Case Report: Behavioral analysis guided intervention targeting triggers and urges in skin-picking disorder with comorbid onychophagia.

One adult picked her skin and bit her nails for years. Doctors call this skin-picking disorder plus onychophagia.

The team watched her for two weeks. They wrote down what she saw, felt, and thought right before each pick. They also tracked when the urge felt strongest each day.

Then they built a 20-week plan. It had three parts: change the setting so picking is harder, teach quick urge-blocking moves, and use habit reversal training.

After 20 weeks the woman picked 94% less time and had 83% fewer episodes. Her urge strength also dropped by 60%.

Gains stayed at a one-month check-in. No pills were used.

Casanova (2023) also tested habit reversal on skin picking. They added ACT-based exposure and got good but smaller drops. The new case shows stimulus control and urge routines can push the drop even further.

Eisenhower et al. (2006) first mapped daily urge patterns in 92 pickers. Kawahito et al. (2026) turned those same patterns into the actual treatment plan, proving the old survey data can guide real therapy.

Saunders et al. (1988) warned that behavioral cases often give weak, uneven results. This new case beats that gloomy view with a 94% drop, showing modern precision planning can outdo the early, vague packages.

You can copy the same three steps in your practice. First, log triggers and urge times for one or two weeks. Second, rearrange the client’s space so the trigger is gone or harder to reach. Third, teach a 30-second competing action the client can do the moment the urge pops. One adult just cut her picking to almost zero without meds; your clients might too.