Brief Report SKIN PICKING AND SLEEP DISTURBANCES: RELATIONSHIP TO ANXIETY AND NEED FOR RESEARCH Ravi Singareddy, M.D, 1 Ali Moin, M.D., 2 Lisa Spurlock, M.D., 1 Orlena Merritt-Davis, M.D., 1 and Thomas W. Uhde, M.D. 1,3 Pathological excoriation (PE) or skin picking is seen in nearly 2% of patients attending dermatology clinics and is often associated with anxiety, stress and frequent help-seeking behaviors. While anxiety and stress are thought to cause poor sleep in the general population, not all anxious people, even those with disabling anxiety disorders, necessarily suffer from insomnia or other sleep problems. The relationship between anxiety symptoms and poor sleep, therefore, remains unclear and sleep quality in PE is unknown. We examined the sleep quality and levels of anxiety in dermatological patients with PE. Dermatological patients with (n ¼ 10) and without (n ¼ 10) PE and healthy controls (n ¼ 10) were assessed on standardized and validated measures of subjective sleep quality [Pittsburgh Sleep Quality Index (PSQI)], anxiety (Spielberger State and Trait Anxiety Inventory; modified Zung Anxiety Scale), stress (Perceived Stress Scale) and work and social disability [Sheehan Disability Inventory subscale (SDI-4)]. Patients with dermatological complaints as a group reported poorer sleep quality, higher scores on Spielberger State and Zung anxiety, perceived stress, and SDI-4. Among both groups of dermatological patients, only the PE group had significantly poor sleep, high anxiety, and perceived stress compared to healthy controls. In the dermatological patients with PE, PSQI-global scores were significantly positively correlated to Spielberger State and Zung Anxiety scores. Dermatological patients with PE are more anxious and have poorer subjective sleep compared to dermatological patients without PE and healthy. Future research is needed to elucidate these relationship factors and to develop new behavioral and drug treatments for the management of PE. Depression and Anxiety, 18:228–232, 2003. & 2003 Wiley-Liss, Inc. Key words: pathological excoriations; sleep; anxiety, stress; work and social disability; skin picking INTRODUCTION Pathological excoriation (PE), also referred to as ‘‘neurotic excoriation’’ or skin picking, is a syndrome that has received little attention in the scientific literature. Patients with this disorder will touch, squeeze, or pick at an area of their skin repeatedly, often causing bleeding, infection, or scarring of the DEPRESSION AND ANXIETY 18:228–232 (2003) 1 Anxiety Disorders Research Division, Department of Psychia- try and Behavioral Neuroscience, School of Medicine, Wayne State University, Detroit, Michigan 2 Department of Dermatology, School of Medicine, Wayne State University, Detroit, Michigan 3 Department of Psychiatry, Hershey Medical Center, Penn State University, Pittsburgh, Pennsylvania n Correspondence to: Dr. Thomas W. Uhde, Department of Psychiatry, Pennsylvania State University, College of Medicine, Hershey Medical Center, PO Box 850, 500 University Drive, Hershey, PA 17033. E-mail: tuhde@psu.edu Received for publication 15 August 2003; Revised 25 September 2003; Accepted 3 October 2003. DOI 10.1002/da.10153 Published online in Wiley InterScience (www.interscience.wiley. com). & & 2003 WILEY-LISS, INC.