Psychosomatics 42:5, September-October 2001 397 The Skin Picking Impact Scale (SPIS) Scale Development and Psychometric Analyses NANCY J. KEUTHEN,PH.D., THILO DECKERSBACH,PH.D. SABINE WILHELM,PH.D., IRIS ENGELHARD, M.S. AMY FORKER,RICHARD L. O’SULLIVAN, M.D. MICHAEL A. JENIKE, M.D., LEE BAER,PH.D. The Skin Picking Impact Scale (SPIS) is a self-report instrument developed to assess the psycho- social consequences of repetitive skin picking. An initial 28-item scale was administered to 31 individuals with severe self-injurious skin picking and 78 individuals with non–self-injurious skin picking. Item difficulty levels and part-whole correlations resulted in a 10-item scale with good internal consistency. SPIS scores for those with self-injurious skin picking were significantly higher than for those with non–self-injurious skin picking. SPIS scores for those with self-injuri- ous skin picking correlated with duration of daily picking, satisfaction during picking, and shame subsequent to picking, as well as Beck Depression Inventory and Beck Anxiety Inventory scores. Sensitivity and specificity analyses indicate that a scale cutoff score of 7 optimally discriminates individuals with self-injurious skin picking from those with non–self-injurious skin picking. (Psychosomatics 2001; 42:397–403) Received January 16, 2001; revised April 25, 2001; accepted May 11, 2001. From the Department of Psychiatry, Massachusetts General Hos- pital and Harvard Medical School. Address correspondence to Dr. Keu- then, OCD Clinic and Research Unit, Massachusetts General Hospital- East #9106, 149 13th Street, Charlestown, MA 02129-2060. E-mail: keuthen@psych.mgh.harvard.edu Copyright  2001 The Academy of Psychosomatic Medicine. Skin picking is a common human behavior that, depending on severity, frequency, location, and physical conse- quences, can be alternatively viewed as relatively normal or pathological. 1,2 Pathological skin picking has been noted to be a feature of a variety of developmental, dermatolog- ical, medical, neurological, and psychiatric conditions. 3–18 High prevalence rates for pathological skin picking have been reported, 19–21 varying from 2% in dermatology patients 19 to 2–4% in student populations. 20,21 Documented medical complications from skin picking range in severity from localized infection, to scarring and disfigurement, to near death. 17,22–24 High rates of psychiatric comorbidity have also been documented, with all subjects in two recent studies satisfying DSM-IV criteria for one or more current or lifetime axis I disorders. 22,23 The clinical features and associated comorbidities of repetitive skin picking have been summarized in numerous articles. 3,5–32 Efforts to reliably and meaningfully classify skin pick- ing have been the subject of considerable debate. 20–26,32 Nosological considerations are of significant importance, particularly if effective treatment is to derive from the clini- cal diagnosis. 17,19,24,27,31–33 To date, the objective study of the severity and impact of skin picking has been hampered by issues of diagnostic heterogeneity, as well as the lack of standardized assessment instruments. The psychosocial consequences of this problem have increasingly received recognition. Confirming anecdotal impressions, many authors 18,20–23,28,31 have cited embar- rassment and guilt as common sequelae to repetitive skin picking. Simeon and colleagues 28 reported moderate dis-