Skin-Picking as Self-Soothing: Is Emotion Regulation the Missing Piece?

Why It Matters

Understanding emotion‑regulation’s role in SPD informs more effective, targeted treatments and guides future research priorities, potentially reducing the disorder’s clinical burden.

Key Takeaways

• SPD patients show greater emotion dysregulation than controls
• Emotion regulation deficits not consistently tied to overall SPD severity
• Focused skin‑picking correlates with poor emotion regulation
• Cognitive reappraisal impairment observed more than expressive suppression
• DBT and ACT emerge as promising, under‑researched treatments

Pulse Analysis

The prevalence of skin‑picking disorder (SPD) – affecting roughly 3.5 % of adults – places it among the most common body‑focused repetitive behaviours. While the diagnostic criteria are well‑established, the drivers of the habit remain debated. A 2025 systematic review by Barber and Fitzgerald synthesized 19 peer‑reviewed studies to test the long‑standing hypothesis that SPD functions as an emotion‑regulation strategy. By comparing SPD cohorts with healthy controls across measures such as distress tolerance, alexithymia and experiential avoidance, the authors provided the most comprehensive quantitative snapshot of the field to date.

The review confirmed that individuals with SPD consistently score higher on emotion‑dysregulation scales, reporting difficulty identifying feelings and low tolerance for psychological distress. However, the link between these deficits and overall symptom severity proved inconsistent, suggesting that dysregulation alone does not dictate how severe the picking becomes. Notably, the subset of ‘focused’ or intentional picking showed the strongest association with poor regulation, especially deficits in cognitive reappraisal. This pattern points to a therapeutic niche: interventions that strengthen reappraisal – such as dialectical behaviour therapy (DBT) and acceptance‑and‑commitment therapy (ACT) – could directly attenuate the urge to pick.

Despite these insights, the evidence base is limited by cross‑sectional designs, publication bias and the exclusion of non‑English and grey literature. Longitudinal studies are needed to determine whether emotion‑regulation training prevents the onset of SPD or reduces relapse rates. Clinicians should consider routine screening for emotion‑processing deficits in patients presenting with BFRBs, and researchers ought to test DBT and ACT protocols against standard habit‑reversal therapies. If future work validates these approaches, schools and workplaces might adopt emotion‑skill curricula as a preventative measure, potentially lowering the public health burden of this under‑recognized disorder.