Talking Therapy For Skin Picking Disorder
Talking therapy is currently thought to be an effective treatment to help change skin picking behaviour.
If you’re offered this, it’ll usually be given through community mental health services.
The most common type of talking therapy offered for skin picking disorder is cognitive behavioural therapy, and may include a technique called habit reversal training.
Habit reversal training works by helping you:
- recognise and be more aware of your skin picking and what’s triggering it
- replace skin picking with a less harmful behaviour
How This Condition Develops
Skin-picking disorder is a repetitive self-grooming behavior. Its also called a body-focused repetitive behavior . Other BFRBs include pulling hair or picking nails.
Skin-picking disorder is classified as a type of OCD. The compulsive urge to pick is often too powerful for many people to stop on their own. The more a person picks at their skin, the less control they have over the behavior.
Its unclear what causes a person to develop this disorder.
The disorder often begins after one of two events or stimuli:
- An infection, injury, or wound starts healing and creates a scab. The itching causes the person to scratch and pick. The new wound or lesion starts to heal and creates another scab. That begins the cycle of picking.
- The behavior is a stress relief habit during a time of stress. The repetitive action and control that skin picking gives may provide relief from other events that cant be controlled.
Skin-picking disorder occurs in both children and adults. It can begin at almost any age, but it typically appears first in adolescence or at the onset of puberty. Women are more likely to develop it than men.
Several conditions commonly occur alongside skin-picking disorder. These illnesses or disorders may be symptoms of a condition, or they may share many common underlying risk factors.
These co-occurring illnesses include:
What Is A Typical Skin Picking Disorder Episode Like
Where, when, and how people pick at skin varies. People can pick skin from one or more parts of the body. Common areas include: face, head, cuticles, back, arms and legs, and hands and feet. People most often pick skin with fingers and fingernails, but people also remove skin in other ways, e.g., by biting, or picking with tools like tweezers or scissors.
People pick for different reasons. People may pick out of habit or boredom, and, at times, may not even be aware that they are picking. People may also pick in an attempt to cope with negative emotions and/or in response to feelings of mounting stress and tension. While picking, people may feel relief. However, feelings of relief are often followed by feelings of shame or guilt. After picking, people discard their skin in different ways. Some people discard the removed skin in the trash or on the floor. Some people eat skin after they have picked it.
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What Triggers Episodes Of Dermatillomania
As with other BFRBs, different individuals may report different triggers for the behavior. Some with dermatillomania, for example, report picking when theyre anxious while the behavior may temporarily relieve anxiety, it often exacerbates it and other negative emotions in the long run. Others may pick when theyre bored or distracted. Some individuals pick while theyre engrossed in another activity and may not immediately notice that they have started picking their skin.
How Does Skin Picking Disorder Develop
Skin picking disorder happens in both children and adults. It can begin at almost any age.
Skin picking disorder often develops in one of two ways:
After some kind of rash, skin infection, or small injury. You may pick at the scab or rash, which causes more injury to the skin and keeps the wound from healing. More itching leads to more picking and more scabbing, and the cycle continues.
During a time of stress. You may absently pick at a scab or the skin around your nails and find that the repetitive action helps to relieve stress. It then becomes a habit.
Skin picking disorder is considered a type of repetitive “self-grooming” behavior called “Body-Focused Repetitive Behavior” . Other types of BFRBs include pulling or picking of the hair or nails that damages the body.
It is classified in the DSM-V as a type of obsessive compulsive disorder because of the compulsive urge to perform repetitive behaviors.
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How Is It Diagnosed
Diagnosing dermatillomania involves a combination of a physical exam, where your healthcare provider looks for signs of this condition on your body. Theyll also ask you questions about your medical history, your life circumstances and any behaviors that might relate to this condition. Diagnostic and lab tests can help rule out other causes for skin picking but are rarely needed to confirm this diagnosis.
Diagnosing this condition requires meeting all five of the following criteria:
What Causes People To Pick Their Skin
Skin picking is especially common among women, believes Dr Ahmed. There are a number of reasons why people become engaged in this repetitive and often damaging behaviour. It could be indicative of an underlying dermatological disorder or conditions, such as acne or eczema, that can promote picking as a response to a lesion or a symptom ,” she says. Recognising these triggerslike stress, anxiety or angeris important when trying to break the habit of skin picking. “There are also people who indulge in habitual picking as a habit during a state of boredom or when idle or tired. Skin picking also comes under the umbrella of obsessive-compulsive behaviours. I ask all my skin pickers if they have other associated behaviourssuch as frequent handwashing, hair pulling or plucking, ritualistic behaviours or excessive tidyingas skin picking can be a sign of further undiagnosed problems that can benefit from treatment, she explains.
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Cosrx Acne Pimple Patches
The obvious use for pimple patches is to help drain and heal breakouts, and theyre great for that purpose, but they also have the added benefit of stopping you from picking at blemishes. This COSRX package comes with two kinds one with dots of varying sizes to use at home or in private, and another with uniform clear patches that are nearly invisible, so you can wear them out and about or even underneath makeup. For those whose skin picking is motivated by acne or other bumps, popping on a patch as soon as you become fixated on a blemish can stop you from touching it. They may be especially useful for those who absently pick or feel around for bumps all over the body as a way to gain awareness and prevent the behavior.
Promising review: Adheres well. Don’t feel or even notice it. Looks almost invisible when you put it on. Even partly camouflages my pimple so you don’t see the redness. Makes it less noticeable. Kim Conard
Best for: acne-motivated skin pickers seeking a multipurpose remedy that will help heal pimples and stop picking.
It Was An Impulse As Natural As Taking A Drink To Quench Thirst
I used a pen next. The kind of ballpoint pen that comes in packs of clear plastic, that are impossible to find when you are rifling through your bag looking for them. I pressed only the very tip of the pen into the wallpaper. It made a slight, barely audible pop as the pen cracked open the wallpaper. I thought it was barely noticeable, so I did it again. And again. And again.
I made tiny holes as far up as I could reach and as low as the trim that separated the wallpaper from the floor. I didnt do it all in one day. It was just something I did. Without thinking much about it. I started making the holes a little bigger, and it wasnt long before someone noticed and I was forced to stop. I was embarrassed and ashamed. I couldnt explain it, so at first I denied it. I knew that no one would believe me if I said, I dont know why I did it, I just did. I had to.
People dont understand reasonless impulses. And they never believe there is no reason.
Its like the time I peeled all the ivory keys off my great uncles piano. It was against the wall of the garage, just left of the stairs that led into the laundry room. It was beautiful. The color of dark amber. The keys didnt need to be pressed to emit a satisfying note. If I tapped my fingernail against the top of a key, it produced a mesmerizing clink. A tiny crisp sound that most would be unable to hear unless they were right next to me.
“Even in my sleep, my hands move to my face, fingertips scanning for non-smooth skin.”
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Why People Pick Ears
In all ear picking habits, the act of picking gives some relief or satisfaction that is reinforcing.
For many people, their ears feel itchy or uncomfortable or the skin is dry. In these cases, ear picking is like scratching an itch. Its done to relieve discomfort.
At other times, ear picking just feels good.
Why does it feel good to pick or clean ears? Your ears are an erogenous zone so they have tons of nerve endings. This makes rubbing or massaging them stimulating and/or relaxing. Just like a massage feels good, messing with your ears can feel good too. This is often reason enough for many people to develop an ear picking habit.
Another reason many people develop an ear picking habit is because they have problems with self-regulation. Innumerable things can make self-regulation harder, including trauma, depression, anxiety, ADHD, autism, personality disorders, or just too much stress in your life. And ear picking can sometimes help you regulate your body and emotions better.
How does it do this? Well, your ear is connected to your vagus nerve. This is a massive nerve in your body that connects your brain to most of your organs. Stimulating this nerve can send relaxing signals to your body, which helps calm the body. Then the vagus nerve sends signals to your brain that your body is calm. This helps with emotional regulation.
Luckily, your nervous system can adapt and change based upon your behaviors, so you can change these connections by stopping your habit.
Why Are More Women Than Men Diagnosed With Excoriation Disorder
Experts believe that gender differences in diagnosis rates are largely reflective of the disorders true incidence in men vs. women. However, an increased emphasis on womens physical appearance in many cultures may compel more women to seek treatment for the condition, thus skewing diagnosis rates slightly.
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How To Recognize The Signs
Understanding the signs and symptoms of skin-picking disorder can help you recognize whether certain behaviors are the result of normal picking, or if they may signify something more serious.
For example, occasional picking is rarely problematic. Scabs often itch while the skin heals, leading many people to scratch at their skin. And despite advice to the contrary, many people pick at pimples and blackheads, too.
People with skin-picking disorder, however, may pick at scabs, bumps, pimples, or other skin lesions until they bleed again or become inflamed. They may also pick at the skin around their fingernails and toenails.
Sometimes, people with the disorder let the picked areas heal only to pick them again. Its a cycle of habit and impulse that can be challenging to overcome.
Other signs and symptoms of skin-picking disorder include:
Manage Stress Andpractice Mindfulness
Reducing stress is a crucial component of healing.Toward that end, Dr. Darling suggests practicing stress management on a dailybasis using techniques such as:
- Guided imagery.
These relaxation techniques,along with a healthy diet, regular exercise and adequate sleep, provide anintegrative approach to the treatment of skin picking disorder.
Those with SPDtypically go into a trance or zone out while picking, she says.In order to overcome the behavior, its important to learn how to staygrounded in the present moment.
Developing awareness through a regular mindfulness-based meditation practice can help you recognize skin-picking urges when they come up. Instead, you can choose to do something different in those moments such as going for a walk.
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What Causes The Condition
There arent any confirmed causes of dermatillomania, but experts suspect a few different factors might play a role, including:
- Genetics. People with dermatillomania are much more likely to have at least one first-degree family member who also has this condition.
- Changes in brain structure. People with dermatillomania are more likely to have some key differences in the structure of brain areas that control how they learn and form habits.
- Stress, anxiety or other conditions. Dermatillomania might be a coping mechanism for other issues or mental health conditions. It might also be related to boredom or other issues.
Other conditions that happen with dermatillomania
People with dermatillomania are more likely to have other mental health or medical conditions. Some of these include:
- OCD or other OCD-related disorders like hair-pulling or nail-biting .
- Depression.
Dermatillomania isnt contagious and cant spread from person to person.
It Started Innocently Enough
I had relatively good skin as a teenager. And while I almost subconsciously destroyed any pimples that did turn up, there were so few that no one really noticed, and neither did I.
During college, though, my streak of good skin ended when I started a new hormonal birth control pill. For months, it seemed there were more bumps on my face than there were smooth surfaces.
These werent just whiteheads, either. They were deep, painful, sometimes throbbing cysts that bothered me constantly and took months to coax down.
Id end up squeezing until the pus had long gone and my face was a bloody mess.
I knew that I made the situation worse by picking at my face and exposing my skin to infection. But somehow my brain made me think that if I could just get everything out of these cystic bumps, it would just smooth out.
It always started out innocently. I would peer into the mirror before putting on makeup in the morning or before getting ready for bed at night.
I would softly touch then push then squeeze just a little! But it always got the best of me. Id end up squeezing until the pus had long gone and my face was a bloody mess.
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Treatment For Excoriation Disorder
Success in treating skin picking depends largely on the teens desire to change and readiness to make a commitment to work on the problem. If a kid comes in kicking and screaming, saying, Im fine. My parents just dont like it that I bite my nails or I bite my cuticles, Dr. Bubrick says, then treatment is going to be tough. But if a kid is coming in and saying, Its really causing me so much distress, I cant wear short sleeves or I cant wear shorts because of my scars or my fingers are bleeding all the time, or I feel self-conscious on a date because my fingers are down to a nub. Then treatments easier.
Insight, motivation and readiness for change are key variables clinicians look for when starting to treat the disorder. Treatment can consist of a number of different approaches, or combinations of approaches:
Dr Bubrick says that treatment for excoriation can be tricky, but if the child is truly committed to changing their behavior, the dysfunctional coping can be overcome. Typically, they come in ashamed and embarrassed about the picking, he says, but the ones who engage the treatment and follow recommendations, even if they think it wont work in the beginning, tend to do really well over time.
Origins Drink Up Intensive Overnight Mask
When I was on Accutane and my skin was utterly parched, this mask not only gave me much-needed hydration, but it also stopped me from picking at my blemishes and flaky skin. Its definitely a bit thick and sticky, so Id recommend keeping it away from your hairline, but its the perfect mask to leave on long term while youre working from home, watching TV, or before bed. The hyaluronic acid and avocado butter will help nourish your skin to heal scabs, and the thick texture will deter you from touching your face for as long as its on.
Promising review: I used this product because my skin gets very dry with all the acne medication Im on and I needed something that works for sensitive skin. This is a great product, I leave it on overnight and my skin is so moisturized in the morning! Definitely worth the price and I would repurchase. Courtney A.
Best for: an at-home deterrent to touching your face thatll also hydrate skin and help heal wounds.
You can buy the Origins Drink Up Intensive Overnight Mask from Amazon for around $33.
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I Didn’t Know That I Was A Member Of A Tribe Of Perfectionistic Body
I just knew I was sick of the distracting shame when I shook hands with someone, and the worry that took hold when I wore light-colored clothing. It also wasn’t merely an aesthetic issue, though my hands always balled up, hiding my fingers, when I saw any sign of a camera. I had been sick with a year’s worth of nuisance colds, and I needed to stop picking up germs off the subway pole and putting them in my mouth. My habit could not be part of my new life.
I won’t pretend that kicking this habit was the hardest thing I’ve ever done. But it took and takes a different kind of resolve than what I was familiar with.
Most of the big decisions I made before then were motivated by a feeling of crisis. Performing anything from a high-school book report to the interview for my big-time job felt like grabbing a parachute in a burning airplane. Throwing myself with all my energy into the unknown wasn’t nearly as terrifying as a future in the lowest-middle class household I grew up in, with a job like that of my parents: working all night doing boring, difficult work to pay only the most threatening past-due bills.
That year, however, I was in a novel and bizarre situation: Things were pretty good. There was no crisis. I’d landed a job at the best company in my field, my life was full of rewarding relationships, and I could pay my bills. My basic needs were being met, so I could focus on making changes that would make me feel good. It felt like a luxurious departure.