What Is Skin Picking Disorder (Dermatillomania)?
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Skin-picking disorder, or excoriation disorder, can be a serious mental health concern that is often chronic and potentially damaging to a person’s self-esteem. It is often tied to other mental health disorders, including obsessive-compulsive disorder (OCD), but it doesn’t necessarily have to be. It usually involves symptoms like chronic skin-picking that leads to significant distress, as well as unsuccessful attempts to stop picking. If you believe you may be living with skin-picking disorder, working with a licensed therapist can be helpful. You can seek out a local mental health professional or match with one through an online therapy platform.
What is skin-picking disorder?
Skin-picking disorder, which can be formally known as a condition called “excoriation disorder” or “dermatillomania,” is a psychiatric condition that typically involves the chronic picking of the skin. There may be periods where it is very intense, and it may go into remission, but nonetheless, if it isn’t treated, it can last for years.
The compulsive nature of excoriation disorder
A primary concern with excoriation disorder can be how much it may disrupt one’s life and self-esteem. People with this disorder may spend hours each day picking at their skin, even to the point of causing harm, such as open wounds. A harmless pimple, a piece of loose skin around the fingernails, or a scab that forms around a wound can develop into skin lesions and scars.
Additionally, some people with compulsive skin-picking disorder might scratch at their skin to remove a perceived defect that they believe is there, but that imperfection may not exist in reality—until they begin to pick at it.
Skin picking disorder: a mental health condition with obsessive-compulsive ties
Skin-picking disorder generally belongs to a category of mental health conditions in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) by the American Psychiatric Association known as obsessive-compulsive and related disorders. This doesn’t necessarily mean that all people with skin-picking disorder have obsessive-compulsive disorder (OCD), but the disorders often coexist and can have some similarities.
Co-occurrence of dermatillomania with OCD and other body-focused repetitive behavior (BFRB)
Skin-picking can also be referred to as a body-focused repetitive behavior (BFRB), which is something that can also be found in other types of conditions, like nail-biting disorder (onychophagia) or hair-pulling disorder (trichotillomania).
Like OCD, many of these BFRBs exist alongside excoriation disorder, and it’s estimated that up to 38% of individuals who pick their skin may also have problems with pulling one’s hair. In hair-pulling disorder or trichotillomania, people may repetitively pull hair out of their scalp, eyebrows, or eyelashes, which can cause significant hair loss, as well as feelings of shame or embarrassment.
Excoriation disorder can occur at any age, but it typically begins during a person’s adolescent years. It’s estimated that this condition affects anywhere from 1%-5% of the population can be affected by it.
Skin picking/excoriation disorder diagnostic criteria
Compared to many other mental health disorders in the DSM, the details on how skin-picking disorder is diagnosed tend to be very straightforward and include a handful of symptoms to look out for.
Here are the diagnostic criteria for excoriation disorder as listed in the DSM-5:
Chronic picking of the skin that leads to dermatological conditions, such as skin lesions
Repeated efforts to minimize or stop skin-picking
The skin-picking leads to clinically remarkable distress or disability in their occupational abilities, social life, or other important aspects of functioning
The skin-picking is not caused by the physiological effects of a chemical, substance (e.g., cocaine), or another medical illness (e.g., scabies)
The skin-picking can’t be further understood by knowing the symptoms of another mental health disorder (e.g., misconceptions or hallucinations in a psychotic condition, efforts to enhance a perceived impairment or flaw in body dysmorphic disorder, intent to hurt oneself although not suicidal*, or stereotypies in stereotypic movement disorder).
Therefore, to receive an accurate diagnosis of excoriation disorder, other conditions must usually be ruled out first.
However, for those who truly have excoriation disorder, as opposed to skin-picking related to substance use or another mental health concern, the specific causes of the condition aren’t typically as clear.
Why do people pick at their skin?
The exact cause of excoriation disorder may be unknown. However, genetics may be at least partially to blame, and it’s possible that those with a family history of the condition, as well as obsessive-compulsive disorder, can be predisposed to excoriation disorder.
On the other hand, external factors can be responsible as well, and excoriation disorder can start to develop after a person picks at a scab, rash, or any small injury. The picking often leads to itching and irritation that may lead the individual in question to pick even more, potentially causing a larger and more severe wound than before.
Stress and anxiety can also play a role, and many people cite that skin-picking provides a sense of temporary relief despite experiencing distressing consequences. It can also arise out of boredom.
Similar to other body-focused repetitive behaviors, like hair pulling, skin-picking doesn’t always have to be a conscious decision. It can happen automatically without much thought from the individual. This can lead to unwanted consequences before a person even realizes it.
The effects of skin picking disorder
Aside from the actual physical appearance aspect of skin-picking, it can also have a tremendous impact on how an individual behaves and interacts with the rest of the world.
Potential mental health effects of excoriation disorder
Skin-picking can cause people to feel embarrassed and shameful. They may develop low self-esteem, and excoriation disorder can eventually contribute to the development of depression and other mental health disorders.
Because of this, people with excoriation disorder may avoid socializing and going out to public places, such as shopping centers, gyms, beaches, and countless other locations. This can make life feel limited for those who experience skin-picking disorder.
If the individual must go out, they will often go to great lengths to conceal the damaged skin. This can involve camouflaging it with makeup or covering up extremities with long sleeves or pants. Additionally, it can cause issues with time management and lateness due to requiring extra time to hide the signs of skin-picking.
Potential physical effects of the urge to pick at skin
In addition to the emotional and mental health concerns that can come with excoriation disorder, there are physical effects that can be very common when people habitually pick their skin, and some of them can require medical treatment. For instance, picking an open wound can lead to infection, and in some cases, it can cause discoloration or even disfiguration.
Therefore, because skin-picking disorder can negatively impact a person’s mental and physical well-being, it’s often crucial that people seek out help as soon as possible. This may be especially true since skin-picking disorder is usually chronic if left untreated.
Treatment for skin-picking disorder
There are several potential treatments for this psychiatric disorder, ranging from wearing gloves to prevent self-injury. According to the TLC Foundation for Body-Focused Repetitive Behaviors, recent research indicates that 2-5% of people experience skin picking to a degree that causes negative impacts like tissue damage.
Skin picking is a medical condition and individuals who experience it have activation in specific brain areas when their symptoms activate. This knowledge has guided many modern treatments. These treatments might include habit reversal therapy, medication, talk therapy, and more.
Selective serotonin reuptake inhibitors
Selective serotonin reuptake inhibitors or SSRIs are a type of medication to help manage the body-focused repetitive behavior associated with this medical condition.
Habit reversal training
Habit reversal training involves teaching individuals who deal with negative impacts from skin picking disorders to recognize situations that might trigger their urge to pick at their skin to feel relief. They can learn to redirect their behavior to avoid picking their skin with specific types of activities that involve using their fingers (e.g., drawing, fidget toys, etc.)
Talk therapy for obsessive-compulsive disorder
One form of psychotherapy called cognitive-behavioral therapy (CBT), can be particularly useful because it usually involves changing a person’s thoughts so they can avoid skin-picking behaviors. This can mean addressing a person’s feelings that may compel them to pick at their skin, and it can also give them new ways of expressing these emotions, so they feel less of an urge to pick.
Like the compulsions that often accompany OCD, skin-picking can be considered a way to soothe anxiety, and eventually, it can grow out of control and become compulsive. Therefore, it may be essential to focus on the thoughts and feelings that cause skin-picking, as well as provide strategies to reduce and eliminate these compulsive behaviors.
Benefits of online therapy treatment
Finding a therapist who can make you aware of these feelings and how you respond to them is often the first step, and you can connect to licensed professionals online who specialize in helping people overcome body-focused repetitive behaviors. Online therapy also tends to be convenient and affordable, and it can be ideal for those who don’t feel comfortable with in-person sessions.
Effectiveness of online therapy
In addition to its convenience, online therapy also tends to be quite effective. Research suggests that it can produce the same results as traditional, in-person treatment options. One review of studies regarding online cognitive behavioral therapy (CBT) found that online therapy could significantly reduce symptoms of mental illnesses like anxiety, depression, PTSD, and more.
Takeaway
Skin-picking disorder usually involves chronic skin-picking that leads to distress. It can be important to note that you can overcome skin-picking disorder with the right support. With online or in-person professional treatment, it’s often possible to discover what drives skin-picking so that you can develop alternative solutions for expressing emotion, managing stress, and feeling in control of your experiences.
Frequently asked questions
Read more below for answers to questions commonly asked about this topic.
What triggers the urge for dermatillomania, or skin picking disorder?
Skin picking disorder (SPD) can involve many different triggers that prompt picking in affected individuals. Negative emotions of any kind are common triggers, especially:
Stress
Anxiety
Boredom
Fatigue
Anger
Large periods of time without structured activities may also trigger skin picking behavior. Some people with dermatillomania may pick at their skin reflexively or automatically when their mind is otherwise occupied. Others may have sensory triggers, such as seeing or feeling minor skin irregularities.
The initial onset of recurrent skin picking may happen during a period of prolonged or intense stress. Major, disruptive life events such as divorce, moving, or the loss of a family might contribute to the development of this condition in some at-risk individuals.
How do you fix skin picking disorder?
Treatment strategies for resolving skin picking disorder are similar to those for trichotillomania (hair pulling disorder), as these conditions appear to have many neurobiological and behavioral similarities. The approach with the best evidence base is a type of behavioral therapy called habit reversal training (HRT). This treatment can involve several components, including:
Awareness training, in which the client learns to better understand their skin picking behavior, including triggers and risk factors
Self-monitoring, in which the individual practices paying attention to their habitual actions and learns to spot when they’re about to start picking
Competing response training, in which the client develops alternative actions to take in response to the urge to pick skin (for instance, they might squeeze a stress ball or put their hands in their pockets)
Stimulus control, which involves modifying a person’s environment or routines to reduce the factors that often trigger skin picking.
Evidence suggests that HRT can work even better when paired with therapies designed to address the distressing thoughts and emotions that may push affected individuals toward skin picking. A combination of HRT with cognitive-behavioral therapy (CBT), acceptance and commitment therapy (ACT), or dialectical behavioral therapy (DBT) may be the most effective treatment for skin picking disorder. This approach may be referred to as the Comprehensive Behavioral Model (ComB) for treating body-focused repetitive behaviors.
In addition to these psychological treatments, some studies have shown potential benefits from medications such as selective serotonin reuptake inhibitors (SSRIs). The evidence for medication is weaker than that for psychotherapy, though.
Is skin picking or excoriation disorder treatable through therapy?
Several treatments for skin picking disorder have shown effectiveness in trials and clinical practice. How well these therapies work may vary from client to client, but systematic reviews have found substantial positive effects from most forms of treatment.
Unfortunately, studies also indicate that less than half of people with SPD seek treatment. This may be for a variety of reasons, including embarrassment or the belief that their behavior is “just a bad habit” rather than a serious condition. But for many people, the biggest barrier may be the belief that there’s no effective treatment. This view may result from repeated attempts to address the problem without success.
However, as noted above, several treatment options with substantial evidence from scientific trials are available for SPD. If you’re experiencing difficulty with skin picking, it may be worth talking about it with a qualified mental health provider.
Is skin picking a mental illness?
Most people occasionally squeeze, pinch, or pick at their skin in response to blemishes or pimples. Doing this every so often may not be a sign of any psychological disorder.
But frequent, severe, damaging skin picking may be a sign of SPD, which is also known as excoriation disorder or dermatillomania. The American Psychological Association classifies this as a mental illness related to obsessive-compulsive disorder.
One of the key differences between ordinary and pathological skin picking may be the level of skin damage that results. The presence of noticeable lesions is an important diagnostic criterion for SPD. Other potential consequences include serious emotional distress, low self-esteem, and social isolation.
How long does it take for skin picking to heal?
The speed at which skin heals after being damaged by repetitive picking can depend a great deal on the severity of the damage. A small scratch or popped pimple may heal in a few days to a week. Large sores or wounds can take months to heal and may leave permanent scarring.
In cases of extremely severe dermatillomania, large skin wounds may become seriously infected. These major lesions may not heal properly without medical intervention, and could require treatments such as antibiotics and tissue grafts.
What home remedy will heal skin picking wounds fast?
Some natural substances or easily available products may help small wounds from skin picking heal more quickly and cleanly. Many of these have mild antibacterial and anti-inflammatory properties, including:
Tea tree oil
Coconut oil
Topical application of these substances may also help keep skin wounds moisturized. Some, like aloe vera, could also have a soothing sensory effect. This might reduce the sensory triggers that lead people to pick at both damaged and healthy skin.
You may be able to enhance the effectiveness of these home remedies by combining them with skin care products such as sticky patches covering spots that you’re tempted to pick. Broad application of a gentle, fragrance-free moisturizer could also help, as could commercial anti-inflammatory or antibacterial formulas. It’s often a good idea to consult with a professional dermatologist for additional advice.
What medication is used for skin picking behavior?
There is currently no pharmaceutical medication known to be a first-line treatment for skin picking disorder. That said, some drug therapies have shown potentially positive effects in trials, such as SSRIs.
Other medications have demonstrated helpful effects in trichotillomania (TTM). Since TTM and SPD are obsessive-compulsive disorders with similar features, these medications might also help with skin picking disorder. Candidates include:
- Clomipramine, a tricyclic antidepressant sometimes used in obsessive-compulsive disorder
- N-acetylcysteine, a drug moderating excitatory neurotransmitters that has shown promise for managing impulse control disorder
- Olanzapine, an atypical antipsychotic thought to help with manic behavior
How serious is skin picking disorder?
The severity of skin picking disorder can vary considerably between individuals. Many people with this condition experience significant personal consequences, such as:
- Embarrassment and shame
- Social isolation
- Low self-esteem
- Long-term skin damage
- Impaired romantic life
- Diminished career opportunities
Is skin picking caused by trauma?
Researchers have found some evidence that trauma may play a role in causing skin picking disorder and trichotillomania. Individuals with these conditions were significantly more likely to report traumatic experiences in childhood. Some studies also indicate a greater likelihood of trauma in adulthood as well. People who undergo significant mental strain may form habits like skin picking and hair pulling in an attempt to cope with the severe stress they feel.
Still, the presence of trauma probably can’t fully explain how skin picking disorder develops. Other factors could include genetic inheritance, personality characteristics, and brain structure. For example, some neurological studies have found differences in the cerebellum — part of the brain involved in motor behavior control — between healthy individuals and those with SPD.
Can picking skin cause nerve damage?
Nerve damage is not a typical complication of skin picking disorder. That said, in some cases, the consequences of SPD-related skin injuries can be extreme and unpredictable. Repeated picking may cause wounds to get worse and worse, resulting in large-scale, severely infected lesions.
Neurological consequences are not unheard of in the clinical literature on SPD. Individuals with serious injuries from this condition could be at risk of nerve damage due to inflammation and infection.
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