Picking at Skin

There are different ways to pick at one’s skin.  Some people, including children and teens, pick at the skin around the nails of the hand. Others pick at little scabs or sores that may be anywhere on the body (such as insect bites, blemishes, or injuries). Some create little sores by scratching themselves or irritating normal surface “bumps” on the skin and then, they pick at the newly formed sore. Some pick at their scalp. “Dermatillomania” is one name for this condition, although each type of picking has its own distinct name.

Lack of Control
Picking at the skin is an impulse control disorder. It has been compared to trichotillomania – a condition in which one pulls out one’s own hair from the eyebrows, or the eyelashes or from the scalp. It has also been likened to OCD (obsessive-compulsive disorder), a disorder in which a person performs ritualistic behaviors in order to reduce anxiety. Dermatillomania has also been considered to be a sub-category of Tourette’s Syndrome – a condition in which a person has compulsive tics (movements and sounds that just MUST be made, even though they serve no constructive purpose. No matter which way we categorize skin picking, it is always seen as a behavior that is related to tension release.

Stress and Dermatillomania
Skin picking occurs more frequently when a person feels stressed. It also decreases when a person is feeling more relaxed and in-control of their lives. Therefore, treatments aim to reduce tension and build emotional stability. Skin pickers often do not have healthy ways of handling their stressful emotions. Psychotherapy may be helpful – especially with teens and adults. Children may benefit from art therapy. Techniques like EFT (emotional freedom technique) can sometimes be helpful. Meditation and relaxation training, as well as hypnosis, have all been helpful in addressing this disorder. For adolescents and adults, there are also support groups that can be helpful. The workbook “The Habit Change Workbook” by Claiborn and Pedrick, takes a cognitive behavioral self-help approach that can also make a positive difference. Psychotropic medications like anti-depressants are sometimes used as part of the treatment. Each person who picks at his or skin has different psychological needs and therefore treatment is individualized to address those needs.

Getting Help
Skin picking can make a person feel out-of-control and ashamed. It is often done in hiding and it is rarely spoken about. People are embarrassed and therefore don’t even talk to their doctor about it. Therefore, people don’t get the help that is available for this highly treatable disorder. If you think that your child may have this disorder, or even if you are just concerned about seeing picking behaviors on occasion, do consider arranging for a mental health assessment. A professional will let you know whether treatment is necessary or not and if so, help design a treatment program that can help way beyond stopping this symptom.

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