Background: Psychiatric disorders, including skin-picking disorder (SPD), may be conceptualized as manifestations of a dysregulated behavioral immune system or maladaptive emotion schema, in which disgust—typically elicited by external threats—is directed toward the self. Method: A total of 147 females (mean age = 32 years) with SPD completed disorder-specific measures of automatic and focused skin-picking, as well as scales assessing self-disgust and disgust sensitivity. Correlation and path analyses were conducted to examine whether misdirected disgust toward one’s own body (self-disgust) and difficulties in regulating disgust (disgust sensitivity) are associated with pathological skin picking. Results: Self-disgust was substantially correlated with focused skin-picking. The path analysis indicated a direct path from self-disgust to focused skin-picking and an indirect path from disgust sensitivity, mediated by self-disgust, to focused skin-picking. Similar associations were not present for automatic skin-picking. Limitations: Due to the cross-sectional design of the study, the results should be interpreted as associative rather than causal and do not allow conclusions about temporal or directional mediation processes. Conclusions: Assessment of both disgust-related traits should be integrated into the diagnostic process for SPD. Disgust regulation training, as well as compassion-based strategies, may be beneficial in modifying pathological skin-picking.
Schienle et al. (Mon,) studied this question.