Development and Validation of a New Behavioral-Cognitive-Metacognitive Model for Explanation of SPD


The purpose of the present study is to provide an overview of the disorder and develop a new behavioral-cognitive-metacognitive model to explain it. The present study is a descriptive-correlational research which uses the structural equation model. In this study, at first, a comprehensive and detailed explanation of skin picking disorder is presented. Then the conceptual model is presented and finally, the model which is developed by using structural equation model is tested by Amos Graphics. The results of the structural equation model showed that the developed model in this study is able to explain skin picking disorder. Also the results of the overall fit indices for structural equation modeling show that the developed model has good fit to the sample data and is closely associated with the theoretical assumptions. Since the model presented in this study is multi-dimensional and takes into consideration all of the three behavioral, cognitive, metacognitive dimensions and these three dimensions are considered interdependent and not dependent and contradictory, it is considered as a new explanatory model. The model may prompt future researches into skin picking disorder and facilitate clinical treatments and case formulations associated with this disorder.

Share and Cite:

Nikfarjam, M. , Rabiei, M. , Rahnejat, A. and Khoramdel, K. (2015) Development and Validation of a New Behavioral-Cognitive-Metacognitive Model for Explanation of SPD. Psychology, 6, 1223-1231. doi: 10.4236/psych.2015.610120.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Brakoulias, V. (2014). DSM-5 Bids Farewell to Hypochondriasis and Welcomes Somatic Symptom Disorder and Illness Anxiety Disorder. Australian & New Zealand Journal of Psychiatry, 48, 688.
[2] Briere, J. (2000). The Cognitive Distortion Scale Professional Manual. Psychological Assessment Resources.
[3] Cartwright-Hatton, S., M. A., Illingworth, V., Brocki, J., Harrington, R., & Wells, A. (2004). Development and Preliminary Validation of the Meta-Cognitions Questionnaire—Adolescent Version. Journal of Anxiety Disorders, 18, 411-422.
[4] Clark, D. A., & Beck, A. T. (2011). Cognitive Therapy of Anxiety Disorders: Science and Practice. New York: Guilford Press.
[5] Denys, D., van Megen, H. J., & Westenberg, H. G. (2003). Emerging Skin-Picking Behaviour after Serotonin Reuptake Inhibitor-Treatment in Patients with Obsessive-Compulsive Disorder: Possible Mechanisms and Implications for Clinical Care. Journal of Psychopharmacology, 17, 127-129.
[6] Donyavi, V., Rabiei, M., Nikfarjam, M., & Mohmmadnezhady, B. (2015). Body Image and Meta-Worry as Mediators of Body Dysmorphic Disorder. International Journal of Clinical Medicine, 6, 170-176.
[7] Donyavi, V., Rabiei, M., Nikfarjam, M., & Rahnejat, A. (2015). Develop and Validate a Metacognitive-Cognitive-Behavioral Model for Body Dysmorphic Disorder. Open Journal of Medical Psychology, 4, 45-52.
[8] Flessner, C. A., & Woods, D. W. (2006). Phenomenological Characteristics, Social Problems, and the Economic Impact Associated with Chronic Skin Picking. Behavior Modification, 30, 944-963.
[9] Freeston, M. H., Ladouceur, R., Gagnon, F., Thibodeau, N., Rheaume, J., Letarte, H., & Bujold, A. (1997). Cognitive-Behavioral Treatment of Obsessive Thoughts: A Controlled Study. Journal of Consulting and Clinical Psychology, 65, 405-413.
[10] Ghahvehchi-Hosseini, F. (2013). Meta-Cognitive Therapy versus Cognitive Therapy in Reducing Meta-Worry in Students with Test Anxiety. Journal of Behavioural Science, 4, 1-8.
[11] Ghassemzadeh, H., Mojtabai, R., Karamghadiri, N., & Ebrahimkhani, N. (2005). Psychometric Properties of a Persian-Language Version of the Beck Depression Inventory—Second Edition: BDI-II-PERSIAN. Depress Anxiety, 21, 185-192.
[12] Grant, J. E., Menard, W., & Phillips, K. A. (2006). Pathological Skin Picking in Individuals with Body Dysmorphic Disorder. General Hospital Psychiatry, 28, 487-493.
[13] Grant, J. E., Odlaug, B. L., Chamberlain, S. R., Keuthen, N. J., Lochner, C., & Stein, D. J. (2012) Skin Sicking Disorder. The American Journal of Psychiatry, 169, 1143-1149.
[14] Hayes, S. L., Storch, E. A., & Berlanga, L. (2009). Skin Picking Behaviors: An Examination of the Prevalence and Severity in a Community Sample. Journal of Anxiety Disorders, 23, 314-319.
[15] Hlal, H., Barrimi, M., Kettani, N., Rammouz, I., & Aalouane, R. (2014). Factitious Disorder and Skin Picking: Clinical Approach: A Case Report. Encephale, 40, 197-201.
[16] Hollon, S. D., & Kendall, P. C. (1980). Cognitive Self-Statements in Depression: Development of an Automatic Thoughts Questionnaire. Cognitive Therapy and Research, 4, 383-395.
[17] Kerlinger, F. N. (2000). Foundations of Behavioral Research. San Diego, CA: Harcourt College Publishers.
[18] Keuthen, N. J., Wilhelm, S., Deckersbach, T., Engelhard, I. M., Forker, A. E., Baer, L., & Jenike, M. A. (2001). The Skin Picking Scale: Scale Construction and Psychometric Analyses. Journal of Psychosomatic Research, 50, 337-341.
[19] Lochner, C., Grant, J. E., Odlaug, B. L., & Stein, D. J. (2012). DSM-5 Field Survey: Skin Picking Disorder. Annals of Clinical Psychiatry, 24, 300-304.
[20] Lovato, L., Ferrao, Y. A., Stein, D. J., Shavitt, R. G., Fontenelle, L. F., Vivan, A., & Cordioli, A. V. (2012). Skin Picking and Trichotillomania in Adults with Obsessive-Compulsive Disorder. Comprehensive Psychiatry, 53, 562-568.
[21] Odlaug, B. L., Lust, K., Schreiber, L. R., Christenson, G., Derbyshire, K., & Grant, J. E. (2013). Skin Picking Disorder in University Students: Health Correlates and Gender Differences. General Hospital Psychiatry, 35, 168-173.
[22] Purdon, C., & Clark, D. A. (1993). Obsessive Intrusive Thoughts in Nonclinical Subjects. Part I. Content and Relation with Depressive, Anxious and Obsessional Symptoms. Behaviour Research and Therapy, 31, 713-720.
[23] Rabiei, M. (2014). Factor Structure, Validity and Reliability of the Revised Version of Skin Picking Scale. Zahedan Journal of Research in Medical Sciences, 9, 40-44.
[24] Rabiei, M., Donyavi, V., Nikfarjam, M., & Mohammad Nezhady, M. A. (2015). Validation of a Classification System for Obsessive-Compulsive and Related Disorders Based on DSM-5. Open Journal of Psychiatry, 5, 137-143.
[25] Rabiei, M., Mulkens, S., Kalantari, M., Molavi, H., & Bahrami, F. (2012). Metacognitive Therapy for Body Dysmorphic Disorder Patients in Iran: Acceptability and Proof of Concept. Journal of Behavior Therapy and Experimental Psychiatry, 43, 724-729.
[26] Rabiei, M., Nikfarjam, M., Movassagh, M. T., & Goldoz-Khayat, N. (2014). The Effectiveness of Metacognitive-Cognitive-Behavioral Intervention on Severity of the Symptoms of Hair Pulling Disorder. Journal of Behavioral Sciences, 7, 373-378.
[27] Rabiei, M., Salahian, A., Bahrami, F., & Palahang, H. (2011). Construction and Standardization of the Body Dysmorphic Metacognition Questionnaire. Journal of Mazandaran University of Medical Sciences, 21, 43-52.
[28] Snorrason, I., Belleau, E. L., & Woods, D. W. (2012). How Related Are Hair Pulling Disorder (Trichotillomania) and Skin Picking Disorder? A Review of Evidence for Comorbidity, Similarities and Shared Etiology. Clinical Psychology Review, 32, 618-629.
[29] Snorrason, I., Stein, D. J., & Woods, D. W. (2013). Classification of Excoriation (Skin Picking) Disorder: Current Status and Future Directions. Acta Psychiatrica Scandinavica, 128, 406-407.
[30] Stein, D. J., Grant, J. E., Franklin, M. E., Keuthen, N., Lochner, C., Singer, H. S., & Woods, D. W. (2010). Trichotillomania (Hair Pulling Disorder), Skin Picking Disorder, and Stereotypic Movement Disorder: Toward DSM-V. Depress Anxiety, 27, 611-626.
[31] Sulkowski, M. L., Mancil, T. L., Jordan, C., Reid, A., Chakoff, E., & Storch, E. A. (2011). Validation of a Classification System of Obsessive-Compulsive Spectrum Disorder Symptoms in a Non-Clinical Sample. Psychiatry Research, 188, 65-70.
[32] Weissman, A. N., & Beck, A. T. (1978) Development and Validation of the Dysfunctional Attitude Scale: A Preliminary Investigation. Proceedings of the 62nd Annual Meeting of the American Educational Research Association, Toronto, 27-31 March 1978.
[33] Wells, A. (2009). Metacognitive Therapy for Anxiety and Depression. New York: Guilford Press.
[34] Zuchner, S., Cuccaro, M. L., Tran-Viet, K. N., Cope, H., Krishnan, R. R., Pericak-Vance, M. A., Wright, H. H., & Ashley-Koch, A. (2006). SLITRK1 Mutations in Trichotillomania. Molecular Psychiatry, 11, 887-889.

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.