Introduction
Body-focused repetitive behaviors (BFRBs) include excessive actions such as pulling, picking, or scratching, encompassing dermatillomania (skin picking), trichotillomania (hair pulling), lip/cheek biting, and nail-biting. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), these behaviors are categorized under obsessive-compulsive disorder (OCD) and related disorders due to their repetitive nature, similar to compulsions observed in OCD. However, there are differences in their triggers and phenomenology, as BFRBs often occur during boredom or specific emotions, unlike OCD, which involves contamination fears. Dermatillomania involves excessive picking, causing open wounds that are prone to infection. It usually begins in adolescence and declines after age 20. Trichotillomania occurs in two styles: automatic (unconscious) and focused (intentional to reduce internal tension). Psychological factors such as anxiety sensitivity (AS) and distress tolerance (DT) significantly affect these disorders. AS refers to fear of anxiety-related sensations, and DT refers to the ability to endure negative emotional states. Low DT leads to maladaptive behaviors to temporarily escape discomfort.
Self-compassion therapy, a third-wave psychological intervention, emphasizes being kind and nonjudgmental toward oneself, recognizing shared human struggles. It has shown efficacy in treating depression, anxiety, and OCD by reducing distress and promoting psychological resilience. This study aims to examine the effectiveness of self-compassion therapy on the severity of symptoms, AS, and DT in women with dermatillomania and trichotillomania.

Methods
This is a quasi-experimental study with a pre-test/post-test/follow-up design. The study population consisted of female patients with dermatillomania and trichotillomania referred to psychology clinics in Tehran, Iran, in 2024. A total of 30 eligible patients were purposefully selected and randomly assigned to intervention (n=15) and control (n=15) groups. Inclusion criteria were the diagnosis of dermatillomania and trichotillomania based on the DSM-5 criteria, age 20-35 years, and having the disorder for at least six months. Data collection tools included Floyd et al.’s [23] anxiety sensitivity index (ASI), Simons and Gaher’s DT scale (DTS), the Massachusetts general hospital hairpulling scale (MGH-HPS), and Keuthen et al.’s [28] skin picking scale (SPS). The intervention group underwent eight 45-min sessions of self-compassion training based on Gilbert’s protocol, while the control group received no intervention. The data were analyzed using the repeated measures ANOVA.

Results
The mean scores of the variables for the two groups are presented in Table 1.


The results of repeated measures ANOVA for comparing two groups in SPS and MGH-HPS scores in the three phases of pre-test, post-test, and follow-up are reported in Table 2.


Based on the findings, the difference between the two groups in the scores of SPS (P=0.020) and MGH-HPS (P=0.002) was significant in three phases. Approximately 17.9% and 28.3% of the differences in the SPS and MGH-HPS scores were related to the group factor, respectively. In addition, the main effect and the interaction effect of time and group were significant on all study variables (P<0.05). In other words, the difference in the SPS and MGH-HPS scores between the two groups over time was significant. Based on the findings, the differences between the two groups in the scores of ASI and DTS domains were also significant in three phases (P<0.05). The main effect and the interaction effect of time and group were also significant on all ASI and DTS domains (P<0.01). 

Conclusions
The self-compassion training is effective in reducing symptoms and AS, and improving DT in women with dermatillomania and trichotillomania. The self-compassion programs should be used through organized workshops to improve DT and reduce AS in these women. Further research should be conducted using qualitative methods and exploring other psychological factors affecting the severity of dermatillomania and trichotillomania symptoms in women. 

Ethical Considerations
Compliance with ethical guidelines
The study was approved by the Ethics Committee of Islamic Azad University, Tehran Medical Sciences Branch (IR.IAU.TMU.REC.1403.108) and was registered by the Iranian Registry of Clinical Trials (ID: IRCT20241019063416N). Informed consent was obtained from all participants.

Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors contributions
Conceptualization, methodology, investigation, review & editing, resources: Sahar Keyvan Tabar and Mansoor Alimehdi; Writing original draft: Sahar Keyvan Tabar; Supervision, and project administration: Mansoor Alimehdi.

Conflicts of interest
The authors declare no conflicts of interest.

Acknowledgments
The authors would like to thank the Parseh Clinic in Tehran and all participants for their cooperation in this study.
 

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