{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T14:05:57Z","timestamp":1768313157295,"version":"3.49.0"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Skin-picking disorder (SPD) often co-occurs with onychophagia and can cause substantial functional impairment. Although evidence-based psychotherapies are effective, benefits may be limited when behavioral analysis is not applied explicitly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 29-year-old man with SPD and onychophagia reported marked occupational impact. Baseline self-monitoring showed 240 min\/day of nail-related behavior, 30 episodes\/day, and high urge intensity. Using behavioral chain analysis, we mapped perceptual antecedents (visual\/tactile irregularities) and diurnal variability of urges. A medication-free, nine-session outpatient program over 20 weeks was delivered, combining stimulus control, urge management routines, and habit reversal training. Outcomes were tracked by daily self-monitoring. Rapid improvement followed initiation of stimulus control and consolidated after urge management routines. By treatment end, daily picking time decreased to 15 min\/day (-94%), episode frequency to 5\/day (-83%), and urge intensity to 4\/10 (-60%); no adverse effects were reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Making perceptual antecedents and diurnal moderators explicit based on chain analysis enabled a targeted, medication-free intervention that produced clinically meaningful reductions in behavior and urges. A chain-guided behavioral framework may help personalize treatment for SPD and related body-focused repetitive behaviors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2025.1738977","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T08:55:31Z","timestamp":1768294531000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Behavioral analysis guided intervention targeting triggers and urges in skin-picking disorder with comorbid onychophagia"],"prefix":"10.3389","volume":"16","author":[{"given":"Makoto","family":"Kawahito","sequence":"first","affiliation":[{"name":"Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University","place":["Fukuoka, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keitaro","family":"Murayama","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry, Kyushu University Hospital","place":["Fukuoka, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hirofumi","family":"Tomiyama","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry, Kyushu University Hospital","place":["Fukuoka, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenta","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry, Kyushu University Hospital","place":["Fukuoka, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomohiro","family":"Nakao","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University","place":["Fukuoka, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"B1","volume-title":"Diagnostic and Statistical Manual of Mental 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onychotillomania","volume":"19","author":"Lee","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1177\/0145445507313800","article-title":"Acceptance-enhanced behavior therapy (AEBT) for trichotillomania and chronic skin picking: exploring the effects of component sequencing","volume":"32","author":"Flessner","year":"2008","journal-title":"Behav Modif"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3999(01)00215-X","article-title":"The Skin Picking Scale: scale construction and psychometric analyses","volume":"50","author":"Keuthen","year":"2001","journal-title":"J Psychosom Res"},{"key":"B15","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1176\/appi.psy.42.5.397","article-title":"The Skin Picking Impact Scale (SPIS): scale development and psychometric 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