By Casey Clark, writer, content strategist and BFRB advocate
If you're reading this, then it's safe to assume that either you pick your skin or you know someone who does. Dermatillomania, also known as skin picking and excoriation disorder, is a medical condition that causes individuals to pick at their skin excessively and can result in both physical, mental, and emotional distress. Dermatillomania is one of many Body-Focused Repetitive Behaviors (BFRBs), a category of mental health conditions that also includes hair pulling (trichotillomania) and nail biting (onychophagia).
Ahead, we gathered some information about what dermatillomania is, what triggers dermatillomania, and even what to replace skin picking with that you can try during your healing journey. Additionally, we have some insights from therapists about dermatillomania and how you can best support yourself and others dealing with this condition.
What is dermatillomania?
Dermatillomania occurs when an individual picks their skin to the point of damage and breakage. If left unchecked, skin picking can lead to significant visible scarring and swelling, which can be painful.
According to Mental Health America, dermatillomania (skin picking) typically begins during adolescence between the ages 13 and 15.
The areas where one skin picks from will vary, however, some common locations include the face, arms, scalp and legs. Most often, people with dermatillomania will pick at pre-existing scabs, wounds, blisters, and other types of lesions. In addition to being painful, picking at one's skin can also be dangerous if an infection arises from the exposed area.
"Too much skin picking can lead to scars, infection, and even treatment-resistant infections," says Libby Gordon, LCSW, therapist and founder of The BFRB Space. "Our goal is everything in moderation and balance, and things can quickly get out of control with BFRBs like dermatillomania."
Aside from physical pain, those with dermatillomania might face significant social and emotional distress. This usually stems from them being ashamed of either engaging in the behavior, or their appearance after the picking takes place. For many individuals, skin picking can bring on symptoms of anxiety and depression which can lead to social isolation and withdrawnness that impedes one's ability to function in their daily life.
What are the different types of dermatillomania?
Similar to trichotillomania, dermatillomania generally falls into two categories: automatic and focused.
Automatic describes those that pick at their skin on an impulse meaning they don't realize they are doing it until it's been done. For example, might one have an episode of picking and then look down to realize they've just re-opened a scab or perhaps created a new lesion that wasn't there before. Oftentimes, individuals are left with feelings of guilt and shame that they've just either hindered their progress or now have to start all over again.
On the other hand, focused refers to one picking at one's skin intentionally. For example, one may stand in front of a mirror and look at the different scabs, scars, and maybe even pimples to see which one looks like it's ready to be picked.
What causes dermatillomania?
There is no specific cause for dermatillomania, however, there are a few factors that might have an effect.
Genetics
It is commonly recognized that genetics have some role in the development of BFRBs, such as dermatillomania, in individuals with the conditions. According to Mental Health America, individuals who have dermatillomania are more likely to have at least one first-degree relative (parent or sibling) who also has this condition.
Environmental factors
Environmental factors also come into play when discussing causes of dermatillomania.
"Environmental irritants and chronic overall overstimulation can cause the need for skin self-soothing," says Gordon.
For example, individuals in high stress environments and situations might find themselves more prone to picking. Also, if one is bored or in private, that also fosters the perfect environment for them to skin pick.
Brain structure
There are even some studies to show how individuals with dermatillomania may have some differences in their brain structure. According to Mental Health America, the differences in the brain structure occur in the brain areas that control how one learns and forms habits.
What are the treatment options for dermatillomania?
There are a few different treatment options for those struggling with dermatillomania.
Behavioral Therapy for Skin Picking
Therapy can be helpful for individuals with dermatillomania to help identify triggers and work through the big feelings and emotions that may arise as a result. More specifically, habit reversal training (HRT) is highly recommended for people with dermatillomania.
The goal of HRT for dermatillomania recovery is to help individuals to become aware of their triggers and behaviors and work on finding healthier alternative behaviors. "Some people pick because they want to “take care” of a specific spot, and some pick in a trance," says Gordon. "Habit reversal training helps you develop awareness so that you can use all the other therapeutic strategies to get the skin and life you want."
Medication for Skin Picking
There is no FDA-approved medication for dermatillomania. You'll want to speak with a psychiatrist to see if medication might be an option for you.
Social Support for People with Skin Sicking
Individuals with dermatillomania may feel alone with their struggles which can make the situation more difficult. Having a support system can make a big difference in coping with BFRBs and giving one hope of a better future. Don't know where to start? The BFRB Change Collective is run by peer coaches who connect individuals to each other and resources to support skin picking recovery.
About the Author:
Casey Clark is a writer and content strategist from New York City who specializes in mental health, beauty and travel. Her work has appeared in The Wall Street Journal, HuffPost, National Geographic and more.
