All About Dermatillomania: Triggers, Symptoms, and Treatment

By: Suzanne Feinstein, PhD

According to the National Institutes of Health, about one in five Americans has some form of mental illness. This includes serious conditions like schizophrenia and bipolar disorder, as well as more common ones like depression, eating disorders, sleeping disorders, and anxiety disorders.

It also includes impulse control disorders like dermatillomania. This is a condition that involves compulsive picking of the skin. While rare, it can be very debilitating and harmful to one’s overall health and well-being.

The good news is that there are some very effective treatments to combat it. 

This article covers the basics of dermatillomania. It explains the symptoms and triggers and explores some of the most effective treatment options. Keep reading to learn more.

What Is Dermatillomania?

Dermatillomania is also known as “excoriation disorder” and is a type of body-focussed repetitive disorder. It is a mental health condition that results in an individual compulsively picking at or scratching their skin. Broken down, the word “dermatillomania” comes from the Greek “derma” or “skin,” “tillo” or “pulling, and “mania” or “excessive behavior.” 

Dermatillomania most often begins during puberty. However, it can happen at almost any age. It is more prevalent in people who have triggering conditions, such as acne, eczema, psoriasis, or other skin issues. 

In general, dermatillomania is relatively uncommon. It only affects about 2 percent of the population, with a little over 5 percent of people having experienced it at some point in their lives. 

What Are the Symptoms of Dermatillomania?

While most people with dermatillomania either pick or scratch their skin (or both), some people dig at or rub their skin. In some cases, people with dermatillomania bite at their skin, especially their lips. 

Most acts of picking or scratching can be categorized in two ways: automatic or focused. Automatic picking happens without conscious thought. As the name suggests, focused picking involves an intense, deliberate focus on one particular area of the skin.

What Causes Dermatillomamia?

Genetics is one of the primary factors in developing dermatillomania. People with the condition are much more likely to have a family member who also suffers from it. 

There are other causes, like changes in brain structure that control habits. Similarly, stress and anxiety can either cause or exacerbate dermatillomania. Additionally, there is a link between compulsive picking and boredom. 

Is Dermatillomania a Form of OCD? 

Often, dermatillomania is incorrectly characterized as an obsessive-compulsive disorder (OCD). The conditions often coexist, but there are notable distinctions. 

To start, OCD involves compulsions which are repetitive behaviors that ward off the anxiety or physical tension that are brought on by specific thoughts, feelings, images, fears or preoccupations. Dermatillomania involves impulsions which are behaviors that are without forethought and without consideration for the consequences. 

Compulsions and impulsions are both repetitive and often difficult to stop. In both cases, there is a physical tension that precedes the behavior and a release of physical tension once the behavior is performed.

In general, people who pick at their skin are more often motivated by feelings of reward and relief, and people with OCD are more motivated by fear. However, this is not always the case. In Tourettic OCD or tic-like OCD, there is significant overlap between compulsions and impulsions.

What Are the Effects of Dermatillomania?

Depending on the severity of the condition, the impacts of dermatillomania can be quite severe. Beyond mild skin damage, a person can endure ongoing pain, discomfort, and diminished quality of life. It can make the person more susceptible to the risk of infection. 

There are emotional and social effects of the disorder. Many people with dermatillomania feel a sense of embarrassment or low self-esteem from their perceived lack of control. This can cause them to withdraw socially and cause problems within relationships. 

Likewise, this can lead to school or job absenteeism. It can trigger anxiety, depression, and feelings of frustration. These can, in turn, worsen inclinations to skin pick. 

How Is Dermatillomania Diagnosed?

Like other health conditions, proper diagnosis is essential for developing a suitable treatment plan for dermatillomania. First, a medical doctor or mental health professional will look for the presence of several symptoms, including the following:

  • Ongoing intentional or compulsive skin-picking
  • Multiple failed attempts to stop skin picking
  • External factors (such as the ones described above) that are common causes of dermatillomania
  • Ruling out skin picking from other medical or mental health conditions

Once a diagnosis is made, the clinician can recommend suitable treatment options. 

What Are the Treatments for Dermatillomania?

Fortunately, there is a very effective treatment for addressing both the causes and symptoms of dermatillomania. 

Therapies 

Cognitive-behavioral therapy (CBT) is a common method of addressing dermatillomania. A specific form of CBT, known as Habit Reversal and Stimulus Control Techniques, helps the patient become more mindful of the thoughts, emotions and/or external stimuli that lead to skin picking. Through physical barriers, logging, mindfulness techniques and body awareness, clients learn how to control their urges and stop the resulting behavior.

Acceptance and commitment therapy (ACT) is used as an adjunctive approach to Habit
Reversal. It focuses on mindfulness and acceptance of uncomfortable thoughts and feelings that can lead to skin picking. It helps to build distress tolerance and empowers the patient to tolerate the urge to pick without surrendering to it. 

Another effective therapy for dermatillomania is exposure and response prevention (ERP). ERP is also used in the treatment of OCD and similar disorders. It involves intentional exposure to situations or objects that trigger skin picking. Over time, the patient can learn to tolerate this discomfort without the resulting negative behavior. 

In some cases, support groups can be a helpful tool for people suffering from dermatillomania by providing validation and support. They can also help diminish feelings of isolation and shame, which are common with dermatillomania. Group therapy can also impart coping techniques from people who have experienced similar challenges.

Medication

In extreme cases, medication used to treat anxiety and depression can be a useful means of treating dermatillomania. Although habit reversal treatment is generally the first-line treatment for body-focused repetitive behaviors, certain medications can help augment the behavior therapy by improving mood and focus and assisting in regulating an overactive nervous system.

Find Treatment for Dermatillomania Near You

Now that you understand the symptoms and triggers of dermatillomania, you can take steps to find help. A trained mental health professional can further assist you in identifying the causes and formulating a treatment plan.  

Since 1995, Advanced Behavioral Health has been treating clients with OCD and body-focused repetitive behaviors such as dermatillomania, trichotillomania, nail-biting, etc. We are located in Midtown Manhattan and specialize in cognitive behavior and other mindfulness-based therapies. Reach out to us today to schedule an appointment.

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