Excoriation disorder also referred to as chronic skin-picking or dermatillomania is a mental illness related to obsessive-compulsive disorder. It is characterized by frequent picking at one’s own skin which results in skin woundsand causes significant disruption in one’s life.
Individuals may pick at healthy skin, minor skin pimples or calluses, and wounds. This disorder is usually chronic, with periods of remission alternating with periods of greater symptom intensity. If untreated, skin-picking behaviors may come and go for weeks, months, or years at a time. It is common for individuals with this disorder to spend significant amounts of time, sometimes even several hours a day, on their picking behavior.
Picking at wound or bumps from time to time isn’t uncommon. However, for some people, picking can become chronic. Frequent picking can irritate existing sores and even cause new ones to form. This can cause additional wound and lead to scarring. People with this disorder pick at their skin out of habit or impulse. They often describe this impulse to pick as something they struggle to control.
Some people may spend a few minutes several times a day picking. Others may pick continuously for several hours each day.When this happens, picking at the skin for example, picking a wound or the skin around your nails can become so frequent and intense that it causes bleeding, sores, and scars.Some people with this disorder repeatedly scratches to try to remove what they see as some kind of imperfection in their skin.
As with obsessive-compulsive disorder (OCD), people with skin-picking disorder experience some type of distress because of the disorder. They may feel embarrassed by the condition of their skin. They may also feel ashamed because they seem unable to stop themselves from engaging in this harmful behavior.
This perceived lack of control is very similar to the compulsions in obsessive-compulsive disorder (OCD). Like OCD, the desire to skin-pick is frequently described as a compelling urge that is often preceded by a strong emotion. However, unlike OCD compulsions, people with skin-picking disorder report a pleasurable gratification from picking.
Anxiety, depression, shame, fear of exposure, and embarrassment over the condition usually leads to attempts at covering up the skin with makeup, clothing or by other means, and can also interfere with normal social interactions resulting in uncomfortable relationships with family and friends. Dermatillomania is not diagnosed when the symptoms are caused by another medical or psychiatric condition. For instance, skin picking can also occur with dermatological conditions, autoimmune disorders, opiate withdrawal, and developmental disorders such as autism.
CAUSES
There may be a genetic link to dermatillomania (Skin Picking), since some people appear to have an inherited tendency tobody-focused repetitive behaviors (BFRBs) such as skin picking and hair pulling, as well as higher-than-average rates of mood and anxiety disorders in first-degree relatives. Other factors, such as individual temperament, stress and age appear to play roles in the development of the condition.
Chronic skin picking behavior often coincides with the onset of puberty Dermatillomania may also be associated with perfectionism that leads to over-grooming or used as a means of avoiding stressful events or releasing tension that builds up as a result of negative emotions such as impatience, frustration, dissatisfaction and even boredom.
WHAT ARE THE SIGNS OF SKIN PICKING DISORDER?
It’s hard to say exactly when skin picking changes from a mild, nervous habit to a serious problem that needs treatment. It may help to ask the following questions:
•Does picking at your skin take up a lot of time during the day?
•Do you have noticeable scars from skin picking?
•Do you feel upset when you think about how much you pick your skin?
•Does picking at your skin get in the way of your social or professional life? For example, do you avoid the beach or the gym because people might see your scars? Or do you spend a lot of time covering up sores before work or social events?
HOW DOES SKIN PICKING DISORDER DEVELOP?
Skin picking disorder happens in both children and adults. It can begin at almost any age.
Skin picking disorder often develops in one of two ways:
After some kind of rash, skin infection, or small injury. You may pick at the scab or rash, which causes more injury to the skin and keeps the wound from healing. More itching leads to more picking and more scabbing, and the cycle continues.
During a time of stress. You may absently pick at a scab or the skin around your nails and find that the repetitive action helps to relieve stress. It then becomes a habit.
Skin picking disorder is considered a type of repetitive “self-grooming” behavior called “Body-Focused Repetitive Behavior” (BFRB). Other types of BFRBs include pulling or picking of the hair or nails that damages the body.
TREATMENT
Individuals who pick skin often make repeated, unsuccessful attempts to stop on their own, as the shame and embarrassment associated with dermatillomania may prevent them from seeking professional treatment. In fact, fewer than one in five people with dermatillomania are thought to seek treatment. For those who do, small-scale psychological studies of both Cognitive Behavioral Therapy and Acceptance and Commitment Therapy, coupled with self-help interventions such as habit reversal therapy, have been shown to reduce symptoms of dermatillomania.
HABIT REVERSAL TRAINING
The therapist helps you identify the situations, stresses, and other factors that trigger the skin picking. Then your therapist will help you find other things to do instead of skin picking, such as squeezing a rubber ball. This will help ease stress and occupy your hands.
Stimulus control. This therapy involves making changes to your environment to help curb skin picking. For example, you might try wearing gloves or Band-Aids to help prevent feeling the skin and getting the urge to pick. Or you might cover mirrors if seeing facial blemishes or pimples brings on picking behavior.
It is also a good idea to see your primary care doctor or a dermatologist about any skin lesions, wounds, or scars caused by the repetitive picking.
Take Care of Yourself and Each Other!
