Dermatillomania

What is Dermatillomania?

Compulsive skin picking is a relatively common mental health issue which can cause significant physical and psychological anguish for those afflicted by it.

Aside from the risk of scarring the skin or developing infections, dermatillomania can lead to significant anxiety, depression, stress and even suicide. Luckily, there are several treatment methods that can help people to overcome the condition.

Overview of dermatillomania

Dermatillomania, also known as skin picking disorder (SPD) or excoriation disorder is a Body-Focused Repetitive Behavior (BFRB) which causes individuals to compulsively pick at their own skin. Often, sufferers will cause significant damage to the skin all over their body which, in some cases, can result in lasting scars. The condition also poses the risk of infection and septicemia, abscesses, and even back and neck pain caused by being positioned in bent-over positions to pick at certain areas of the body.

It is thought that dermatillomania is often linked with other mental illnesses, and serves as a method for individuals suffering from emotional turmoil, stress, anxiety or fear. For some, it may serve as a coping mechanism for conditions such as major depression and generalized anxiety disorder. However, for some, the compulsion to pick at the skin comes simply out of boredom, or because it feels pleasurable to do so.

In certain instances, dermatillomania occurs as a result of the desire to remove imperfections from the skin. For example, someone who sufferers from acne may be compelled to pick at the pimples on their face in an attempt to remove them. However, it is when the picking becomes so severe that it begins to have an impact on an individual’s quality of life that it should be treated.

Many individuals who suffer from dermatillomania find the condition causes their mental well-being to further suffer. They may feel embarrassed, guilty or ashamed of the issue and of the marks it leaves on their body, and have a sense of helplessness for having a habit which is difficult to break. They may pick their skin to find relief from their anxiety, stress or low mood, and subsequently feel worse due to the effects of the picking. In this respect, dermatillomania causes a vicious cycle of negative thoughts and behaviours which can make it very difficult to overcome.

Dermatillomania is often closely compared to trichotillomania, a condition which causes individuals to compulsively pull out their own hair. Although it is most common for individuals to target the hair on their head, many trichotillomania sufferers will also pull out eyelashes and eyebrow hairs, and hair elsewhere on the body.

Symptoms of Dermatillomania

Many people are guilty of picking at their skin from time to time, perhaps to remove blemishes or to occupy their mind when feeling bored or stressed. However, when it comes to dermatillomania, the picking becomes compulsive and frequent, and episodes are usually triggered or accompanied by anxiety, stress or tension.

Individuals with dermatillomania will often stroke, squeeze, scratch, rub or even simply repetitively touch their skin, often without even realizing. Usually, people pick or dig at their skin using their fingernails, but sometimes tweezers are used instead.

The face is a common area that is picked, but individuals may also pick at their hands, fingers, fingernails and cuticles, the arms, legs, neck, back and shoulders, and even on the scalp, abdomen or chest. Usually, individuals have one particular area of the body that they may focus on, and will only move to another area to allow the first to heal adequately enough before picking can begin again.

If picking occurs on an area of the body which is not typically visible to other people, it can be hard to notice when a loved one is suffering from dermatillomania. However, it may be possible to notice them rubbing or poking a particular area or reaching underneath clothes to pick at skin during times that are particularly stressful.

The physical effects of dermatillomania include:

  • Open wounds and sores
  • Scabs on the skin
  • Darkened areas of skin and scars
  • Infection, showing itself as localized redness and skin that feels hot to the touch around a wound

There are also many psychological symptoms, including:

11.5% of individuals with dermatillomania attempt suicide, which demonstrates just how damaging the condition can be for mental health.

Dermatillomania Causes

Dermatillomania has been linked to various other mental health conditions. Body dysmorphic disorder (BBD), which causes people to see themselves much differently, and usually far more negatively, than others, is strongly associated with dermatillomania. Due to the sufferer’s preoccupation with a certain part of their body, they may find themselves picking at the skin compulsively in order to address perceived imperfections.

Depression and anxiety are also common causes of dermatillomania, with the picking behavior used as a form of self-harm, or as a distraction from or outlet for negative emotions. Some also believe dermatillomania to be a facet of obsessive compulsive disorder (OCD), which causes individuals to develop obsessive and compulsive thoughts or behaviors.

However, according to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), dermatillomania, officially known as excoriation disorder since 2015, is a condition in its own right with defined clinical features. This means that it can occur as a primary disorder, without having necessarily been caused by any other condition.

Researchers have found that dermatillomania is more common in individuals who have a family history of the condition, or of OCD. However, it is not completely clear if it is simply genetics at play, or if it could be a learned behavior that could be passed from one family member to another.

It’s important to note that there are many medical conditions which can cause skin picking, but in these instances, a diagnosis of dermatillomania is not necessary since the cause of the picking is clearly the primary condition. For an individual to be diagnosed with dermatillomania, they must not be suffering from a medical condition that can cause skin picking.

Some common examples of such conditions include:

  • Eczema
  • Psoriasis
  • Diabetes
  • Liver disease
  • Hodgkin’s disease
  • Systemic lupus

Skin picking is a common habit of individuals who use cocaine and methamphetamine. Both of these drugs are dopamine agents, and tend to cause a sensation of something crawling under the skin, which is what leads to uncontrollable picking. This doesn’t mean to say that dermatillomania is caused by the use of these drugs, since in these instances the skin picking is deemed a side effect of the drugs while they remain in the body and doesn’t develop into a compulsive, long-term habit.

However, it does offer some interesting insights into one theory about the causes of dermatillomania. Since there is clearly a link between dopamine and skin picking, some experts believe that those with dermatillomania have some kind of dysfunction in the dopamine reward system and it is this which causes the compulsion to pick.

Treatments for Dermatillomania

There is no definitive cure for dermatillamania, but there are two main treatment methods that can help sufferers to gradually stop the harmful behavior.

Medication

Firstly, some doctors may prescribe medication to treat the compulsive skin picking. The type of medications provided will depend on the underlying mental health conditions that an individual has shown signs of, or the mental health issues which have occurred as a result of the dermatillamania.

Selective Serotonin Reuptake Inhibitors

SSRIs (selective serotonin reuptake inhibitors) have proven to be very effective in treating depression and OCD. Although they have not been studied widely enough as a treatment for dermatillomania, anecdotal evidence suggests that they can also be effective in alleviating skin picking compulsions. If an individual reports that skin picking tends to be triggered by anxiety, medications such as benzodiazepines may be used to help relieve anxiety.

Although medications can be useful for dermatillomania, for many sufferers it is vital that they seek treatment which helps them to actually change their behavior and find healthy alternatives to skin picking.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT), which is based on the theory that our thoughts, emotions and behaviors are all intertwined, can help individuals to recognize the thoughts and feelings that influence the skin picking behavior. CBT aims to help people find rational responses to distressing thoughts and feelings, and they can then use this knowledge to adopt more positive thought processes to help break the habit of skin picking.

Acceptance Commitment Therapy

Acceptance commitment therapy (ACT), is another behavioral treatment which aims to help patients accept certain thoughts and find methods for defusing them. It encourages individuals to become more mindful of their thoughts and feelings and, rather than being defeated or overwhelmed by them, to learn how to accept and deal with them in a healthy way.

Habit Reversal Training

Perhaps the most successful behavioral treatment for dermatillamania is Habit Reversal Training (HRT). This type of therapy firstly helps individuals to learn when and why the skin picking compulsion tends to take hold, in order that they can begin to recognize circumstances which are likely to be problematic.

The individuals will then learn to substitute the skin picking with another behavior which does not cause themselves harm. This could be clenching their fists together, sitting on their hands, or finding something to fidget with that will keep their hands occupied. They can do this behavior whenever they feel the urge to pick and whenever they come up against a situation in which they would usually feel compelled to pick.

Dermatillomania Prevention

Individuals who suffer from dermatillomania may be able to adopt certain habits or take preventative measures to minimize the damage they do to their skin and reduce the frequency or severity of picking episodes. The following tips may be particularly helpful.

Wear gloves

Those who tend to pick at their skin without realizing may benefit from wearing gloves as much as possible. Not only will the gloves prevent the fingernails from doing excessive damage to the skin, but the sensation of fabric against the skin serves as a signal that picking was attempted, which provides an opportunity to explore the thoughts, feelings and circumstances at hand to learn when picking tends to occur.

Adopt a new skincare regime

Applying nourishing lotions or creams not only helps damaged skin to recover, but it also works to replace a negative behavior with a positive one. The process of applying lotions might help to soothe anxiety in a similar way to picking, and by using a cream which takes some time to settle into the skin, individuals will be reminded not to pick once they find their fingers touching tacky or oily skin.

Set a time limit for picking

For those who tend to have picking episodes at certain times of the day, for example when they visit the bathroom, or when sat watching television, it can be helpful to set a time limit for each episode. This means that they don’t have to try to quit picking completely and right away, which could exacerbate feelings of anxiety or stress, but they can minimize the damage done in each session. Setting a timer can provide an audio cue to help snap out of the destructive behavior.

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Last Reviewed:
September 23, 2017
Last Updated:
December 13, 2017
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