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Dermatillomania

It sounds horrible, doesn’t it? Dermatillomania. Try saying that five times fast!
There’s a simpler way of saying it – it’s also known as CSP, or compulsive skin picking. Basically, it’s an impulse control disorder in which the sufferer feels compelled to constantly pick at their own skin. Depending on the severity of the disorder, the damage can be significant.

What Causes Dermatillomania?

If you’re reading this, it may be because in addition to biting your nails (onychophagia), you’re also picking at your skin. The cause isn’t really known, but it’s believed that dermatillomania may be connected to OCD (obsessive-compulsive disorder) and BDD (body dysmorphic disorder).
With dermatillomania, the sufferer constantly squeezes or picks at skin lesions or pimples, and may also do the same with otherwise healthy skin, to the point of causing bleeding, infection, bruising, and even permanent skin damage. It’s a way of relieving anxiety, and that’s why it’s connected with OCD and BDD. It also often goes hand in hand with trichotillomania, which is a disorder in which the sufferer feels compelled to pull out their hair. In fact, about 25% of people who are diagnosed with BDD or OCD also have CSP.

What Are the Symptoms?

Usually, people with CSP pick at their face, but other areas of the body can also be targeted. A CSP sufferer might pick at moles, freckles, acne, or other skin discolorations, or even at perfectly normal skin. Basically, they see defects that no one else does. People with CSP might use their fingernails or teeth, or even pins and tweezers to attack real or perceived skin defects. For reasons that aren’t really known, the problem is often worst in the evening.
People with CSP usually try to hide the effects of their compulsion, in much the same way as other self-mutilators do – by wearing long sleeved clothing and scarves, avoiding wearing shorts or other revealing clothing, or wearing makeup in an effort to hide the damage. Sometimes, the problem is so severe that sufferers simply stay indoors, avoiding going to work or interacting with family and friends. Even when they do go to work or spend time with other people, they may spend a lot of time going to the bathroom to find a private area where they can pick at themselves unobserved. It’s distressing not just for the sufferer, but for the people who care about him or her.

How Is Dermatillomania Treated?

Usually, treatment isn’t even sought until the problem becomes so severe that recurrent picking on the face, scalp, hands, arms, lips or other visible areas becomes noticeable. Then the sufferer’s loved ones insist on treatment. Alternatively, the sufferer actually begins to realize that every time he or she is feeling stressed, there’s an overwhelming urge to scratch or pick, and he or she seeks treatment. Most of the time, the disorder is developed in the teens or early 20s, and it might just seem like an unconscious habit until it becomes uncontrollable.

Unfortunately, when it comes to treatment, most general practitioners are uninformed about the disorder. A lot of the time, a patient ends up being referred to a dermatologist. That’s fine as far as it goes – the dermatologist can recommend treatments that will repair some of the damage. But in the final analysis, most sufferers are going to need to be treated by a psychiatrist or a psychologist. Then, cognitive behavioral therapy or habit reversal training is the best method of treatment. The sufferer learns how to identify events and situations that could lead to picking, and also learns how to use other techniques to respond to the triggers. Frequently, this involves keeping a journal that helps the sufferer to identify the times, places, and circumstances that are most likely to trigger the behavior.

Another method of treatment is to help the sufferer replace the picking with another habit. It’s similar to treating nail biting – the bad behavior is replaced with something other that can be done with the hands. Perhaps the patient will take up a hobby like knitting or woodworking. Even playing solitaire can help. Ordinary household tasks like folding laundry or washing dishes can replace the picking. Essentially, the patient says to himself or herself, “I will not pick with my hands. I will use my hands to do something else.” It requires a commitment, and usually at least a year of therapy, but the disorder can be overcome.

Ways to Stop Picking

If you’re picking at yourself and you want to stop, first do what we just suggested – find something else to do with your hands. If you don’t feel that you can do that, then try the following:

-Cover your hands with gloves or oven mitts. Try to keep them on until the urge passes.

-Cover your mirror – if you feel that you look less than perfect, then don’t look at yourself. It’s your perceived imperfection that’s making you pick, so just stop looking.

-Keep your skin clean. The better your skin looks, the less likely you are to pick.

-If your CSP manifests as biting, try having a snack or chewing some gum when you feel the urge to start biting.

-Use false nails. This works for nail biters, and it can work for CSP sufferers as well. Picking when you’re wearing false nails is less enjoyable – you’re not getting the sensation. Also, false nails are thick and unwieldy, so they make it more difficult to pick.

-Apply hand lotion. You’re doing something else with your hands, and also it’s harder to pick when your hands are lubed up.

-Throw away your toys – get rid of your pins, tweezers, and anything else that you’ve been using for picking.

-Use a stress ball or something else that you can hold in your hand that will provide sensory stimulation while keeping your hands busy.

Once you’ve started picking, it’s not easy to stop, but it’s not insurmountable. Understand why you’re doing it, find ways to discourage yourself from doing it, and get help. You can beat this.

 

"Quitting nail biting was a very rewarding experience for me. I gained confidence and lowered my stress levels. I learned that I have the power to change my habits and with that I have the power to accomplish anything. You can too."

Travis Grubesky