Robert R Selles1, Joseph F McGuire2, Brent J Small3, Eric A Storch4. 1. Department of Psychology, University of South Florida, Tampa, FL. Electronic address: rselles@mail.usf.edu. 2. Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA. 3. School of Aging Studies, University of South Florida, Tampa, FL. 4. Department of Psychology, University of South Florida, Tampa, FL; Department of Pediatrics, University of South Florida, St. Petersburg, FL; Department of Health Policy and Management, University of South Florida, Tampa, FL; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL; Rogers Behavioral Health - Tampa Bay, Tampa, FL; All Children's Hospital - Johns Hopkins Medicine, St. Petersburg, FL.
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.
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.
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