Dermatillomania (Skin Picking)

Definition

Also known as excoriation disorder, or compulsive skin picking, dermatillomania is a psychological condition that manifests in the form of repetitive touching, scratching, picking, and digging at one’s own skin. It is an impulse-control disorder and one of several body-focused repetitive behaviors (BFRB) currently classified in the DSM-5 as Obsessive Compulsive and Related Disorders. Dermatillomania affects up to 5 percent of the population and approximately 75% of those are female. The difference between dermatillomania and normal picking at skin imperfections and irregularities, is that the behavior is chronic, results in tissue damage, and causes the individual marked distress and dysfunction.

Symptoms

Repetitive skin picking extends to pulling, scraping, and even biting both healthy and damaged skin from various parts of the body, though most often on the face, hands, fingers, arms, and legs. This behavior, which commonly begins in adolescence but can occur at any age, often results in visible skin damage and disfigurement from lesions, discoloration, open wounds, scars, and infections. Dermatillomania is generally a chronic condition, though symptoms may arise and disappear from time to time.

Anxiety, depression, shame, fear of exposure, and embarrassment over the condition usually leads to attempts at covering up the skin with makeup, clothing or by other means, and can also interfere with normal social interactions resulting in uncomfortable relationships with family and friends. Dermatillomania is not diagnosed when the symptoms are caused by another medical or psychiatric condition. For instance, skin picking can also occur with with dermatological conditions, autoimmune disorders, opiate withdrawal, and developmental disorders such as autism.

Causes

There may be a genetic link to dermatillomania, since some people appear to have an inherited tendency to BFRBs such as skin picking and hair pulling, as well as higher-than-average rates of mood and anxiety disorders in first-degree relatives. Other factors, such as individual temperament, stress and age appear to play roles in the development of the condition. Chronic skin picking behavior often coincides with the onset of puberty Dermatillomania may also be associated with perfectionism that leads to over-grooming, or used as a means of avoiding stressful events or releasing tension that builds up as a result of negative emotions such as impatience, frustration, dissatisfaction and even boredom.

Treatments

Individuals who pick skin often make repeated, unsuccessful attempts to stop on their own, as the shame and embarrassment associated with dermatillomania may prevent them from seeking professional treatment. In fact, fewer than one in five people with dermatillomania are thought to seek treatment. For those who do, small-scale psychological studies of both Cognitive Behavioral Therapy and Acceptance and Commitment Therapy, coupled with self-help interventions such as habit reversal therapy, have been shown to reduce symptoms of dermatillomania. While no medications are approved as a first-line treatment for skin picking, limited studies have found that some antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and nutraceuticals, such as n-acetyl cysteine (NAC), may help.

References

The TLC Foundation for Body-Focused Repetitive Behaviors website. What Is Excoriation (Skin Picking) Disorder?

Lochner C, Roos A, Stein DJ. Excoriation (skin-picking) disorder: A systematic review of treatment options. Neuropsychiatric Disease and Treatment. July 14, 2017;13:1867-1872.

Last reviewed 04/17/2018