Skin Picking Disorder: What is it?

We have often found ourselves absent-mindedly picking at the skin around our nails or picking at scabs on our hands or legs. But like everything else, Skin Picking Disorder becomes the predominant thing on your mind and you do it repeatedly enough to cause damage to your skin or to let it interfere with your daily functioning.

What exactly is the Skin Picking Disorder?

Also known as Excoriation Disorder or Dermatillomania (Derma – skin, till – pull, mania – madness), skin picking is a disorder which involves an individual repeatedly picking their own skin, so much that the skin may even bleed, form sores and scars, and that causes a significant disruption in the individual’s general lifestyle.

This behavior is grouped as a Body-Focused Repetitive Behaviours (BFRBs) because people tend to pull, rub, scratch, or dig into their skin and sometimes do it to remove perceived imperfections from their skin and to ‘groom’ themselves which causes more tissue damage, discoloration, and scarring.

In the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), skin picking is classified as an ‘obsessive-compulsive and related disorder’ because of the compulsive urge to perform this repetitive behavior of skin picking.

OCD symptoms- How to identify Skin picking disorder?

These are some of the signs and ocd symptoms that can help you identify skin picking disorder:

• Repeating picking of unhealthy (scabs, scars, wounds) or even perfectly healthy skin
• Clear skin damage – Cuts, bleeding, sores, scars, or infections in affected skin areas which can lead to the need for medical treatment.
• Urge to remove imperfections – Some people feel the need to remove imperfect skin which often stems from a need to maintain a good body image to others or to themselves.
• Spending unusual amounts of time in picking different areas of skin so much that it interferes with work or social relationships that you prioritize this over important things in life.
• Increase in skin picking especially during anxiety, nervousness, or stress
• Causes significant stress
• Feeling ashamed and embarrassed of your skin because of all the damage so much that you avoid going to public events where you have to expose the skin to people such as swimming, at the gym, or at the beach.

How can it develop/ what causes ocd?

Skin picking can develop after occasional picking at a rash or skin injury which causes more injury to the skin in turn and eventually becomes a cycle. It can also develop out of stressful situations as absent-minded nervous skin picking which then becomes a habit.

Skin picking disorder effects

Apart from what is already discussed, it is important to look at things from the point of view of the person with the disorder and understand just how much this condition can impact a person’s life. Skin picking can cause so much pain and isolation in an individual where they feel so emotionally distressed about the behavior and the inability to stop even though it might hardly be in their control. It can lead them to go to great lengths to hide the concerned areas of the skin which also adds to the amount of time they spend focusing on their skin apart from picking itself that time management becomes really difficult for them.

Because there’s a whirlwind of preoccupation and emotions involved in this, this can also cause strained relationships with family and friends as they start avoiding talking about it or stop enjoying any quality time with loved ones. Because of this, it might be important for carers to get professional help to cope with this problem as well.

How to cope with it: obsessive compulsive disorder treatment for Skin Picking Disorder

Skin picking disorder cannot be self-diagnosed. If you identify signs, it is best to see a doctor who will rule out any other underlying causes such as medical conditions or other mental health disorders that commonly occur with skin picking disorder and treat the larger issue first. Once the doctor has diagnosed skin picking disorder, there are two most important types of treatment you can take:

Medication – Antidepressants (SSRIs) are generally prescribed for obsessive-compulsive related disorders and help in reducing the obsessive thoughts and urges and the compulsive need to pick the skin.

Psychotherapy – Because skin picking can get so emotionally distressing, it is important to talk to someone who will understand the thoughts and feelings you express and help you identify what is causing this urge to pick at skin even though you know it is harmful to you. Cognitive-Behavioral Therapy will help you address thoughts arising from low self-esteem, any body image issues, thoughts and feelings arising from stressors that makes you indulge in this behavior and then actively help you train yourself in two ways:

• Habit Reversal Training where the therapist will help you keep a track of and identify what situations trigger these urges and feelings for you and directly address those situations. In this, the therapist will also help you replace skin picking with less harmful behaviors like squeezing a rubber ball, painting, keeping a fidget spinner, solving a Rubik's cube, or basically anything that will keep your mind and hands occupied.
• Stimulus Control where the therapist will help you make your environment such that it automatically helps you avoid picking your skin and doesn’t give you many chances to do it. So, you might be asked to wear rubber gloves or band-aids or keep moisturizers with you at all times. If looking at yourself in the mirror triggers these feelings then you might be asked to reduce the number of mirrors around you or cover them.

Additionally, if you think you have this disorder, make sure to go to a dermatologist who can help you treat the injuries on your skin and find support groups in your area which might be difficult in India but you may find online forums where you can find a support group for similar issues and work to deal with this problem along with them.

Skin picking can be a difficult condition to deal with so it is most important to remember to be supportive of yourself while you learn to identify and cope with the problem because it can be a slow process at first but every small goal you achieve is a step towards healing that you must be proud of and slowly watch the condition become less and less distressing.

Most importantly, start sharing your feelings and worries with people you trust around you and let the emotions out instead of letting it manifest into skin picking behavior.

Remember that it is not only okay but good to ask for emotional support. Contact at Cadabam’s Hospitals or call us at 97414 76476