch EA, Merlo LJ, Larson MJ, Geffken GR, Lehmkuhl H, Jacob ML, Murphy TK, Goodman WK (2008) Impact of comorbidity on cognitive-behavioral therapy response in pediatric obsessive compulsive disorder. J Am Acad Child Adolesc Psychiatry 47:583–592
Eyberg SM, Nelson MM, Boggs SR (2008) Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. J Clin Child Adolesc Psychol 37:215–237
Shapira NA, Lessig MC, Murphy TK, Driscoll DJ, Goodman WK (2002) Topiramate attenuates self-injurious behaviour in Prader-Willi syndrome. Int J Neuropsychopharmacol 5:141–145
Hellings J, Warnock J (1994) Self-injurious behavior and serotonin in Prader-Willi syndrome. Psychopharmacol Bull 30:245–250
Bloch MR, Elliott M, Thompson H, Koran LM (2001) Fluoxetine in pathological skin picking. Psychosomatics 42:314–318
Simeon D, Stein DJ, Gross S, Islam N, Schmeidler J, Hollander E (1997) A double-blind trial of fluoxetine in pathologic skin picking. J Clin Psychiatry 58:341–347
Author information
Authors and Affiliations
Corresponding authors
Additional information
Portions of this paper were supported by a grant from the Foundation for Prader-Willi Research to the second author.
Rights and permissions
About this article
Cite this article
Morgan, J.R., Storch, E.A., Woods, D.W. et al. A Preliminary Analysis of the Phenomenology of Skin-picking in Prader-Willi Syndrome. Child Psychiatry Hum Dev 41, 448–463 (2010). https://doi.org/10.1007/s10578-010-0180-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10578-010-0180-7