What to Do When Your Skin Picking Is Causing You Psychological Stress?

Skin picking, also known as dermatillomania, compulsive skin picking, psychodermatosis or self injurious skin picking, is an obsessive-compulsive or impulse-control disorder that may be an attempt to manage intense emotions. Picking at your skin occasionally is common, but "a small percentage of people engage in this type of behavior frequently enough and/or extensively enough to cause themselves significant problems including widespread scarring, and noticeable wounds on their skin. The scars and lesions are often a source of significant shame and embarrassment," according to the Obsessive Compulsion Foundation.

Skin Picking and Obsessive Compulsive Disorder

• Skin picking is a mild problem for some, but for others, it can be quite time-consuming. The fight against urges to pick at the skin is constant and can result in physical damage and emotional distress. This disorder can cause the sufferer to experience depression, isolation and other significant difficulties in life. Skin picking may lead to stress and anxiety, which can result in more picking, creating a self-perpetuating cycle.

  Skin picking may fall within the Obsessive-Compulsive Disorder Spectrum. These are behaviors, sometimes called Body-Focused Repetitive Disorders (BFRDs), in which an individual causes physical injury to himself or damages her appearance. This could include skin picking, hair pulling, nail biting, cuticle tearing or blemish squeezing.

Who is Afflicted and When

• Emotionally and sometimes physically painful, these disorders are not rare. Skin picking and hair pulling are more common in females. The behavior usually begins in childhood or adolescence and may affect one in 20 individuals.

  Skin picking and other similar disorders may occur when someone is stressed or bored, excited or sedentary. Episodes of picking may be conscious responses to anxiety or depression, but these actions are frequently unconscious. Many individuals, sometimes in a trance-like daze, spend hours a day picking at their skin. The behavior may occur at any time of day but is often more extreme in the evening.

Children, Teens and Their Families

• Children and teens who suffer from skin picking may withdraw from family and friends or refuse to go to school to avoid being teased by their peers and scolded by their teachers. Parents mistakenly punish children who persist in these behaviors, and family members may act as if the sufferer is doing so deliberately. They may try to get their loved one to stop by bringing attention to the behavior or telling them they should just stop doing it.

  No one who suffers from this disorder wants to do these things, and most would stop if they could. This condition often leads to angry scenes and disputes within families, and the negativity increases the sufferer's frustration and stress.

Family Therapy

• Denial and shame can prevent many young sufferers from getting much-needed help. Symptoms may be minimized or criticized by parents as being nervous habits, laziness, attempts to get attention or expressions of anger and rebellion.

  Family therapy may help all family members to be more patient, accept the problem and not blame the sufferer. Working with the whole family can help calm contentious interactions and encourage patience when facing setbacks and lapses.

Behavioral Therapy

• Behavioral therapy or cognitive behavioral therapy is the most common method for treating conditions such as skin picking. According to the American Association of Marriage & Family Therapists, "Behavioral therapy usually consists of two approaches: Habit Reversal Therapy (HRT), which teaches the sufferer a set of alternative behaviors that can help them focus themselves, interrupt, and block the behavior, and Stimulus Control (SC), which teaches them how to identify, change, and control the different triggers present in their routines, environments, and moods that lead to the behaviors."

  Psychologists and therapists who specialize in cognitive behavioral therapy, a method that deals with the thoughts and behaviors of an individual, are often the most informed professionals to contact about skin-picking problems. While it is not always easy to find health care providers who treat these disorders, an increasing number of therapists use methods and treatments that have had some success.

Medication

• When combined with behavior therapy, medication may be useful and is highly recommended for people who are unable to follow behavioral instructions and whose skin-picking urges feel completely irresistible. Medications that may help include antidepressants classified as selective serotonin reuptake inhibitors, such as fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro).

Difficulty of Finding Appropriate Treatment

• Individuals with this disorder may consult dermatologists, but they seldom turn to mental health providers. The behavior is assumed to be a bad habit. Most people who engage in this say they have been told to "just stop" by parents or significant others. For the most part, the disorder is simply ignored by primary care physicians or others who have seen the physical results.

Keeping Hands Busy

• Keeping your hands busy can be very helpful in treating compulsive skin picking. Knitting, rubbing smooth stones, cooking or baking, drawing and handling "sensory toys" or "fiddle toys" help limit these repetitive and potentially destructive actions. Companies such as Trainers Warehouse specialize in objects that can be used for this purpose. Sensory or "fidget" toys such as the Koosh, a stress ball, clay, stretchy strings or small Slinky toys occupy the fingers and take the focus off skin picking.