Research shows that many people pick at their skin from time to time. However, when this becomes a habit – occurring for various reasons including boredom, anxiety or stress – it can be considered a mental health condition, known as ‘dermatillomania’ or ‘excoriation disorder’.
What is skin picking?
This condition is characterised by compulsive picking or scratching of the skin and falls under the umbrella of obsessive-compulsive disorders (OCDs) but differs significantly from OCD in several aspects, according to an article published by Cleveland Clinic.
Unlike OCD, dermatillomania lacks obsessions and often provides a sense of relief or reward during picking episodes. Moreover, it frequently involves self-damage (when you pick at skin enough to cause wounds and scarring), which is uncommon in OCD.
Who is more likely to develop the condition?
According to a study published by the United States National Library of Medicine, females are slightly more likely to develop the condition, however, males are not far behind, with the ratio standing at 1.2 female:male.
An article published by the International OCD Foundation states that skin picking disorder may affect as many as 1 in 20 people, occurs in both men and women, and can begin in childhood or adulthood.
Skin picking and your body
An individual with dermatillomania picks at their skin compulsively. For some, the picking is automatic movement and they may not even be aware they’re doing it. Others may be fully aware that they’re picking, but can’t stop themselves. These two modes of picking are classified as ‘automatic’ and ‘focused’ picking.
Oftentimes, skin picking occurs in areas of the skin that are dry, rough, or present with a blemish or irregularity. This includes pimples, scabs, cuts, or scratches.
Chronic skin pickers run the risk of creating new wounds or reopening old ones, which can often lead to bleeding, scarring and even infections.
In cases where the condition is severe, damage to the skin can be so extensive that surgery such as skin grafting may be required. Additionally, the issue of infection often presents itself with open wounds, and so antibiotic treatment would be required.
According to the article published by Cleveland Clinic, infections from these wounds can sometimes spread throughout the body, leading to an overwhelming immune system overreaction called sepsis, which is a life-threatening medical emergency.
Symptoms of skin picking
The symptoms of skin picking can vary from person to person but typically include:
Repetitive picking: Engaging in frequent or repetitive picking at one’s skin.
Urges to pick: Feeling strong urges or impulses to pick at the skin, often difficult to resist.
Preoccupation with skin imperfections: Constantly scanning the skin for perceived imperfections, such as blemishes, bumps, or irregularities.
Damage to the skin: Causing damage to the skin through picking, resulting in lesions, scabs, sores, or bleeding.
Compulsive behaviour: Feeling a sense of relief or gratification when picking, followed by guilt, shame, or regret afterward.
Common areas for skin picking include the face, scalp, neck, arms, hands, forearms, thighs, calves, feet, and toes.
4 tips to break the habit
An article published by Harvard Health shares four tips on breaking the habit of skin picking:
Identify your triggers
Recognise the factors that may prompt you to pick at your skin, whether it’s boredom, itchiness, negative emotions, the presence of blemishes, or the tactile sensation of your skin.
Understanding these triggers can guide you in determining the appropriate treatments. For instance, if your skin picking is related to a specific dermatological issue like acne or itching, consulting a dermatologist might be the initial step.
Alternatively, if your picking stems from psychological factors such as depression or anxiety, seeking assistance from a mental health professional specialising in skin picking may be more beneficial.
Boundaries against picking
Employing techniques of stimulus control can help minimise skin picking by modifying your surroundings to make picking more challenging.
Tactics like maintaining short nails, wearing gloves during peak picking times, or wearing clothing that restricts access to the skin can be effective. Additionally, keeping your hands occupied with items like stress balls, fidgets, or tangle toys can serve as distractions. Ensure you have these items readily available in various settings such as work, home, and your bag to provide consistent support.
Try CBT
Consider cognitive-behavioural therapy (CBT), a structured form of psychotherapy designed to address maladaptive behaviours and thoughts. A specialised form of CBT tailored for skin picking disorder (SPD) integrates techniques like stimulus control and habit reversal training. In habit reversal training, individuals learn to substitute picking with a harmless motor behaviour when triggered.
Chat with your doctor
Although no medications are available for specifically treating excoriation disorder, some evidence suggests that selective serotonin reuptake inhibitor (SSRI) antidepressants and N-acetylcysteine (NAC), an antioxidant supplement, may offer benefits.
However, it’s essential to approach medication discussions with healthcare professionals who can guide dosage, treatment duration, potential interactions, and side effects, even for over-the-counter supplements like NAC.
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