What Happens in Your Brain When You Pick: Findings from a fMRI Study
This Friday, we’ll take a look at a 2016 study on abnormal brain activation in excoriation disorder. I was asked to present more research and I decided to start with this study because it shows the actual processes that take place inside a person’s brain. Consider the growing but still rather modest body of research available, I thought this might be an interesting place to begin presenting what researchers see.
The goal of the study was to assess the functioning of front-striatal circuits in people who have dermatillomania and compare the findings with healthy controls. The likely reason why study authors focused on this particular area of the brain is because altered fronto-striatal functioning has been well documented in people who have OCD.
Fronto-striatal circuits connect the frontal cortex with basal ganglia. In particular, a part of basal ganglia called the striatum, which is kind of an entrance point to the basal ganglia, a place where a lot of the input comes from. Striatum has three parts (caudate nucleus, putamen and ventral striatum) and they are all involved in voluntary motor control. We don’t have to be neuroscientists par excellence to understand why voluntary motor control may be an issue for automatic picking or overwhelming urges. Connections between the striatum and the frontal cortex would play a crucial role in executing your decision to stop picking.
Study sample is relatively small, although well selected. Study participants were men and women ages 18 to 54 who have been formally assessed and diagnosed with dermatillomania with symptoms present for at least a year without interruption.
The structural imaging results were clear: “No individually clinically significant MRI structural abnormalities were identified.” In other words, if you pick your skin, your brain doesn’t look any differently than anyone else’s. The Tower of London task was used and no significant differences were observed with it either.
The Tower of London is a well-known and often used a test of planning ability in neuropsychological research. Participants are asked to pre-plan a sequence of moves to match a start set of discs to a goal, and then to execute those moves. The crucial part of the test is the part that involves planning, so prior to actual execution.
“Whole brain analysis indicated that SPD was associated with significant underactivation during the task, compared with the control group, in a single cluster.” That single cluster was maximal in the caudate nucleus – a part of the striatum. The study summarizes it further: “[dermatillomania] was associated with significant underactivation in distributed neural circuitry including the bilateral dorsal striatum, bilateral anterior cingulate and right frontal regions. These neural abnormalities appeared to be unrelated to symptom severity or age at symptom onset.”
According to this study, it appears that skin picking is associated with functional brain abnormalities in regions involved in habit formation, action monitoring and conscious control of motor actions.
Considering that the study only assessed symptom severity in the past 7 days and didn’t find any correlation with the discovered atypical brain activation patterns it’s hard to think of these results as in any way being a trait, and could merely be indicative of a state. In other words, they may reflect specific functioning in the moment, but aren’t necessarily stable and unchangeable. To know this for sure, more research is needed and certainly bigger sample sizes, since 15 is barely sufficient to draw any conclusions.
Limitations of the study notwithstanding, we can, perhaps, try and think about it in practical terms. What can we learn about the areas in which a person needs to grow and develop to reduce their symptoms? If we extrapolate the findings, we can think about it like this:
1. Habit formation
2. Action monitoring
3. Conscious control
Each of these components can be improved in different ways. There are many habit-building strategies out there that you can draw on to improve this capacity overall, not just in one particular domain. Similar to discipline – it’s a quality you can build in different areas, even those unrelated to your skin picking and once you increase your ability to stay disciplined you can intentionally use that capacity to reduce skin picking.
Mindfulness is one way to learn how to observe yourself (action monitoring) and to train yourself to be nonreactive (conscious control).
This might also tell us why psychotherapy still holds up as the golden standard of BFRB treatment. Even the simplest behavioral interventions designed to reduce picking or hair pulling involve all three components.
If you want a place to start, check out our Step 1 webinar. Alternatively, here are a few suggestions to begin:
· Read Atomic Habits by James Clear and practice introducing a new habit.
· Start a mindfulness practice, either using a book, an app or by finding a teacher. You can also check out our free self-compassion course here.
· Practice mindfulness without meditation by choosing parts of your life you want to bring more awareness and simply slow down and observe your thoughts and feelings.
· Practice delaying gratification in areas of your life that have seemingly nothing to do with picking.
· Cultivate discipline by adhering to a morning or an evening routine.
Remember that there are many ways to begin changing. If you don’t feel ready to directly attack your skin picking, you can train the skills and capacities needed to curb picking in other areas of your life. In addition, different ways in which you can create the necessary changes are only limited by your creativity.
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