Skin Picking Disorder (Excoriation)
What Is Skin Picking Disorder?
Skin picking disorder (Excoriation Disorder) involves picking at one's skin repeatedly and often results in wounds and scarring.
Most people generally tend to pick at scabs and pimples. But those with this disorder will not only pick at scabs and pimples, they will also pick at healthy skin.
The most common areas that people pick are the face, hands, and arms.
What Are the Signs of Skin Picking Disorder?
Skin picking may range from mild to severe. A certain amount of skin picking is normal, so it's important to know the signs and symptoms. People with skin picking disorder can spend an hour or more per day picking at their skin.
Do you repeatedly pick at scabs, pimples, calluses, and previously picked areas despite attempts stop?
Do you bleed and have scars from skin picking?
Does picking at your skin interfere with meeting your social or professional obligations?
Do you avoid situations where others may notice the scars?
Do you wear clothing that covers the areas of skin picking?
Do you feel shame, embarrassment, and a loss of control with picking your skin?
How Does Skin Picking Disorder Develop?
Skin picking disorder often develops in adolescence right around the time of puberty.
It may start because of skin conditions such as acne and then progresses to other areas.
Skin picking can affect a person at any age and the frequency of skin picking can fluctuate over time. Skin picking can decrease and increase depending on the level of stress. It can disappear for a range of weeks to a year and then come back.
What Causes Skin Picking?
Skin picking disorder is considered an Obsessive-Compulsive related disorder. It is a common It is also more common in people diagnosed with OCD and is a compulsion that often reduces anxiety or stress. It is also genetically linked so that there could be a parent who has symptoms of OCD.
Skin picking often follows intense emotions, stress, anxiety, or even being bored. There may be a feeling of relief from anxiety and stress following the skin picking.
What Are the Consequences of Skin Picking?
Skin picking disorder can interfere with social and occupational obligations. This happens as the individual spends more time picking their skin and then is late or absent from these obligations.
People will also avoid social situations due to fear of embarrassment. This avoidance can then interfere with interpersonal relationships and maintaining helpful social support.
Chronic skin picking can result in skin damage, scarring, and in some cases infections that can be life threatening.
What Is the Treatment for Skin Picking?
A combination of medication and therapy can be highly effective at treating this disorder.
Medications such as antidepressants, anticonvulsants such as Lamictal (lamotrigine), and antipsychotic medications such as Risperidone (risperdal) can be helpful.
Cognitive Behavioral Therapy (CBT) is often very effective at treating OCD and skin picking disorder. CBT helps individuals identify the triggers and associated thoughts and feelings connected with skin picking.
More helpful thoughts and behaviors are replaced to reduce anxiety and shift the individual away from skin picking.
A person can engage in Habit Reversal which aims at using another behavior such as using stress balls or anything else to keep the hands busy.
Gloves, bandages, hiding mirrors, and other changes in a person's environment can be used to minimize skin picking. This is known as Stimulus Control.
Other helpful alternatives include:
Drawing, coloring, or painting
Skin picking disorder is classified as an obsessive compulsive related disorder and is referred to as Excoriation Disorder by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DMS-5).
It involves repeated picking at scabs, calluses, and healthy skin that causes bleeding and scarring.
Without treatment this disorder can interfere with social, educational, and occupation obligations.
Successful treatment involves a combination of medication and therapy such as cognitive behavior therapy.
Many people do overcome this disorder and learn how to cope with stress and anxiety more effectively.