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Abstract
Background: Pathologic skin picking (PSP) is characterized by the repetitive and compulsive picking of skin which results in tissue damage. Objectives: This article sought to examine the evidence supporting the phenomenological, and biological links between PSP and substance use disorders. Methods: A review of the literature examining clinical presentation, comorbid psychiatric conditions, and treatment studies was used to examine the relationship of PSP and substance use disorders. Results: Prevalence rates of PSP range from 1.4–5.4% in the general population, with a much higher preponderance in females and in psychiatric patients. Significant medical complications are common, including scarring and infection. Although some pharmacologic agents (selective serotonin reuptake inhibitors, opioid antagonists, and glutamatergic agents) and non-pharmacologic treatments (habit-reversal therapy, Internet-based treatments, and acceptance-enhanced behavior therapy) have shown early promise in treating this often disabling disorder, evidence-based treatment options are still limited. Conclusions: PSP shares several clinical similarities with substance use disorders including the failure to stop the behavior despite knowledge of the consequences and an associated pleasurable quality while engaging in the activity. Scientific Significance: The consideration of some other impulse control disorders (e.g., pathological gambling) as addictions has helped advance treatment strategies. Conceptualizing PSP as an addiction, in some individuals, may lead to more effective treatment approaches.