The role of skin picking and dysmorphic concerns for impaired mental health accompanying skin conditions

Abstract

Background: Individuals with skin conditions are prone to experience impaired mental health. Such effects may manifest in symptoms of depression and anxiety. Dermatological patients also report dysmorphic concerns and are vulnerable to skin picking behaviours that can further aggravate the state of the skin. The current study aimed at testing the mediating role of these two factors in explaining impaired mental health among patients with skin conditions. Method: Based on a large survey in the German population (n=1028), we examined group differences in mental health among individuals with three skin conditions (acne, atopic dermatitis, and psoriasis: n=178) and controls without skin conditions (n=850). We analysed indirect effects of dysmorphic concerns (DCQ) and skin picking behaviours (SPS) on group differences in depression, anxiety, and well-being, using mediation modelling in PROCESS. Additional control analyses accounted for influences of age, gender, impulsivity, and obsessive-compulsive symptoms. Findings: Participants with skin conditions reported lower well-being and higher degrees of depression, anxiety, dysmorphic concern, and skin picking compared to controls (ps <.01). Mediation analyses showed that both, dysmorphic concerns and skin picking behaviours, fully mediated the effects of skin conditions on all assessed mental health variables (all delta R² >.15). These effects remained stable in control analyses. Discussion: Dysmorphic concerns and skin picking are important factors that contribute substantially to affected mental health associated with skin conditions. The results imply the importance of addressing these cognitive-affective and behavioural components in psychological interventions. This could, in turn, alleviate distress and improve the well-being of dermatological patients.