Also known as excoriation disorder and skin-picking disorder, dermatillomania is a psychological condition that manifests as repetitive, compulsive skin picking. It is an impulse-control disorder and one of several body-focused repetitive behaviors (BFRBs) currently classified in the DSM-5 under Obsessive-Compulsive and Related Disorders. Dermatillomania affects up to 1.4 percent of the total population, and approximately 75 percent of those affected are female. There is a difference between dermatillomania and normal picking at skin imperfections and irregularities—the behavior is chronic, results in severe tissue damage, and causes the individual marked distress and dysfunction.
Repetitive skin picking extends to pulling, squeezing, scraping, lancing, and even biting both healthy and damaged skin from various parts of the body. People with dermatillomania often target their face, hands, fingers, arms, and legs; they may use either their fingers or an instrument, like tweezers or pins. They can spend hours a day on their picking behavior, which can last for months or even years. Dermatillomania often results in visible skin damage and disfigurement from lesions, discoloration, open wounds, scars, and infections. It is generally a chronic condition, though symptoms may arise and disappear from time to time.
Dermatillomania is generally a chronic condition, though symptoms may arise and disappear from time to time. Individuals with this condition can spend hours thinking about picking and trying to resist the urge before giving in. Anxiety, depression, shame, fear of exposure, and embarrassment over the condition usually lead to attempts at covering up the skin with makeup, clothing, or by other means; they 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 dermatological conditions, autoimmune disorders, opiate withdrawal, and developmental disorders, such as autism.
According to DSM-5, excoriation disorder can be diagnosed when the following criteria are met:
- recurrent skin picking results in skin lesions
- repeated attempts are made to decrease or stop the skin picking
- the skin picking cuases clinically significant distress—including a feeling of loss of self-control, embarrassment, and shame—or impairment in functioning.
The skin picking does not generally occur in the presence of other individuals.
There may be a genetic component 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 that may play a role in the development of this condition include individual temperament, stress, and age. Chronic skin picking behavior often coincides with the onset of puberty, as well as a dermatological problem, such as acne. Dermatillomania can be associated with perfectionism, which leads to over-grooming; it can also be 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.
Individuals who pick their own 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 the 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. People with this condition may require antibiotics to treat potential infections or, in extreme cases, surgery.