Feeling uncomfortable in your own skin: a qualitative study of problematic skin picking in Italian women

Skin picking disorder (SPD) is a body-focused repetitive behavior recently added to the DSM-V. It mainly affects women, with a prevalence ranging from 1.5 to 5.4%. Picking causes skin lesions that can lead to serious infections and permanent skin problems, usually on the face, scalp, arms, and legs. The behavior impairs quality of life and is associated with psychological distress and difficulties in managing emotions. The disorder causes social embarrassment, leading to avoidance and social withdrawal. As the literature on the perspectives of people with SPD is limited, our research aimed to analyze the meanings they attribute to the behavior and its consequences. A second aim was to explore how interacting with an online community can affect the management of the condition. Using a qualitative descriptive approach, we interviewed twenty-one Italian women (aged 18–50) who self-identified as having SPD and were recruited through an online forum dedicated to the disorder. Three themes framed our analysis: “A stick in the wheel of everyday life,” “Other people’s eyes make you realize what you are doing is wrong,” and “The struggling search for control.” These themes highlight the impact of SPD on different areas of life, the difficulties in accessing competent healthcare providers, the stigma experienced by participants, and the usefulness of the online group on an informative, emotional, and social level. A better understanding of these patients’ perspectives can be useful for those providing professional care and those planning services for them in a Health Co-Inquiry approach that values patients’ activation.