Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA.
Department of Psychiatry, University of Southampton, Southampton, United Kingdom.
CNS Spectr. 2022 Oct;27(5):621-625. doi: 10.1017/S1092852921000468. Epub 2021 Apr 30.
Skin picking disorder and trichotillomania, also characterized as body-focused repetitive behaviors (BFRBs), often lead to functional impairment. Some people with BFRBs, however, report little if any psychosocial dysfunction. There has been limited research as to which clinical aspects of BFRBs are associated with varying degrees of functional impairment.
Adults (n = 98), ages 18 to 65 with a current diagnosis of trichotillomania (n = 37), skin picking disorder (n = 32), trichotillomania plus skin picking disorder (n = 10), and controls (n = 19) were enrolled. Partial least squares regression (PLS) was used to identify variables associated with impairment on the Sheehan Disability Scale.
PLS identified an optimal model accounting for 45.8% of variation in disability. Disability was significantly related to (in order of descending coefficient size): severity of picking, perceived stress, comorbid disorders (specifically, anxiety disorders / obsessive-compulsive disorder), trait impulsivity, family history of alcohol use disorder, atypical pulling/picking sites, and older age.
At present mental disorders are viewed as unitary entities; however, the extent of impairment varies markedly across patients with BFRBs. These data suggest that whereas symptom nature/severity is important in determining impairment, so too are other variables commonly unmeasured in clinical practice. Outcomes for patients may thus be maximized by rigorously addressing comorbid disorders; as well as integrating components designed to enhance top-down control and stress management. Interestingly, focused picking and emotional pulling were linked to worse disability, hinting at some differences between the two types of BFRBs, in terms of determinants of impairment.
抓挠障碍和拔毛癖，也被称为躯体关注性重复行为（BFRBs），常导致功能障碍。然而，一些 BFRBs 患者的心理社会功能受损程度很小或没有。目前，关于 BFRBs 的哪些临床特征与不同程度的功能障碍相关，研究还很有限。
纳入了 18 至 65 岁的成年人（n=98），包括当前患有拔毛癖（n=37）、抓挠障碍（n=32）、拔毛癖加抓挠障碍（n=10）和对照组（n=19）。采用偏最小二乘回归（PLS）来识别与 Sheehan 残疾量表损伤相关的变量。
PLS 确定了一个最优模型，可解释残疾程度 45.8%的变异性。残疾与（按系数大小降序排列）：抓挠严重程度、感知压力、共病障碍（特别是焦虑症/强迫症）、特质冲动性、酒精使用障碍家族史、非典型拔毛/抓挠部位和年龄较大显著相关。
目前，精神障碍被视为单一实体；然而，BFRBs 患者的损伤程度差异很大。这些数据表明，尽管症状性质/严重程度对确定损伤很重要，但其他在临床实践中通常未测量的变量也很重要。通过严格解决共病障碍，以及整合旨在增强自上而下控制和压力管理的成分，患者的治疗结果可能会得到最大化。有趣的是，集中抓挠和情绪性拔毛与更差的残疾相关，暗示这两种 BFRBs 在损伤决定因素方面存在一些差异。
