Compulsive Skin Picking – Understanding the Painful Challenges of Dermatillomania

Woman scratching her face

Compulsive skin picking (CSP) is an impulse control disorder. It compels people to damage their skin by picking at it repetitively. If you live with this challenging condition, you know exactly the kind of raw and painful toll it takes – both physically and emotionally. Also known by the tongue-twisting name dermatillomania, this form of self-mutilation affects as many as 1 in 20 people.[1]

What are the signs of CSP?

There are several indicators of CSP or dermatillomania. Some of the most common include:

  • Visible sores or scars
  • Inability to resist the urge to pick at the skin
  • Feelings of tension or anxiety right before picking the skin
  • Feelings of relaxation or the release of tension immediately after picking the skin

The face is the most commonly affected body area for individuals with CSP. However, the fingers and arms are often target areas as well. People living with CSP may pick at normal features of the skin, such as moles or freckles. Actual defects or imperfections, such as scabs and acne, are often targeted as well. Sadly, many individuals with CSP also pick at imagined flaws on their skin, eventually creating real ones as a result.

Most people with CSP use their fingers to pick at their skin. Some, however, will use tools or objects, such as tweezers, fingernail clippers, or pins. These sharp, pointed objects can quickly do significant damage to the skin, often resulting in frequent bleeding and lasting scars.

What causes CSP?

No one knows exactly what triggers this often embarrassing disorder. Some research suggests it has many similarities to obsessive compulsive disorder (OCD). In fact, it often occurs in people with OCD, with about 25% of OCD sufferers engaging in compulsive skin picking.[2] It also frequently co-occurs with another psychiatric disorder known as body dysmorphic disorder.[3]

Some experts believe dermatillomania has a lot in common with substance abuse. Others believe it fits best with a group of disorders called body-focused repetitive behaviors (BFRB), which includes disorders like compulsive hair pulling (otherwise known as trichotillomania). Most likely, it is caused by a complex combination of genetic, biological, and environmental factors.

What experts can agree on is that many people with CSP have the urge to pick when they feel anxious or depressed. However, the behavior often becomes an unconscious habit. They begin to do it even when there are no feelings of stress or other strong negative emotions. Many CSP sufferers also report pleasurable feelings after they’ve picked, which is why some experts believe dermatillomania is similar to a substance abuse disorder.

Dermatillomania often starts during the teenage years, frequently coinciding with the appearance of acne. However, young children and adults can also develop the disorder. Like many disorders, stressful events – like the loss of a job or a death in the family – may also trigger its onset.

It’s important to recognize that repetitive skin picking can also be a symptom of another disorder. The behavior is sometimes seen in people with autoimmune disorders, substance abuse disorders, psychosis, and developmental disorders such as autism. If you pick your skin compulsively consult with your doctor to rule out other illnesses as a potential cause.

But I’m just picking at my skin…that’s not a problem, right?

Many of us pick at our skin from time to time, whether it’s to minimize an unsightly scab or fuss over a blemish. But compulsive skin picking goes significantly beyond that. People with CSP often suffer from bruises, bleeding, sores, and scars as a result of their constant picking. On a physical level, the behavior increases their risk for infection and tissue damage.

Those who live with dermatillomania know that the negative effects extend far beyond the physical. They often have to limit or alter their daily activities. For example, someone who picks at their arms may wear long sleeves in the summer to hide fresh self-inflicted wounds or scabs. Someone who compulsively aggravates the skin around their fingers may avoid shaking hands or even resort to wearing gloves when around others. The compulsive picking may also cause physical pain or discomfort that also limits activities. For example, someone whose fingertips are raw from constant picking may find writing or typing too painful.

In a few rare cases, the behavior becomes so severe that it causes potentially life-threatening consequences. For example, picking that goes deeper than the top layer of skin can result in the need for skin grafts or surgery. One CSP sufferer reportedly picked through the skin and muscles on her neck, exposing her carotid artery as a result.

Can I be treated for compulsive skin picking?

Yes, you can get treatment for CSP. When skin picking interferes with your physical health or emotional well-being, it’s time to consult an expert. Not all mental health professionals are familiar with CSP, so it’s best to find a therapist who has experience treating it. There are a number of treatment approaches including:

  • Habit Reversal Training (HBT): This common treatment for excessive skin picking is a form of Cognitive Behavioral Therapy. Your therapist will work with you to identify the emotional and environmental triggers for your urge to pick. Once you develop an awareness of your particular triggers, your therapist will teach you strategies for coping when those situations arise. For example, you might learn that when you feel stressed, you can clutch a small ball or play with a “finger toy” instead of picking your skin. In addition to finger toys (sometimes called fidget toys), you might find a hobby (e.g. knitting) that keeps your hands busy. The goal is to learn to manage urges in a healthy way rather than pick on your skin.
  • Stimulus Control (SC): This type of therapy helps you find ways to alter your physical environment so you’re less likely to pick. If you pick at blemishes on your face, for example, you might put a piece of tape on the floor in front of your bathroom mirror as a reminder to stay far enough away to keep from seeing the blemishes that trigger the desire to pick. If you target your fingers, you might wear gloves or bandages as a physical barrier and cue that reminds you to stop, even when the behavior starts unconsciously.
  • Medication: Some therapists will recommend medication as part of a treatment strategy. To date, no drug has been FDA-approved specifically for the treatment of CSP. However, selective serotonin reuptake inhibitors (SSRI) medications, such as Paxil and Zoloft, have been found to be effective for some people. Because there are potential side effects with SSRIs such as stomach discomfort, weight gain, and sexual dysfunction, they’re not recommended for every patient. Medication should be prescribed only in conjunction with other therapies, like HBT. As the sole form of treatment, it is rarely effective.

No matter which treatment you and your therapist choose, remember that CSP is a complex disorder that may require several different approaches. No single treatment is ideal for every person, so don’t be discouraged if one option doesn’t work. While some cases are successfully treated within a few weeks to a few months, others require many months to a year or more before the behavior is totally eliminated.

Compulsive skin picking is not merely a harmless habit. From infections that can hurt your health to embarrassment about simply shaking hands, CSP has serious consequences. Don’t let it continue indefinitely. Find a qualified mental health professional with the skills to help you lead a life free from sores, scars, and embarrassment.

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