About Skin Picking Disorder
Skin picking disorder, also known as excoriation disorder, is a psychological condition characterized by the repetitive and compulsive picking, scratching, or pulling of the skin. It is classified as a body-focused repetitive behavior (BFRB) and affects approximately 1.4% of adults in the United States. This disorder can lead to tissue damage, such as sores, hyperpigmentation (dark spots on the skin), scars, and even skin infections.
People with skin picking disorder may engage in this behavior despite attempts to stop, and may experience major psychological, physical, or social limitations as a result. Symptoms often develop during adolescence or adulthood and can last for various lengths of time. Skin picking can be triggered by various factors such as stress, boredom, or a desire to remove perceived imperfections. Without treatment, skin picking disorder can cause painful lesions and significant emotional distress.
Treatment options include cognitive-behavioral therapy (CBT), other forms of therapy, and medication. It is important to consult with a healthcare professional for individualized advice and guidance.
The exact disease causes of skin picking disorder (SPD) are not fully understood. However, there are several factors that may contribute to its development:
Non-modifiable risk factors of SPD cannot be changed or controlled. These include:
- Genetic predisposition: There may be a genetic component to SPD, as it can run in families.
- Gender: Females are more commonly affected by SPD than males.
Modifiable risk factors of SPD can be influenced or changed. These include:
- Stress and mental health conditions: High levels of stress and certain mental health conditions, such as obsessive-compulsive disorder (OCD), may increase the risk of developing SPD.
- Skin conditions: People with skin conditions, such as acne or eczema (dry, itchy, and inflamed patches of skin), may be more prone to skin picking.
- Perfectionism: Individuals with perfectionistic tendencies may engage in skin picking as a way to achieve an ideal appearance.
- Body-focused repetitive behaviors (BFRBs): Engaging in other body-focused repetitive behaviors, such as hair pulling or nail biting, may increase the risk of developing SPD.
It's important to note that these risk factors do not guarantee the development of SPD, and individual experiences may vary. If you have concerns about skin picking or suspect you may have SPD, it's best to consult with a healthcare professional for proper evaluation and guidance.
The most common early symptoms of skin picking disorder (SPD) include:
- Engaging in skin picking despite multiple attempts to address the behavior
- Developing recurring skin lesions or open wounds due to picking
- Experiencing significant psychological, physical, or social limitations as a result of skin picking
As the disorder progresses or reaches higher severity, additional symptoms may occur, such as:
- Painful lesions and bleeding
- Scarring and disfigurement
- Significant psychological distress
- Social withdrawal and avoidance of interactions due to appearance-related beliefs
- Feelings of shame or distress after picking episodes
- Craving, urge, or sensation before a skin picking episode
- Itching, warmth, pain, burning, or a feeling of dryness before or during picking
It's important to note that these symptoms can vary from person to person, and some individuals may also have underlying mental health conditions like obsessive compulsive disorder (OCD) or attention-deficit/hyperactivity disorder (ADHD). Treatment options for skin picking disorder focus on identifying triggers, addressing the behavior, and managing any underlying medical or psychiatric conditions. Consult with a healthcare professional for personalized advice and treatment recommendations.
To diagnose skin picking disorder (SPD), doctors typically perform the following examinations, tests, and procedures:
- Physical examination: Doctors will examine your skin to determine if the lesions or scabs are due to a skin disorder or condition like eczema (dry, itchy, and inflamed patches of skin) or psoriasis (red, scaly patches of skin).
- Behavioral assessment: Your doctor will ask you about your behaviors and the feelings you experience while engaging in skin picking habits.
- Medical history: Doctors will inquire about any underlying conditions or mental health issues that may contribute to skin picking.
If skin picking disorder is suspected, additional examinations, tests, and procedures may be conducted to determine the stage or severity of the disorder:
- Diagnostic Interview for Skin Picking Problems (DISP): This semi-structured interview assesses the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for skin picking disorder and clinical features such as frequency, duration, and body location of picking episodes.
- Skin Picking Symptom Assessment Scale: This scale evaluates the severity of skin picking symptoms and associated mental health symptoms.
These assessments can help healthcare professionals understand the extent and impact of skin picking disorder on an individual's life. However, it's important to consult with a healthcare professional for an accurate diagnosis and appropriate treatment plan.
The goals of treatment for skin picking disorder include reducing or eliminating the compulsive picking behavior, addressing any underlying mental health or developmental conditions, and improving overall well-being.
Here are the recommended treatments and how they work to achieve these goals:
Medication:
- Selective serotonin reuptake inhibitors (SSRIs) and other antidepressants: These medications can help reduce the urge to pick by affecting serotonin levels in the brain.
- Anticonvulsants and antipsychotics: These medications may be prescribed for off-label use to help manage skin picking behaviors.
Therapy:
- Cognitive Behavioral Therapy (CBT): This therapy helps identify and address triggers, negative habits, and impulse control issues. It focuses on developing healthier coping methods and alternative activities to replace skin picking.
- Behavioral therapies: Approaches such as Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT) can help individuals learn mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness skills (techniques that help people communicate clearly, set boundaries, and build healthy relationships).
Therapeutic procedures:
- Wearing gloves or adhesive bandages: These physical barriers can prevent tissue damage and reduce the urge to pick.
Health behavior changes:
- Stress management techniques: Practicing stress reduction techniques can help manage anxiety and reduce the likelihood of skin picking.
- Altering the environment: Modifying the environment to minimize exposure to triggers can be helpful.
Other treatments:
- Supportive family therapies: Involving family members in therapy sessions can provide education and support for individuals with skin picking disorder.
- Biomaterial-based physical barrier strategies: These strategies involve using protective materials/cloth as a supporting or alternative treatment.
It's important to remember that treatment plans should be tailored to each individual's specific needs. Consulting with a healthcare professional is recommended to determine the most appropriate treatment approach.
Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.