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.