Dematillomania, also referred to as skin picking disorder or excoriation disorder, refers to the compulsive picking, rubbing, scratching or digging into one’s skin. This is not the same as the occasional picking at a pimple or scab, which is a common behavior. Compulsive skin picking involves damaging the skin by repetitive picking, resulting in noticeable sores.
Because dermatillomania is considered an obsessive-compulsive related disorder, learning how to stop compulsive skin picking will involve addressing the mental health disorder behind the behavior. There are focused therapies that help individuals access tools for learning how to stop compulsive skin picking behaviors, which can ultimately improve their quality of life.
About Compulsive Skin Picking
Skin picky disorder is a mental health condition that is associated with obsessive-compulsive disorder (OCD). Also referred to as a body-focused repetitive behavior, compulsive skin picking usually is first seen in early adolescence. A much higher incidence of this disorder involves females, who represent approximately 75% of the individuals affected by the compulsive skin picking.
The behavior is directed toward disturbing the skin, whether it is healthy skin or acne, scabs, or some form of skin lesion. The compulsive nature of the disorder may result in the individual spending large chunks of time on the picking behavior, even several hours a day. Compulsive skin picking results in open sores that can bleed or scar the skin. The area of the skin targeted may shift from one region to another, and can persist for weeks, months, even a year if untreated. Attempts are often made to camouflage the skin damage using make-up or clothing.
While the link to OCD is common, there are other causes for skin picking behaviors. These might include withdrawal from opiates, a dermatological disorder, a skin infection such as scabies, body dysmorphic disorder, psychosis, or an autoimmune disorder. Before pursuing a treatment plan, a careful evaluation should be conducted.
Effects of Skin Picking Disorder
Individuals who struggle with skin picking disorder often find their lives negatively impacted by it. There are several ways that skin picking disorder can cause problems in someone’s life, including:
- Skin infections
- Secondary infections
- Scarring of the skin
- Social isolation
- Shame and embarrassment
- Emotional distress
- Strained interpersonal relationships
Signs of Skin Picking Disorder
Signs of skin picking disorder are evident visually, as the individual will appear with multiple, sometimes dozens, of visible sores covering an area of skin. They may wear long sleeves and long pants during hot weather. They may have attempted to cover the sores using make-up. They may exhibit signs of depression. They may avoid activities they once enjoyed such as going to the beach, water skiing, pool time. They may become isolated, due to embarrassment about the appearance of the skin.
The DSM-5 has classified Excoriation (skin picking disorder, dermatillomania) as an obsessive-compulsive and related disorder. It lists the following diagnostic criteria:
- Recurrent skin picking that results in lesions
- Repeated attempts to stop the behavior
- The symptoms cause clinically significant distress or impairment
- The symptoms are not caused by a substance or medical, or dermatological condition
- The symptoms are not better explained by another psychiatric disorder
The disorder shares common features to OCD. Just as someone with OCD feels anxiety caused by an obsessive thought, leading to the compulsive behavior, skin picking disorder has a similar path. The individual may experience an urge or physical tension that precedes the picking, followed by unpleasant emotions that lead to rationalizing the behavior, giving themselves permission to pick the skin. Following the skin picking session, the individual experiences urge reduction and a sense of pleasure or relief, as well as the negative effects of shame, depression, isolation, sores and even disfigurement.
This is a similar experience to classic OCD, where the discomfort linked to the obsessive or disturbing thoughts leads to repetitive behaviors that result in feelings of shame, embarrassment, isolation, and depression. OCD is a mental health disorder within the anxiety spectrum. Because of the close relationship to OCD, treatment interventions for skin picking disorder are similar.
How to Stop Compulsive Skin Picking
The treatment plan for individuals with skin picking disorder will depend on whether it is intrinsically a mental health disorder or simply an unconscious bad habit. Once a thorough evaluation has been conducted, it can be determined if the person meets the criteria for a mental health disorder. If not, a therapy known as habit reversal training can help identify triggers that lead to the skin picking episodes, and then respond with more healthy behaviors.
When, however, the behavior is a diagnosed mental health disorder, the usual treatment protocol will be similar to that of an OCD diagnosis. The individual will be prescribed both antidepressant drug therapy along with psychotherapy, specifically cognitive behavioral therapy (CBT).
CBT has been found to be the most effective type of psychotherapy for treating OCD. It is a short-term therapy that helps patients recognize thought distortions that precede the compulsive behaviors. Working with the therapist, the individual will learn to notice triggering disordered thoughts and then reframe the thought patterns so the compulsive behaviors will not be necessary for relief.
In addition to the antidepressants and CBT, many also find value in learning stress-reduction techniques that they can access when they perceive an upcoming trigger. Deep breathing exercises can be done anywhere and will almost immediately reduce feelings of anxiety. Another option is mindfulness meditation; keeping the mind focused on the present moment and concentrating on the breathing process can also promote a sense of relaxation.
The Treatment Specialist Provides Online Mental Health Information
The Treatment Specialist provides readers with a digital library of important mental health and substance use disorder information and data. When you or a loved one is struggling with dermatillomania, understanding how to stop compulsive skin picking is essential information. The Treatment Specialist can provide helpful information to help you resolve these behaviors, as well as suggest treatment options for OCD. For more information about skin picking disorder, please contact The Treatment Specialist today at (866) 408-0734.