Dermatillomania: What is it and how is it treated?

By: Suzanne Feinstein, PhD

What is it? 

Dermatillomania is a mental health condition in which you pick at your skin to self-soothe. You try to satisfy an urge without too much consideration for the long-term physical and aesthetic consequences. You are lured into a semi-trance by the many tactile and visual qualities that your skin possesses. 

When you pick, your focus shifts from an emotional state (ie anxiety, fatigue, boredom) to a more hypnotic state. The bumps, dry skin, raised scabs, scratches and bug bites keep your fingers occupied, your eyes gratified and your mind quiet. Without any warning, you’re addicted to the self-soothing behavior. You feel discouraged about your ability to break free of this habit. 

How is it related to OCD?

Skin picking is a behavior which is not well understood by most therapists. You may also struggle with obsessive compulsive disorder (OCD). OCD is an anxiety disorder in which you perform repetitive behaviors or compulsions to alleviate distress brought on by recurrent thoughts, feelings, fears or preoccupations known as obsessions. Common examples of compulsions include frequent hand washing to alleviate a constant feeling of being unclean, checking the stove to assuage one’s doubt of leaving on the gas, and excessive arranging of items in an attempt to satisfy the need for perfect order. 

You may engage in skin picking compulsions to satisfy your need for symmetry (“I have a scab on my cheek so I need to pick it to make my skin smooth”), or your need for exactness (“This bump looks or feels different from my normal skin. I need it gone”). If you try to refrain from picking, you may feel a sense of unease and tension. 

How does it differ from OCD?

However, if you are a skin picker, you may not be aware of any obsessive thoughts or physical tension to be the reason behind your behaviors. Your picking behaviors may occur most frequently when you are involved in sedentary (low stress) behaviors such as watching television, surfing the web, reading, talking on the phone, etc. You might be in a trance-like state when you pick your skin. Thus, skin picking is not exclusively categorized as an anxiety disorder such as OCD

How is it related to an impulse control disorder?

Diagnosticians have stated that skin picking can be defined as an “impulsion” instead of compulsions since the behavior is not always triggered by thoughts or fears, but rather by an inability to control simple urges or impulses. Thus, certain therapists argue that it is more appropriate to classify skin picking as impulse control disorder, and feel that they should be grouped with other impulsive disorders, such as compulsive gambling, binge eating and substance abuse.

Needless to say, the ongoing controversy about how to properly classify skin picking and the scarcity of literature about the disorders leave most therapists stumped about the most effective way to treat these problems. 

How is it treated?

Many therapists make the mistake of implementing a cookie cutter approach in treating skin picking and see little or no improvement in the people they treat. It is important for therapists to understand that each person has a different motivation behind the skin picking and treatment needs to be tailored specifically to the needs of the individual.

Unfortunately, the embarrassment and shame that come from the self-induced redness, scarring and pock marks are not strong enough deterrents to control this destructive behavior. Once this altered state of consciousness is entered, the primitive urge to satisfy the senses is stronger than the voice of logic that pleads with you to stop. 

At ABH, located in Midtown Manhattan, we help people who engage in this body-focused repetitive behavior to take control over their urges. Through weekly sessions, we set reachable treatment goals, offer helpful tips, and support you through good days and bad. We teach you how to prevent the skin picking trance from occurring in the first place. By acquiring more adaptive tools to deal with undesirable emotional states, this self-soothing habit can be reversed. It takes a great deal of mindfulness, commitment and perseverance to triumph over this stubborn disorder. But victory does await. 

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