Restricted accessResearch articleFirst published online 2003-01
Emerging skin-picking behaviour after serotonin reuptake inhibitor-treatment in patients with obsessive–compulsive disorder: possible mechanisms and implications for clinical care
Pathological skin-picking is a self-injurious, impulsive behaviour with repetitive, and ritualistic characteristics. A number of studies show that selective serotonin reuptake inhibitors (SSRIs) may be efficacious in reducing skin-picking behaviour. Two case reports are presented demonstrating that SSRI-treatment may induce or aggravate pathological skin-picking behaviour. Possible mechanisms of SSRI-induced pathological skin-picking and implications for clinical care are discussed.
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