Increased emotional reactivity to affective pictures in patients with skin-picking disorder: Evidence from functional magnetic resonance imaging.

The predominant symptom of skin-picking disorder (SPD) is the recurrent picking of one's own skin, leading to tissue damage and discomfort. Psychological disorder models suggest an enhanced emotional reactivity in patients with SPD, which contributes to the maintenance of symptoms. This functional magnetic resonance imaging (fMRI) experiment analyzed both subjective and neuronal responses to affective pictures (categories: fear, disgust, happiness, neutral) in 19 women with SPD and 16 healthy controls. Also, affective traits (disgust, anxiety, depression) were assessed. Those with SPD scored higher on trait anxiety/depression, and reported higher intensities of negative emotions experienced during the picture viewing. On the neuronal level, the clinical group showed enhanced localized brain activation to fear, disgust and happiness in the amygdala, the insula and the orbitofrontal cortex. These regions are part of a brain circuit mediating affective responses and affective awareness. The current fMRI study provides first data on the neuronal basis of elevated emotional reactivity to affective pictures in SPD.