ArticleFrontiers in psychiatry2025
Case Report: Behavioral analysis guided intervention targeting triggers and urges in skin-picking disorder with comorbid onychophagia.
Article in Frontiers in psychiatry, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Skin-picking disorder (SPD) often co-occurs with onychophagia and can cause substantial functional impairment. Although evidence-based psychotherapies are effective, benefits may be limited when behavioral analysis is not applied explicitly. Case presentation: A 29-year-old man with SPD and onychophagia reported marked occupational impact. Baseline self-monitoring showed 240 min/day of nail-related behavior, 30 episodes/day, and high urge intensity. Using behavioral chain analysis, we mapped perceptual antecedents (visual/tactile irregularities) and diurnal variability of urges. A medication-free, nine-session outpatient program over 20 weeks was delivered, combining stimulus control, urge management routines, and habit reversal training. Outcomes were tracked by daily self-monitoring. Rapid improvement followed initiation of stimulus control and consolidated after urge management routines. By treatment end, daily picking time decreased to 15 min/day (-94%), episode frequency to 5/day (-83%), and urge intensity to 4/10 (-60%); no adverse effects were reported. Conclusion: Making perceptual antecedents and diurnal moderators explicit based on chain analysis enabled a targeted, medication-free intervention that produced clinically meaningful reductions in behavior and urges. A chain-guided behavioral framework may help personalize treatment for SPD and related body-focused repetitive behaviors.
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