A systematic review and meta-analysis of psychiatric treatments for excoriation (skin-picking) disorder

• Published in: General hospital psychiatry 2016-07, Vol.41, p.29-37
• Main Authors: Selles, Robert R., M.A, McGuire, Joseph F., Ph.D, Small, Brent J., Ph.D, Storch, Eric A., Ph.D
• Format: Article
• Language: English
• Subjects: Behavior Therapy - methods; Behavioral treatment; Disruptive, Impulse Control, and Conduct Disorders - drug therapy; Disruptive, Impulse Control, and Conduct Disorders - therapy; Excitatory Amino Acid Antagonists - therapeutic use; Excoriation disorder; Humans; Pharmacological treatment; Psychiatry; Self-Injurious Behavior - drug therapy; Self-Injurious Behavior - therapy; Serotonin Uptake Inhibitors - therapeutic use; Skin - injuries; Therapy
• ISSN: 0163-8343; 1873-7714
• DOI: 10.1016/j.genhosppsych.2016.04.001

Abstract Objective While individual trials suggest benefit of interventions for excoriation (skin-picking) disorder (ExD), limited systematic evaluation of treatments, or their collective benefit, exists. Methods The present study examined the current state of treatments for ExD in a systematic review and meta-analysis and explored potential treatment moderators. Twelve trials were identified for review, including five with a control condition. Of these, nine were eligible to be included in the meta-analysis (three with a control). Results A fixed-effects meta-analysis found a large overall treatment effect size ( g = 1.13), comprised of large effects for behavioral treatments ( g = 1.19), lamotrigine ( g = 0.98) and selective serotonin reuptake inhibitors ( g = 1.09). Clinician-rated measures did not significantly differ from self-rated measures; however, larger effects were observed on self-rated measures of severity, as compared to impairment [Q(1) = 4.63, P = .03]. Treatment type, trial length and trial methodological quality were not significant moderators. For controlled trials, the comparative efficacy of treatments for ExD was in the moderate range ( g = 0.47). Conclusion Findings suggest that treatment for ExD has benefit; however, the meta-analysis did not provide strong evidence to support any specific treatment or to suggest its unique clinical benefit over control conditions. Overall, there is a lack of study on treatments for ExD and additional randomized controlled trials with inclusion of multiple informants in assessment is needed.