Medical Issues, Relationships, Therapy, Toolkit

Help for Dermatillomania – Chronic Skin Picking

In this blog we are going to talk about dermatillomania, or chronic skin picking (CSP) Chronic skin picking is a serious problem, and one that can make those who experience it pretty miserable. People who suffer from dermotillomania repetitively touch, scratch, pick at, or dig into their skin. People use their fingernails or sometimes instruments like tweezers or pins. They are usually attempting to remove whiteheads or blackheads, small irregularities, scars or scabs, or what they perceive as imperfections in the skin. Chronic skin picking may result in scarring or infection. In more serious cases, severe tissue damage and permanent disfigurement can result.

Dermotillomania is what we call a Body-Focused Repetitive Behavior in which a person cause harm or damage to themselves. Other Body Focused Repetitive Behaviors include chronic hair pulling (called trichotillomania), biting the insides of the cheeks, and nail biting or picking at the cuticles or skin around the nails. Chronic skin picking is sometimes confused with self-harm behaviors like cutting, however, it is not the same type of condition.

So why do people develop chronic skin picking? There is no one single reason. Skin picking or other BFRBs can occur when a person experiences feelings such as anxiety, fear, excitement or boredom. Some people report that they have a sense of urgency to pick, feeling like a kind of irresistible urge. They may experience the act of repetitively picking at their skin as pleasurable, or it provides a sense of relief of tension and stress.

Many hours can be spent picking the skin, and often clients report losing track of time when they begin to pick the skin. Others report that they began skin picking when they had an injury to the skin, or experienced skin conditions such as acne. They began picking the sores or scabs, and this led to dermatillomania. This repetitive behavior can negatively impact a person’s social, work, and family relationships. It can create a sense of embarrassment, shame, or even self-hatred.

Skin picking often occurs on its own – unconnected to other physical or mental disorders. But it is important to identify early on whether or not skin picking is a symptom of another problem that needs treatment. For example, skin picking could be a symptom of allergies, skin disorders, autoimmune problems, body dysmorphic disorder, obsessive-compulsive disorder, substance abuse disorders (going through opiate withdrawal is an example of a situation which could lead to compulsive skin picking), developmental disorders (like autism), and psychosis. Establishing whether skin picking is an independent problem or a symptom of another disorder is an important first step in creating an appropriate treatment plan. For example, if your picking is the result of an allergic reaction to your pets, or your detergent, therapy may not be the most effective treatment of choice, although it can help retrain the repetitive behavior.

How is Chronic Skin Picking treated?

There are a variety of treatments to try, and different people find that different methods, or a combination of methods, work best for them.  Cognitive behavioral therapy can help reverse habitual behaviors and challenge faulty thoughts, such as “I have to pick and remove this rough spot on my skin.” We can also try to control the triggers and environments in which picking occurs. For example, if being in the bathroom is a trigger to start picking, we can ask the client to dim the lights, cover the mirror, set a timer for five minutes at which time they have to exit the room, or put a piece of tape on the floor just close enough to the bathroom mirror to allow you to brush your teeth, but not close enough to trigger the urge to pick. I always ask my clients to keep track of skin picking behaviors – when it is done, for how long, and how severe. That way we can chart patterns, such as extra stress, fatigue, menstrual cycle effects for female clients, and other clues that will help us get to the bottom of how picking occurs.

While there is no magic pill for chronic skin picking, some clients have responded medications such as Prozac. Medications must be prescribed by your MD, and can work well especially in conjuction with behavioral therapy to change the habit of picking. Another great resource is seeking out a support group, whether online or in person. It can be a great help to know you are not alone, and to learn how others have coped with dermatillomania.

How do you know if Skin Picking is a problem for you?

The general answer is, how is it affecting your life? If the picking is time-consuming, causes noticeable tissue damage, and causes you to feel distressed, there is a good chance it has reached a problem level. If you find that chronic skin picking is causing impairment in social, occupational, and physical functioning, such as avoiding social activities such as going to the pool, gym or beach; being late for work or other events because of the time it takes to cover up swelling, redness, bleeding, or scars from picking; or you are avoiding people or places to hide the effects of skin picking, it’s time to seek help. I have included several helpful resources at the end of this post – check those out and see if any are a fit for you. It’s a good idea to see your family doctor or a dermatologist to rule out any physical causes of skin picking. More and more of us, as clinical therapists, are here to offer support and resources as well.

I welcome your comments and ideas if you have experience or suggestions to share with others about dermatillomania.

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5 thoughts on “Help for Dermatillomania – Chronic Skin Picking”

  1. I’m a skin picker, and i have been for years. I remember picking scabs when i was a kid, and it escalated when i got older and started breaking out. At my worst i could spent 4-6 hours a day picking, and i had days where i never even left my flat. It massively affected my social and academic life for years, and i never realised it was me causing it. I spent thousands on different skin treatment, and nothing worked. Not a single one of the skin care professionals realised what i was doing.

    Finding out that its got a name, and i’m not alone, was a big breakthrough. For years i’d thought i was a freak of nature. After finding out I’ve tried several different treatments, but not been very sucessive. Well, they helped me accept myself, and become aware of what im doing and why. But im still picking, and i still hate myself for doing it.

    I recently moved to england from norway, and im hoping to find someone who can help me over here. In norway there’s only 1 specialist on the diagnosis, and she’s a psychiatric nurse. I have and will be blogging about my experiences with dermatillomania at my blog (norwegianinleeds.wordpress.com).

    Thank you for spreading the word! If more people knew of the disorder, then so many girls could be helped before it got as far as it did with me.

    Camilla x

  2. Having read this I believed it was really enlightening.
    I appreciate you finding the time and effort to
    put this content together. I once again find myself spending way too much time both reading and posting comments.

    But so what, it was still worth it!

  3. Yes, I’ve had this problem since a young age. It’s getting more serious now. I only use my fingernailes while picking on my skin. Most of my skin is all damaged now (my face, back and arms, in particular). I suffer on my own! 😦 😥 I’m a girl and I’m 21.

  4. I’m 33yrs old and I have been picking since I was 10, that I can remember. After tracking my picking I found that I am using it as a coping mechanism to deal with emotions that I have. It is my form of self soothing and avoiding feelings that are uncomfortable. I never learned how to manage my emotions because my mother is borderline and my father has emotional issues and my skills are very weak and distorted. I am working with a therapist and psychiatrist who has ruled out any psychological issues and I will be starting prozac tomorrow to help the process along. I am also learning mindfulness measures that are very helpful.

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