Skin Picking Disorder
What is Skin Picking Disorder?
Skin picking disorder, also known as excoriation disorder or dermatillomania, is a psychological condition characterized by recurrent picking at one’s own skin, leading to tissue damage and significant distress or impairment in daily functioning. While it may seem like a simple habit, skin-picking disorder is a complex and serious condition that can have profound effects on an individual’s physical and mental health.
The diagnostic criteria for skin-picking disorder require that picking be recurrent and result in skin lesions, thereby reflecting the frequency and intensity of the picking. In addition, the clinical diagnosis requires that the picking results in the person feeling distressed or impaired.
Symptoms of SPD
The primary symptom of skin-picking disorder is the repetitive picking of one’s own skin, often resulting in tissue damage, scarring, and infection. Common areas for picking include the face, arms, legs, and hands, but any part of the body can be affected. Other symptoms may include:
- Preoccupation with skin imperfections
- Feeling a sense of relief or gratification after picking
- Attempts to conceal or cover up picking behaviors
- Difficulty stopping or controlling the urge to pick
- Shame, guilt, or embarrassment about the picking behavior
What causes this disorder?
The exact cause of skin picking disorder is not fully understood, but it is believed to be a combination of genetic, biological, environmental, and psychological factors. It’s sometimes called a body-focused repetitive behaviour and is similar to repetitive hair pulling disorder (trichotillomania), and can be related to obsessive compulsive disorder (OCD) or body dysmorphia. Some individuals may have a genetic predisposition to the disorder, while others may develop it as a coping mechanism for traumatic stress, anxiety, or boredom. Certain neurotransmitters in the brain, such as serotonin and dopamine, may also play a role in developing skin-picking behaviors.
Prevalence
Skin-picking disorders are present in around 2% of the world’s population and appear in both men and women at roughly the same rates.
Treatment
Treatment for skin picking disorder typically involves a combination of therapy, medication, and self-help strategies. Cognitive-behavioral therapy (CBT) has been shown to be effective in helping individuals identify and challenge the thoughts and behaviors that contribute to skin picking. Techniques such as habit reversal training and mindfulness-based interventions can also be helpful in reducing picking behaviors.
In some cases, medication may be prescribed to address underlying mental health conditions such as anxiety or depression that may be contributing to skin picking. Selective serotonin reuptake inhibitors (SSRIs) and other antidepressants are commonly used to help manage symptoms.
Self-help strategies such as keeping a skin-picking diary, finding alternative activities to occupy the hands, and practicing stress-reduction techniques can also be beneficial in managing the urge to pick. Below are the common self-help strategies used to manage skin-picking disorders.
Do:
- keep your hands busy – try squeezing a soft ball or putting on gloves
- identify when and where you most commonly pick your skin and try to avoid these triggers
- try to resist for longer and longer each time you feel the urge to pick
- Care for your skin when you get the urge to pick it – for example, by applying moisturizer
- Tell other people – they can help you recognize when you’re picking
- keep your skin clean to avoid infection
Don’t:
- do not let your nails grow long – keep them trimmed
- do not keep things like tweezers and pins where you can easily get at them
Relation to Dissociation
Although the medical community largely ignores it due to the overlap in treatment options, skin picking in recent studies has been tied to dissociation. Around 70% of people with chronic skin picking reported disassociation shortly before, during, or after skin picking. Almost 50% reported feeling like they were on “autopilot,” and around one-third reported feelings of alterations in time perception.
Skin picking is often found in those who have had traumatic events, and the skin picking itself is considered a maladaptive coping mechanism for those with prior trauma.
Personal Experience with Skin Picking Disorder
There are a few reasons that we pick our skin. When we were a teen, our mother was obsessed with our appearance, skin included, and I was subjected to many dermatology appointments to help with any acne that appeared as a teen. It caused me to obsess over my blemishes, and habitually pick at them, and afterwards, make sure they were covered with heavy makeup, causing even further blemishes.
Part of it is self-flagellation related, the fact that we feel that we deserve the pain and disfigurement, a type of penance for being weak in the face of my trauma, as if we don’t’ deserve a beautiful face or body.
Another reason, is anxiety. We have noticed that in addition to skin picking, we chew our lips, tongue, and inner cheek if we are anxious or nervous at a higher rate. It seems to calm us to do these things.
As an adult, the acne has lessened, but the need to touch and pick at any bumps or imperfections is there. We will stare in the mirror for hours and pop any pimple or unearth any blackhead we find, leading to scarring and pitted skin. We can’t stop. We don’t even know we are doing it, often. We dissociate heavily during, and feel a deep sense of depersonalization when we are picking, as if it isn’t a human body or face we are touching.
In the past, having long, thick acrylic nails physically prevented us from picking at the blemishes, the rounded, thick edges of the nails unable to do more than glide over the skin. However, up-keeping acrylic nails can be difficult to add to a hygiene ritual, as well as expensive, and this method can’t be done consistently.
We are hoping that researching and writing this article will help us implement some of the professional advice we have researched, and we look forward to testing the self-help treatment options at our disposal. — EJK
Sources:
Website, N. (2022, March 29). Skin picking disorder. (National Health Services, UK) nhs.uk. https://www.nhs.uk/mental-health/conditions/skin-picking-disorder/
Grant, J. E., & Chamberlain, S. R. (2021, October 1). Trichotillomania and Skin-Picking Disorder: An Update. Focus. https://doi.org/10.1176/appi.focus.20210013 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9063575/
Kłosowska, J., Antosz-Rekucka, R., Kałużna-Wielobób, A., & Prochwicz, K. (2021, July 19). Dissociative Experiences Mediate the Relationship Between Traumatic Life Events and Types of Skin Picking. Findings From Non-clinical Sample. Frontiers in Psychiatry. https://doi.org/10.3389/fpsyt.2021.698543 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8326802/
Spitzer, C., Lübke, L., Müller, S., Conrad, R., & Gallinat, C. (2023, March 1). State and trait dissociation in pathological skin picking. European Journal of Trauma & Dissociation. https://doi.org/10.1016/j.ejtd.2023.100317 https://www.sciencedirect.com/science/article/abs/pii/S2468749923000066