Neuroanatomical correlates of impulsive action in excoriation (Skin-Picking) disorder

Austin W. Blum, Samuel R. Chamberlain, Michael D. Harries, Brian L. Odlaug, Sarah A. Redden, Jon E. Grant

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Excoriation (skin-picking) disorder (SPD) has similarities to obsessive-compulsive disorder (OCD) and is included within the obsessive-compulsive and related disorders (OCRD) diagnostic class in DSM-5. Separate neuroimaging and neurocognitive studies suggest that people affected by SPD find it difficult to inhibit dominant motor responses due to a failure of “top-down” control mechanisms. No study has examined the neural correlates of SPD in participants with varying degrees of impulsive motor behavior. This study correlated cortical thickness and volumes of selected subcortical structures with stop-signal task performance in participants with SPD (N=15) and in healthy control subjects (N=8). All participants were free from current psychiatric comorbidity, including OCD. In volunteers with SPD, longer stop-signal reaction times were correlated with cortical thinning in the right insula and right-inferior parietal lobe and with increased cortical thickness in the left-lateral occipital lobe, though these findings did not withstand correction for multiple comparisons. There were no significant correlations between cortical thickness in these three structures and stop-signal reaction times in the control group. This study suggests that structural abnormalities in the insular cortex and parietal and occipital regions may play a role in the pathophysiology of SPD. Further neuroimaging research is needed to understand the neurobiology of SPD and its relationship with other putative OCRDs.

Original languageEnglish (US)
Pages (from-to)236-241
Number of pages6
JournalJournal of Neuropsychiatry and Clinical Neurosciences
Issue number3
StatePublished - Jul 2018
Externally publishedYes

Bibliographical note

Funding Information:
Supported by a Wellcome Trust Clinical Fellowship (reference 110049/ Z/15/Z) to Dr. Chamberlain and in part by the University of Chicago Research Computing Center.

Funding Information:
Dr. Grant has received research grant support from the American Foundation for Suicide Prevention, Takeda Pharmaceuticals, and the TLC Foundation for Body-Focused Repetitive Behaviors; he receives yearly compensation from Springer Publishing for acting as Editor-in-Chief of the Journal of Gambling Studies; and he has received royalties from American Psychiatric Publishing, McGraw Hill, Norton Press, Johns Hopkins University Press, and Oxford University Press. Dr. Chamberlain serves as a consultant for Cambridge Cognition and Shire. Dr. Odlaug has received research funding from the TLC Foundation for Body-Focused Repetitive Behaviors; he receives royalties from Oxford University Press; and he has consulted for and is currently employed by H. Lundbeck A/S. All other authors report no financial relationships with commercial interests. Received May 7, 2017; revision received Sept. 20, 2017; accepted Sept. 25, 2017; published online April 24, 2018.

Publisher Copyright:
© 2018, American Psychiatric Association. All rights reserved.

Copyright 2018 Elsevier B.V., All rights reserved.


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