For many of us, the pores and skin is solely a boundary – a barrier between us and the world. However for many who reside with body-focused repetitive behaviours (BFRBs) comparable to skin-picking, hair-pulling, or nail-biting, the pores and skin can grow to be the very web site of emotional wrestle.
BFRBs are a bunch of circumstances characterised by repetitive and hard-to-control choosing, pulling, biting, or in any other case manipulating the physique leading to injury to the tissue. BFRBs are sometimes misunderstood as a ‘dangerous behavior’, regardless of being recognised as a part of the spectrum of obsessive–compulsive and associated problems (American Psychiatric Affiliation, 2013). BFRBs have an effect on an estimated 2-5% of individuals (Snorrason et al., 2012) and are related to disgrace, emotional dysregulation, and appreciable purposeful impairment. But we nonetheless know comparatively little in regards to the mechanisms that hold these behaviours going or how they relate to the way in which people expertise their our bodies.
Interoception – our means to sense inner bodily indicators comparable to heartbeat, pressure or discomfort – has not too long ago gained consideration as a possible think about circumstances involving emotion-regulation difficulties (Khalsa et al., 2018). This contains rising work on affective (C-tactile) contact, which performs a task in calming and social-emotional processing (McGlone et al., 2014). In skin-picking dysfunction (SPD), people usually report urges, discomfort or “not-just-right” sensations previous choosing episodes, and aid or grounding afterwards (Snorrason et al., 2010). These observations have prompted researchers to discover whether or not interoception, together with affective contact, could play a task within the onset, upkeep or regulation of BFRBs.
On this weblog, we summarise and critically consider a current systematic evaluation by Kłosowska et al. (2025), which synthesises the small however rising proof base on interoception in SPD. We additionally replicate on what these findings may imply for observe and for folks residing with BFRBs.
What’s the position of bodily sensations and affective contact in relation to skin-picking dysfunction? This systematic evaluation synthesises the proof in relation to how we interpret inner bodily indicators.
Strategies
5 databases have been searched utilizing phrases referring to skin-picking dysfunction (SPD) and interoception to establish quantitative research exploring how folks with SPD sense and interpret bodily indicators. Articles have been included in the event that they have been peer-reviewed, revealed in English, included a validated measure of no less than one facet of interoception (a modality or a dimension), and included a validated measure or DSM-5/ICD-11 analysis of SPD. Gray literature was excluded, in addition to research that explored skin-picking within the context of a unique situation. From side to side quotation chasing was additionally used to make sure that related research weren’t missed.
Recognized articles have been double screened by two researchers, earlier than related information was extracted. To account for the heterogeneity of research designs and measures, the crew assessed methodological high quality utilizing the Combined Strategies Appraisal Instrument standards.
Outcomes
9 articles based mostly on eight completely different samples have been included on this systematic evaluation, with information from a complete of 1,338 individuals. Nearly all of individuals have been feminine, with imply ages starting from 23.87 to 34.32 years. Most research in contrast people with skin-picking dysfunction (SPD) or SPD signs to wholesome controls. 5 research have been quasi-experimental, one was a randomised managed trial, one used an intensive longitudinal design, and one was cross-sectional.
A number of completely different interoceptive modalities have been explored in relation to SPD, together with:
- Visceral indicators: One research discovered that compared to wholesome controls, people with SPD signs confirmed considerably decrease cardiac interoceptive accuracy after controlling for potential confounders. In addition they discovered that increased interoceptive accuracy within the SPD group was related to a decrease probability of skin-picking through the subsequent measurement interval (OR = 0.10, 95% CI [0.02 to 0.44], p = .002).
- Affective contact: Out of 4 articles based mostly on three research, one discovered a constructive reasonable correlation between skin-picking urges throughout affective (C-tactile) contact and SPD symptom severity, and two discovered that people with SPD rated contact (C-tactile and non-C-tactile) as considerably much less nice and extra arousing , with the next urge to skin-pick in response to the touch. An experimental research additionally discovered that the severity of SPD signs decreased from baseline to post-training after receiving both Delicate Contact Coaching or Progressive Muscle Leisure.
- Ache: Three research explored altered ache processing in people with SPD. Two research discovered no vital variations in ache tolerance between people with SPD and wholesome controls and between people with SPD, trichotillomania, or wholesome controls. A ultimate research discovered that people with reasonable or excessive SPD signs reported considerably much less constructive have an effect on and larger arousal from electrocutaneous pulses compared to wholesome controls, however there have been nonetheless no vital variations in ache scores.
- Itch: One research discovered that people with SPD reported a considerably increased urge to itch in response to itch-related and picking-related stimuli compared to wholesome controls, in addition to the next urge to select in response to itch-related stimuli.
One additional research investigated interoceptive sensibility, which is a person’s perceived sensitivity to bodily sensation. They discovered that individuals with SPD had decrease emotional consciousness scores compared to wholesome controls, and that increased physique listening scores have been related to lowered perceived management over skin-picking episodes within the subsequent measurement interval. This was the one included research that explored an interoceptive dimension fairly than a modality.
Throughout 9 research, there seems to be an rising sample between disturbances in interoception (the interpretation of inner bodily indicators) and skin-picking behaviours in people with Pores and skin Choosing Dysfunction.
Conclusions
Primarily based on the findings from this systematic evaluation, Kłosowska and colleagues conclude that there’s preliminary proof to point a relationship between skin-picking and disrupted interoception, highlighting a possible mechanism that would contribute to or assist preserve SPD. Nonetheless, with solely 9 articles recognized, nothing is conclusive and rather more analysis is required. Because the authors state:
Agency scientific suggestions can not but be made […] advancing analysis on interoceptive processes in skin-picking dysfunction (SPD) may facilitate the event of novel interventions, addressing the present shortage of accessible therapies.
Whereas the findings of this systematic evaluation spotlight an attention-grabbing space future intervention, a lot additional analysis on interoception in Pores and skin Choosing Dysfunction is required earlier than this may be explored.
Strengths and limitations
There are a number of strengths to this systematic evaluation, together with the very fact that it’s the first systematic synthesis of interoception in skin-picking dysfunction (SPD), mapping out a extremely under-explored space and providing a transparent overview of what’s presently identified. This endeavour is useful for clinicians and researchers in understanding what the present evidence-base is, and what gaps in data stay. A rigorous methodology was additionally used, with the protocol pre-registered and the evaluation reported based on PRISMA pointers, which aids methodological transparency and the reliability of the info. The authors used a well-known, broad definition of interoception that captured a number of dimensions, which will increase the probability that each one related research have been recognized and included. Lastly, most research have been rated as having a comparatively low threat of bias, rising the reliability of the findings; nonetheless, there have been queries in relation to choice, reporting, and omitted-variable bias.
Nonetheless, there are limitations to the evaluation itself and the included research. First, the proof base is extraordinarily small, together with 9 articles carried out by 4 completely different analysis teams. Not solely does this imply that there are limits to the statistical energy of those findings and generalisability, however there’s additionally the potential for investigator bias, which the authors acknowledge; nonetheless, that is usually unavoidable in such an under-researched space. Moreover, it’s troublesome to immediately examine the completely different research as there was a number of methodological heterogeneity, which is why a meta-analysis was not carried out. This reduces the reliability of the conclusions drawn, therefore why the authors are so tentative. Lastly, the exclusion of gray literature may imply that related analysis was not included, comparable to research which are presently underneath peer-review and haven’t but been revealed. In just a few years’ time, it may very well be attention-grabbing to undertake an up to date systematic evaluation to see how a lot the proof base has expanded.
Because the very first systematic evaluation investigating interoception in relation to Pores and skin Choosing Dysfunction, this paper helpfully maps the present proof base for researchers and clinicians. Nonetheless, with small pattern sizes and excessive heterogeneity, findings are nonetheless preliminary.
Implications for observe
Given the early levels of this proof, any scientific implications from this systematic evaluation ought to be drawn cautiously. Nonetheless, there are some attention-grabbing areas for future consideration, together with:
- Exploring bodily cues as a part of evaluation: For some people with skin-picking dysfunction (SPD), bodily sensations could precede skin-picking episodes. Clinicians may gently discover these sensations as a part of a broader formulation, with out assuming they function in the identical method for everybody.
- Supporting emotion regulation and physique consciousness: Given wider help for the speculation that skin-picking is related to emotional regulation (Khalsa et al., 2018) and the discovering from one research on this evaluation that people with SPD display decrease emotional consciousness, clinicians may think about interventions that strengthen emotion regulation or secure, compassionate physique consciousness. Nonetheless, research have but to check interoception-focused interventions for SPD immediately, that means such approaches ought to be thought of exploratory fairly than evidence-based.
- Affective contact as a possible future space of curiosity: Preliminary findings on affective contact elevate attention-grabbing questions on sensory consolation and dysregulation in SPD. Whereas these outcomes are too restricted to tell scientific interventions, they spotlight the potential significance of sensory components in understanding how people soothe or regulate inner states.
- Trauma- and neurodiversity-informed observe: Some folks with SPD could have heightened sensitivity to sensory cues or discomfort with interpersonal contact. The place related, clinicians could think about a trauma- and neurodiversity-informed method, starting with client-led exploration of sensations and making certain any methods involving contact prioritise consent, consolation and emotional security.
For me (Marta), as each a researcher and lived-experience advocate, the findings from this systematic evaluation really feel deeply validating. For years, attachment-based and emotion-regulation fashions of BFRBs have been overshadowed by behavioural and neurobiological explanations. But the rising science of interoception and affective contact provides a language many people recognise intuitively — security, connection, and aid via the pores and skin. Our earliest experiences of care are communicated via contact, and empirical work more and more helps this hyperlink: insecure attachment predicts altered sensitivity to affective contact (Krahé et al., 2018) and better BFRB severity (Isibor, 2025; Shen, 2024). Though preliminary, this implies that contact and attachment kind a shared sensory–emotional system that underpins how we regulate misery. Seeing interoception and affective-touch analysis spotlight these identical pathways, brings each scientific validation and private recognition.
These findings additionally resonate with my scientific work and my position as a mother or father of neurodivergent youngsters. I see day by day how sensory experiences form emotional regulation; typically soothing, typically overwhelming. For some folks with SPD, bodily cues comparable to pressure, irritation, or a “build-up” of discomfort precede choosing; for others, contact itself will be dysregulating. Trauma histories, sensory sensitivities, and neurodiversity can all affect how the physique is felt and the way security is signalled. Which means any future sensory-based approaches should stay client-led, light, optionally available, and grounded in consent.
Total, these findings invite cautious optimism. The proof will not be but robust sufficient to information scientific observe, however it encourages curiosity in regards to the physique’s position in self-soothing. Beneath many repetitive behaviours could lie a physique attempting to control itself; and the pores and skin, removed from being the enemy, may very well be a part of the answer.
Whereas additional analysis is required earlier than interventions focusing on interoception will be thought of for skin-picking, these findings present meals for thought concerning the position of emotional regulation and physique consciousness inside observe.
Assertion of pursuits
Marta has lived expertise of Physique-Centered Repetitive Behaviours and has co-authored analysis on this space. She can also be concerned in advocacy and psychoeducational work referring to BFRBs. No different conflicts of curiosity to declare.
Marta used AI help (OpenAI GPT-5) for structuring this weblog. All writing and reflections are her personal.
Edited by
Dr Nina Higson-Sweeney.
Hyperlinks
Major paper
Kłosowska, J., Żegleń, M., Badzińska, J., & Prochwicz, Ok. (2025). Interoception abnormalities and skin-picking dysfunction: Systematic evaluation and narrative synthesis of preliminary proof. Neuroscience & Biobehavioral Critiques, 106349. https://doi.org/10.1016/j.neubiorev.2025.106349
Different references
American Psychiatric Affiliation. (2013). Diagnostic and statistical handbook of psychological problems (fifth ed.).
Isibor, M. (2025). Emotion regulation as a mediator of the affiliation between attachment safety and skin-picking dysfunction symptom severity. Attachment: New Instructions in Psychotherapy and Relational Psychoanalysis, 19(1), 54–69. https://doi.org/10.33212/att.v19n1.2025.54
Khalsa, S. S., Adolphs, R., Cameron, O. G., Davenport, P. W., Feinstein, J. S., Feusner, J. D., … Zucker, N. (2018). Interoception and psychological well being: A roadmap. Organic Psychiatry: Cognitive Neuroscience and Neuroimaging, 3(6), 501–513. https://doi.org/10.1016/j.bpsc.2017.12.004
Krahé, C., von Mohr, M., Gentsch, A., Man, L., Vari, C., Nolte, T., & Fotopoulou, A. (2018). Sensitivity to CT-optimal, affective contact is determined by grownup attachment fashion. Scientific Reviews, 8(1), 14544. https://doi.org/10.1038/s41598-018-32865-6
McGlone, F., Wessberg, J., & Olausson, H. (2014). Discriminative and affective contact: Sensing and feeling. Neuron, 82(4), 737–755. https://doi.org/10.1016/j.neuron.2014.05.001
Shen, T. (2024). A correlation research of attachment and body-focused repetitive behaviour in non-treatment-seeking folks. Lecture Notes in Schooling Psychology and Public Media, 47. https://doi.org/10.54254/2753-7048/47/20240894
Snorrason, I., Belleau, E. L., & Woods, D. W. (2012). How associated are hair pulling dysfunction (trichotillomania) and pores and skin choosing dysfunction? A evaluation of proof for comorbidity, similarities and shared etiology. Medical Psychology Evaluate, 32(7), 618-629. https://doi.org/10.1016/j.cpr.2012.05.008
Snorrason, Í., Smári, J., & Olafsson, R. P. (2010). Emotion regulation in pathological pores and skin choosing: Findings from a non-treatment searching for pattern. Journal of Habits Remedy and Experimental Psychiatry, 41(3), 238-245. https://doi.org/10.1016/j.jbtep.2010.01.009
