Little research investigated personality features in SP subtypes. The present study was the first contribution assessing the role of EMS in SP subtypes in a large community group self-reporting picking behaviour. Understanding processes associated with SP might help development of tailored conceptualization and treatment strategies targeting different EMS for different subtypes.
Intercorrelation between Automatic and Focused subtypes was strong, whereas correlations of both Automatic and Focused subtypes with Mixed one were moderate. This finding was in contrast with evidence [5] showing that the subtypes were not correlated but it was consistent with prior research reporting moderate to strong intercorrelations [6].
Correlations between subtypes and EMS were all positive except for Emotional Deprivation EMS, which negatively correlated with all three subtypes: individuals with higher expectation that their needs for emotional support will not be adequately met by others reported SP to less extent than those reporting stronger Emotional Deprivation EMS.
Correlations between three SP subtypes and EMS were all weak, except for the association between Mixed SP and Negativity/Pessimism and Failure to Achieve EMS, which were moderate. Thus, individuals self-reporting Mixed SP endorsed stronger beliefs of being fundamentally inadequate relative to peers in areas of achievement and a focus on the negative aspects of life while neglecting the positive ones. This evidence is consistent with the association between Mixed SP and depression [6]. A moderate correlation was found also between Automatic SP and Approval/Recognition Seeking EMS: individuals with more intense Automatic SP behaviour tend to put excessive emphasis on gaining approval from others, at the expense of developing a true sense of self, consistently with reports indicating approval seeking and separation anxiety as predictors of avoidant personality [18]. This evidence might support the hypothesis that avoidant personality traits might be involved in the Automatic subtype, and that this subtype might be related to the so-called vulnerable narcissistic personality picture, often associated to avoidant personality, in the same manner as self-injurious behaviour [19]. Analyses of covariance showed that the three SP subtypes were associated with common EMS and differentially with specific EMS.
EMS common to subtypes
Higher Dependence/Incompetence EMS predicted stronger both Automatic and Focused SP, whereas lower Emotional Deprivation was common to all subtypes. This result indicated that individuals viewing themselves as unable to handle everyday responsibilities without help from others tend to report both subtypes. The relation between the two subtypes and Dependence/Incompetence EMS may be explained by the fact that individuals who are not able to stop picking may feel frustrated, then may get into a helpless vicious cycle [20]. The connection between these EMS and SP might be an effect also of the association between subtypes, particularly Focused, and depression [21]. This result is consistent with a study [22] showing that Dependence/Incompetence EMS were associated with non-suicidal self-injurious behaviour. Supporting the link between Emotional Dependence and SP, Estévez and colleagues [23] reported that Emotional Dependence was associated with impulsive behaviour and that it mediated the relation between Attachment and Impulsivity. The result about the role of Dependence in Automatic SP is interesting since loneliness was an emotional trigger of SP behaviour [24]. In addition, the association between a sense of incompetence and SP may be attributed to a negative self-judgemental attitude, a cognitive factor found to be related to depressive traits [25].
Emotional Deprivation EMS resulted a protective factor against all the three subtypes of SP, as more intense SP behaviour was associated with lower Emotional Deprivation. This result indicated that those individuals self-reporting picking behaviour to less extent believed that their needs for emotional support are not adequately met by others. This result might be in contrast with the literature, since Emotional Deprivation is believed a risk or maintenance factor for a number of symptoms and disorders [26]. However, it might be hypothesized that individuals who have SP tendencies have difficulties identifying/describing feelings, given the relation between Alexithymia and SP [21]; thus, they could not identify these needs as unmet. Since Obsessive Compulsive Disorder (OCD) and body focused repetitive behaviours have clinical overlap [20], a further explanation might be in research on parenting associated with development of OCD [27], where OCD severity was linked with parental overprotection.
Younger age predicted stronger levels on all three SP subtypes, supporting evidence that SP behaviours concern mostly late adolescents and young adults [28].
EMS specific to SP subtypes
Higher Approval/Recognition Seeking predicted stronger Automatic SP. This association might be explained by perfectionism reported in SP: feelings of dissatisfaction and imperfection regarding the body can activate the picking episode with the aim to obtain approval/recognition by others and avoid feelings of shame or social rejection [28, 29]. Many individuals suffering from SP begin picking at an area of imperfection/blemish that they fixate on [30]. The role of Approval/Recognition Seeking seemed in line with case reports of Body Focused Repetitive Behaviours: Pélissier and O’Connor [31] described a patient who identified frustration/impatience as dominant emotions during the injurious behaviour (occurring when she was waiting or on wasting time) and identified automatic thoughts (“I’m not fast enough”, “I’m not performing well”), which increased her tension provoking the behaviour. Approval/Recognition Seeking might be considered an outcome of an authoritarian parenting and less parental acceptance which literature found playing a role in the development of OCD spectrum [27, 32].
Higher Emotional Deprivation predicted less intense both Automatic and Focused SP. This result was in contrast with previous evidence [9], where avoidant traits were related to SP and with research [26] indicating that shame proneness/social avoidance were associated with SP, due to skin lesions. Maybe the use of a community group accounts for this difference, as the individuals did not have clinical SP resulting in tissue damage.
Higher Mistrust/Abuse EMS predicted Focused subtype. This relation was consistent with evidence demonstrating that the Focused subtype is associated with borderline traits [10], since the Disconnection/Rejection domain was the most specific to borderline personality and Abuse/Mistrust EMS was one of the most closely associated EMS to borderline traits [26]. The association between Focused SP and borderline personality was demonstrated in a study where patients with Borderline Personality Disorder reported higher Focused SP behaviour than controls [10]. The role of Mistrust/Abuse EMS may be consistent with evidence showing that SP is associated with a history of childhood sexual/interpersonal abuse [33], which often predicts borderline personality [34], The association between Mistrust/Abuse EMS and Focused SP found in the current study might be consistent with models of self-injurious behaviour, which is seen as a compensatory regulation in posttraumatic adaptation [35]. In a study with outpatients, Mistrust/Abuse EMS correlated moderately with socially avoidant and vindictive interpersonal behaviours. This evidence supports the relation found in the current study between Mistrust/Abuse and SP, as in previous research also avoidant and passive–aggressive personality predicted significantly the Focused SP subtype [10].
The lack of a significant relation between SP subtypes and Shame/Defectiveness EMS appeared in contrast with studies demonstrating an association between social avoidance/shame and SP behaviour [36].
Higher Failure to Achieve EMS predicted stronger Mixed SP tendencies. Individuals with stronger Mixed SP tendencies seem to focus on the negative aspects of life while minimizing the positive ones and viewing themselves as inadequate relative to peers. These associations might be explained by the role of negative self-evaluation including higher disgust propensity in OCD spectrum disorders [37, 38].