Excoriation – Skin Picking Disorder

What Is It?

Excoriation disorder which is also being known as chronic skin-picking or dermatillomania is a kind of a mental illness linked to obsessive-compulsive disorder. It means repeated picking at one’s own skin which in turn leads to skin lesions thus causing a significant disruption and complications in one’s life. People who face skin picking disorder develops a higher tendency of picking their skin and many times, picking a scab or skin around your nails can result in frequent and intense pain which causes bleeding, sores, and scars.

People with this kind of disorder; repeatedly keep on scratching or removing their skin which results in causing bleeding as well.

Detail about it:

Skin picking disorder is a body focused repetitive behavior (BFRB) which is getting experienced by more than 1.4% of adults in the United States. People who have skin picking disorder are the ones who repeatedly pick, pull, or tear their skin or pimples which eventually results in bleeding as well. Skin picking disorder is found more in females as compared to males and the symptoms of these mostly develop during adolescence and adulthood.

Reasons for it?

There is no hard core reason which clearly lets us know when skin picking changes from a mild as kind of nervous habit can result in a more serious problem which needs to be cured on times. In case you also face the beneath problems then you need ask the following questions to yourself:

• Does picking your skin take much time during the day?
• Do you observe any kind of scars from skin picking?
• Do you feel depressed while thinking about how much you pick your skin?
• Do you engage in skin picking despite of various attempts to address the behavior
• Do you develop recurring skin lesions or open wounds due to your skin picking disorder
• Do you witness any kind of psychological, physical, or social impairment which is due to skin picking
• Is skin picking habit affecting your social or professional life? For instance, if you try to avoid going to the beach or gym as it might give a chance to others to see your scars or in case take lot of time to cover your sores before work or social events, then the situation is serious and you need to consult your doctor.

How it Develops?

Skin picking habit can happen to both children and adults and can happen at any age. Skin picking disorder can develops in one of two ways:

• Skin picking habit result after some kind of rash, skin infection, or small injury. In case you pick at the scab or rash, which results in to injury to the skin and keeps the wound from healing then it’s a kind of skin picking disorder. Also, more itching results in to more picking and more scabbing, and the cycle continues.
• In case you are suffering from stress, chances are that you might absently pick at a scab or the skin around your nails and find that the repetitive action more beneficial in removing the stress. It later can become a habit which leads to a kind of disorder among people.

Skin picking disorder is named as Body-Focused Repetitive Behavior, besides there are many other kinds of BFRBs including pulling or picking of the hair or nails as well.

Causes of Skin Picking Disorder

There are many conditions which commonly occur alongside skin-picking disorder and these kinds of illnesses or disorders might result in the symptoms of a condition, or they may share many common underlying risk factors.

Co-occurring illnesses include:

• Obsessive-compulsive disorder (OCD)- This kind of mental health disorder results in repetitive behaviors which can impact a person’s quality of life.
• Body dysmorphic disorder- People with this body-image disorder start experiencing negative thoughts about the way their body looks which can result to skin picking to remove “imperfections.”
• Major depressive disorder- Also, in case someone is facing depression or disorder might result in skin picking.
• Trichotillomania (hair-pulling): Almost 38 percent of people who have skin-picking disorder also start experiencing this kind of condition.

Although skin picking has no specific reason to it, it might happen from biological and environmental factors as well and this kind of disorder can develop along with OCD or another mental health condition which are discussed in detail:

OCD

OCD is a mental health condition which is characterized by unwanted repetitive thoughts and behaviors and more than 2% of the entire population in the US is getting affected by OCD. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists, skin picking is a common compulsion which is affecting people with OCD.

Trichotillomania

Trichotillomania is a compulsive condition which is linked to OCD; it results in habitual behaviors like hair pulling, nail biting, and teeth grinding. More than 40% of people with skin picking disorder also faces have trichotillomania.

ADHD

ADHD is a neurodevelopmental condition which hinders a person’s ability to pay detailed attention and to control his/her impulsive behaviors. This is one of the most common neurodevelopmental conditions especially among children.

Autism spectrum disorder

Autism spectrum disorder (ASD) is a neurodevelopmental condition which in turn affects behavior and communication of the people and the doctors consider autism a spectrum disorder as it can result in diversified symptoms that appear at different intensities. Though autism symptoms vary from person to person, some of the common symptoms which are seen in most of patients include:

• inconstant eye contact
• patients stop showing any kind of enjoyment during activities or interactions involving other people
• patients start showing more or less sensitivity to sensory information which includes noise, lights, or temperature
• repeating certain behaviors or phrases, which is known as echolalia

The behavioral symptoms of ASD can result in repetitive behavior which includes skin picking, that often results in hurting oneself as well.

Treatment

According to many studies it is found that both medication and cognitive-behavioral therapy (CBT) can eventually lower symptoms of excoriation disorder.

Medication- By giving medication to the patients, the growth rate of Excoriation can be reduced greatly, successful treatment include the usage of selective serotonin reuptake inhibitors (SSRIs), which are antidepressants which also lowers obsessive thoughts and compulsive behaviors. A mental health expert will look for the ways which can help in resisting things in your environment which can cause skin picking. Wearing gloves or adhesive bandages to cover scabs or cuts also helps in avoiding picking.

• Selective serotonin reuptake inhibitors (SSRIs) and other antidepressants are given to the patients
• anticonvulsants such as lamotrigine (Lamictal)
• antipsychotics such as risperidone (Risperdal)

Cognitive-behavioral therapy (CBT)- By Cognitive-behavioral therapy, the doctors can have an understanding about people’ thoughts and behavior patterns and how ways can be taken to lower repetitive behaviors among the individuals. Through this therapy, the individuals learn how to change their thoughts so that they can avoid picking at their skin and can get some relief from their disorders.

Some of the kinds of alternative activities for people who face stress, anxiety, or boredom are mentioned underneath:

• squeezing a rubber ball
• using a Rubik’s cube
• drawing, painting, or knitting

Take self-action at home

People who have skin picking disorder can take action at home by practicing stress management techniques and making changes in their environment which can help in lowering the exposure to potential triggers.

Some of the ways to manage skin picking disorder at home include:

• Patients can apply soothing topical ointments like aloe vera gel or high quality coconut oil along with exercising regularly to overcome skin picking disorder.
• They can practice yoga, meditation, or deep breathing exercises which are some of the best alternatives to lower stress or anxiety
• People can remove or cover the mirrors to avoid seeing skin blemishes
• They can hide the tools which otherwise can be used to pick or pull skin like tweezers, nail clippers, and scissors

Outlook

Once it has being made confirmed that you are suffering from Skin picking disorder, your doctor will look for the ways to develop a treatment plan and will find a treatment plan which can works for you and will be done on a trial and error basis. Although treatment can in managing the symptoms and quash the behaviors, there are chances that you might experience periods when you pick again even after long periods of stopping the behavior. This does not means that getting rid of this problem is difficult, its just that you and your doctor need to reconsider the treatment plan and update it to suit your needs.

Ways to cope with it

As next plan of action, there are few things which you need to consider while getting the best treatment plan and it includes:

Find a support group in your community and talk to people who will understand your problem and your experience. They will support you as and will help you in finding the best treatment plan that can works amazing for you; moreover, they will also understand the course of the disorder and what you might expect in the future. You can also take opinion of a mental health expert or therapist or can get in touch with your hospital’s education outreach office which will offer you a list of experts and groups which can be contacted in need.

Set your goals

On top of getting the best medical treatment to get rid of this disorder, it is important that you be supportive to yourself and understands that this is some bad phase which eventually will disappear with the passage of time. You need to set your own goals and celebrate when you achieve them. Always remember that nothing happens within a wink of an eye and your success will be slow-going. Keep on motivating yourself for every small accomplishment, and show yourself some grace if you don’t meet a certain goal.

Preparing for your appointment

In case you have a skin wound or lesion which is bothering you then you are advised to make an appointment with your doctor at the earliest; you may be referred to a doctor who is experienced in the diagnosis and treatment of skin conditions (dermatologist) In case, you already have skin cancer then there are higher chances of second cancer. You can talk to your dermatologist about how many times you need your skin to be examined so that some other signs if skin cancer can be identified.

• You need to write down your medical history, which include some other conditions as which you have being facing, also mention any kind of radiation therapy which you have received, even it was several years back as well.
• Then make a list of medications and natural remedies which include any prescription or over-the-counter medications, vitamins, supplements, or herbal remedies which you have being taking.
• Write down questions to ask your doctor and create a list of questions in advance which you can ask the doctor and will help you make to the most of your time with your doctor.
• Don’t get panicked by hearing the word cancer as it can be cured if steps are taken on time, you can ask some family member to go with you so that you or other person can remember what the doctor advised.

How to get rid of this diagnosis:

Skin-picking disorder is difficult to get diagnosed by its own and you need to consult a doctor so that he/she can help you in recovering from this disorder. Although you might suspect that the symptoms are caused by skin-picking disorder, your doctor will help you in knowing the exact cause of it so that the diagnosis procedure can be started accordingly. Post conducting a physical exam, your doctor will ask you about your behaviors and what all feelings you develop post performing.

In case your doctor suspects skin-picking disorder, they will refer you to a professional who will help you in getting rid of this disorder. Family medicine doctors or internists can also give you mediation in case skin picking disorder happens due to stress, anxiety, or OCD.

References

1. https://www.dovepress.com/excoriation-skin-picking-disorder-a-systematic-review-of-treatment-opt-peer-reviewed-article-NDT
2. https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abnormal-brain-activation-in-excoriation-skinpicking-disorder-evidence-from-an-executive-planning-fmri-study/996700F797013DDBFA93B8D678767225
3. https://www.dovepress.com/excoriation-skin-picking-disorder-a-systematic-review-of-treatment-opt-peer-reviewed-article-NDT