Compulsive Skin Picking
Dermatillomania – Compulsive Skin Picking (CSP) involves picking at normal skin variations such as freckles and moles, at actual pre-existing scabs, sores or acne blemishes, or at imagined skin defects that nobody else can observe. Fingernails, teeth, tweezers, pins or other possible mechanical devices are used and as a result, CSP may cause bleeding, bruises, infections, and/or permanent disfigurement of the skin.
Sometimes skin-picking is preceded by a high level of tension and a strong “itch” or “urge”. Likewise, skin-picking may be followed by a feeling of relief or pleasure. A CSP episode may be a conscious response to anxiety or depression, but is frequently done as an unconscious habit.
Psychiatrists classify this as an Impulse Control Disorder. In addition to Dermatillomania and Compulsive Skin Picking, other terms to recognize this disorder are Chronic Skin Picking (CSP), Body-Focused Repetitive Behaviors (BFRBs), Neurotic Excoriation, Superficial Compulsive Self-Mutilation and Pathological Skin Picking (PSP), Obsessive-Compulsive Spectrum Disorder.
The various forms include:
- Skin Picking: Dermatillomania
- Skin Biting: Dermatophagia
- Hair Pulling: Trichotillomania
- Nail Biting: Onychophagia
There is only a limited knowledge regarding the neurobiology that drives Dermatillomania, and there have been no neuroimaging studies of patients with compulsive skin picking.
Studies have shown a linkage between dopamine and the urge to pick. Drugs that are dopamine agonists, which increase the pharmacological effects of dopamine, have been shown to cause uncontrollable picking in users. Dermatillomania could be a result of a dysfunction in the dopamine reward functions.
Psychotherapy: Cognitive-behavior therapy has been studied as a means of treating skin-picking and related disorders. Therapy may involve several different techniques, outlined below:
- Habit Reversal Training (HRT) is a four-step process which teaches the person with how to relax, how to breathe and feel centered, and to perform muscle response exercises. HRT includes self-monitoring and stimulus control and social support.
- Self-Monitoring is simply making the person with CSP more aware of their behaviors. As the behavior can often be unconscious, awareness can be improved by simply keeping a log of picking behaviors. The very act of recording the behavior can also interrupt the process and reduce the picking.
- Stimulus Control (SC) is a behavioral treatment that helps sufferers identify and eliminate, avoid, or change the environmental factors, moods, or circumstances that trigger picking. The goal is to consciously control these triggers to create new learned connections between the urges and alternative, non-destructive behaviors. For example if picking usually occurs while alone, the person will be encouraged to spend more time with others. If the picking occurs in front of the mirror, then the person may be asked to cover the mirrors in their home.
- Competing Response is a technique designed to give the person an alternative to picking. This can include fidget toys, knitting, beading, or other activities to keep the hands busy.
These techniques are all temporary means of helping the person learn to resist the urge to pick. The more the urge is resisted, over time the weaker the urge becomes. Once the urge fades, these techniques become less necessary. The length of time it takes to extinguish the behavior depends on how long the person has had the problem and how diligent they are in resisting the urges. Although therapy typically lasts from 10-12 weeks, it can take up to 12 months for the urge to pick to finally fade away.
Interfering with wound healing is a form of self-harm.