A Personal Note:
It is normal for people to pull, pluck, scratch and dig at their skin. But for some people this behavior becomes excessive and begins to cause scarring, infection, disfigurement and most of all shame and humiliation. For anyone with this problem, the embarrassment and emotional pain can be overwhelming. It may cause them to avoid socializing or becoming intimate. People with this disorder tend to try to hide the effects of their picking and are often extremely sensitive to comments or questions about their hair or skin.
If you or someone you know has this disorder, please know Dermatillomania is not just a bad habit but is a real mental illness.
If you are suffering Dermatillomania, the first thing you must know is that you are not alone. There are thousands (perhaps millions) of people out there who suffer in silence; wearing hats, makeup, long sleeves and pants in the summer to hide what they are doing to themselves because they cannot stop. Although Dermatillomania isn't openly discussed, as sufferers know what they are doing is considered wrong and undesirable, there are professionals who can help, along with support groups, medications, supplements, and therapies, all designed to help you stop.
As a fellow sufferer, please understand that Dermatillomania is not a matter of willpower or “just leaving your skin alone"; it is a real disorder with real treatment options out there.
Please take the time to read the information below. Follow the links if you feel that you need help with one of these disorders.
I am sure that I do not need to tell you that I am not a medical professional and this is simply meant to be informative. Any diagnosis or treatment should be handled by a trained professional.
What is Dermatillomania?
Dermatillomania or Compulsive Skin Picking (CSP) is the urge to rub, pick, scratch, squeeze or dig into the skin, often to remove some perceived irregularity or flaw such as a flake of dry skin or a pimple or scab. The action may be performed with the fingers, nails, tweezers, needles, or any other instrument.
Picking can happen on any part of the body or in a combination of places.
Picking is usually preceded by an intense urge to “fix” the spot.
The urge becomes the focus of attention until relief is found by acting on the urge.
Often the picking happens in a trance-like state and in severe cases, a person can spend several hours a day performing the actions associated with trying to “smooth out” or remove all the problem spots.
Many people do not realize that CSP is a real illness and do not report it or seek treatment.
CSP is now often considered by many professionals as a Body-Focused Repetitive Behavior (BFRB).
Some professionals will classify it as an subtype of Obsessive-Compulsive Disorder because a large percentage of people with OCD also pick their skin.
Many of the emotional and psychological processes resemble those of Trichotillomania (Compulsive Hair Pulling) and you may find the resources for Trichotillomania helpful, as well.
Dermatillomania has a much higher incidence in women than in men.
CSP is not the same as self-injuring or self-harming behaviors (like cutting or burning). Dermatillomania sufferers are not trying to inflict damage upon themselves. Instead, people with CSP are trying to “correct” some imperfection.
“Is skin picking a self-injurious behavior, like cutting or burning yourself?
No. Chronic skin picking can sometimes be confused with self-injurious and self-mutilating behaviors like cutting or burning of the skin because of the appearance of skin wounds and the fact that skin picking is self-inflicted. However, it is very important to distinguish between these two types of behaviors. People with CSP do not wish to cause themselves pain in order to relieve a sense of numbness or to assert a level of control over their bodies like those who cut or burn themselves. While people who pick their skin may find picking to be a pleasurable act, the aftermath is actually one of distress and shame.”
Cause of Dermatillomania:
Until 20 years ago, disorders like CSP and Trichotillomania were considered categories of other psychological disorders. More recent studies have concluded that these are unique disorders with their own causes and symptoms that do not necessarily match up to those of Obsessive- Compulsive or Anxiety Disorders.
No one knows why this becomes a problem for some people but not for others.
Some believe Dermatillomania is a natural “grooming instinct” gone haywire. These people theorize that there is a genetic or biological component.
Others think it is a self-soothing mechanism or emotional outlet because many sufferers report being “zoned out” or in a trance-like state while picking.
Before a diagnosis can be made, a doctor must rule out other physical illnesses which may be causing the urge, such as a skin infection or allergic reaction.
Symptoms of Dermatillomania:
- Inability to resist urges to pick at real or perceived blemishes in one's skin
- For some, mounting tension before one picks
- For some, gratification and relaxation while picking
- Noticeable sores or scarring on the skin
- Increased distress and/or interference with daily life
It is hard to tell when picking crosses into Compulsive Skin Picking, but generally, when the time spent picking or the damage done by the picking begins to affect one's life, it has become a problem. If a person avoids certain activities (like going to the beach or intimacy), calls into work, or misses other events due to picking, or is unable to effectively to hide the picking, it is time to seek help.
As Dermatillomania is under-reported and not well-studied, there is no singular universal treatment.
Some promising treatments for Dermatillomania include:
- Medication: SSRI’s (antidepressants) are often subscribed for those suffering Dermatillomania. Many Dermatillomania sufferers also suffer from anxiety, depression and Obsessive-Compulsive Disorder; antidepressant treatment is almost always explored as an option.
- Natural Remedies: Some Dermatillomania sufferers benefit from the B-vitamin inositol, which seems to reduce the urge to pull or pick. It is broken down by the body into two neurotransmitters that enhance the activity of serotonin in the brain. Serotonin is a brain transmitter that may be implicated in Obsessive-Compulsive Disorder. Inositol must be taken in large quantities, but will not build up to toxic levels because it's a water soluble vitamin.
- Cognitive-behavior therapy has been studied as a means of treating Dermatillomania and related disorders. Therapy may involve several different techniques, outlined below:
- Habit Reversal Training (HRT) is a four-step process that teaches the person with Dermatillomania how to relax, how to breathe and feel centered, and to perform muscle response exercises. HRT includes self-monitoring and stimulus control (described below), and social support.
- Self-Monitoring is making the person suffering Dermatillomania more aware of their behaviors. Dermatillomania behavior can often be unconscious; awareness can be improved by starting a log of picking behaviors. The very act of recording the behavior can also interrupt the process and reduce the picking.
- Stimulus Control (SC) is a behavioral treatment that helps Dermatillomania sufferers identify and eliminate, avoid, or change the environmental factors, moods, or circumstances that trigger picking. The goal is to consciously control these triggers and create new connections between the urges and non-destructive behaviors. For example, if Dermatillomania happens alone, the person is encouraged to spend more time with others. If the picking occurs in front of a mirror, the person may be asked to cover the mirrors in their home.
- Competing Response is a technique designed to give the person an alternative to picking. This can include fidget toys, knitting, beading, or other activities to keep the hands busy.
- Online Dermatillomania Support Groups. Some of these support groups use the 12-step Alcoholics Anonymous program to help people to “quit” picking. Links to some of these sites will be provided below.
National Alliance on Mental Illness (NAMI) 1-800-950-NAMI (6264)
Youth Crisis Hotline: 1-800-HIT-HOME (448-4663)
Self-Injury Hotline SAFE (Self Abuse Finally Ends) 1-800-DONT CUT (1-800-366-8288)
Related Resource Pages on Band Back Together
Skinpick.com - Provides comprehensive information about dermatillomania, on-line counselling, and an "Ask The Expert" section
The OCD Center of Los Angeles - Treatment center specializing in OCD, compulsive skin-picking, and related conditions. The website has several resources available, including an on-line test to help individuals determine if they have dermatillomania.
Trich.org - The Trichotillomania Learning Center provides information for those suffering from trichotillomania, but many of the resources on the site are helpful for those suffering from dermatillomania.