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Dermatillomania – Frequently Asked Questions

Dermatillomania – Frequently Asked Questions

My first YouTube video on Dermatillomania was made in March of 2012, and it has been far and above the most watched and commented-upon video I have ever made. I hear from viewers several times a week, still, and they have provided me with some great questions for a follow-up video. In this blog I will be working from a list of the most frequently asked subscriber questions, and will do my best to answer with the most up-to-date information I have at my disposal.

What is dermatillomania? When I am asked this question, generally what people mean is, is skin picking part of Obsessive Compulsive Disorder? Is it related to anxiety? Is it just a habit? Let me answer by first talking about the new Diagnostic and Statistical Manual, or the DSM 5, and then what I see in my practice. The DSM 5 categorizes dermatillomania, or excoriation, in the section on Obsessive-Compulsive and Related Disorders. In my experience, does every client who comes to me for help with skin picking also have a diagnosis of Obsessive Compulsive Disorder or OCD? No. I have seen many clients with dermatillomania and I can’t state that there is ONE single type of person who picks.  Some do have OCD. Some struggle with anxiety. Some have ADHD. Some began picking as children or young teens, in response to either some stressful life event, or when they first began to notice their skin breaking out. So in working with my clients, the “why” of picking is important and we work on that, but we focus a bit more on the skin picking as it presents in their lives today, in the here and now.

Another common message I get is that the person who picks says family/friends/significant other don’t understand.  They may be trying to help, like pointing out the picking behaviors, watching the person’s behaviors and offering correction, or even saying things like “I don’t get it. Why don’t you just stop??” Chances are none of the above are helpful for most people with dermatillomania. Occasionally, I will meet someone who has requested friends and family to keep an eye out and, if they see them picking, to remind them. This can be useful for those who are unaware that they have started picking – it has become an almost automatic habit. So bringing it into their awareness – for some – can be helpful. The key here is that the person ASKS for the reminders.  In most cases, my clients know they are picking, and there is a degree of embarrassment about it already. Expressing confusion or criticism can actually make the situation worse. What I suggest is having an honest talk with those closest to you about your skin picking. Tell them what you experience, and what they can do to help. Offer them some reading material or let them read this blog. It is understandable for those close to you to want to help in whatever way they think is appropriate. They may have deep concerns for your wellbeing and be acting out of caring for you. But if it makes you feel worse to be monitored or told to just stop, it’s okay to tell them so, to share resources, or to even bring them into therapy with you for one session to talk about it.

A great question I have received several times is “How can I find a doctor who understands dermatillomania?” As a Marriage and Family Therapist, I work often with medical doctors for a variety of my clients’ issues. Dermatologists are physicians who specialize in disorders of the skin. Most of my clients have seen a dermatologist before they come to me for treatment of the behavioral side of skin picking. Other types of physicians who may treat the physical side of dermatillomania are primary care physicians or psychiatrists. When you are seeing a physician for any reason, including skin picking, I advise everyone to do some preparation before the visit. If you are going to see a dermatologist, you can ask if the doctor treats dermatillomania, or excoriation. Some doctors may be much more familiar with this problem than others. The last thing you want is to be told, once again, “Why don’t you just stop it??” Your doctor should listen to you without judgment, ask questions to understand your particular case, allow you to ask any questions you have, and be open to discussing various treatment options with you. Now, I have the luxury of spending an hour with each of my clients. Doctors sometimes are more pressed for time. It’s a good idea to jot down a brief history of your skin picking, any relevant information such as previous treatment, and most important, any questions you have for the doctor.  I live in a big city with a lot of dermatologists, and even I have a difficult time finding one who really gets the big picture of dermatillomania. I have been blessed to work with Dr. Sabrina Fabi, who has come to my office to offer a support group for my clients. The relief on their faces, finally meeting a doctor who understood both the physical and psychological factors involved in dermatillomania, was amazing. I know she can’t be the only one. So if you are an MD watching this, or if you are a patient of a wonderful doctor who understands dermatillomania, let me know!

I will close with this last question: “Is there hope I can ever stop picking?” YES! Dermatillomania is not easy to overcome, but absolutely, it can be done. There are a number of tools people use to reduce or stop skin picking, from Cognitive Behavior Therapy all the way to medications. I don’t know what your particular path to recovery looks like, but I can tell you that it is there.

Thank you for reading! I welcome your comments below.

The video version of this blog post can be seen here: http://youtu.be/xCKWNw-h9ns

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