The primary characteristic of Compulsive Skin Picking (CSP) is
the repetitive picking at one's own skin to the extent of causing
damage. Usually, but not always, the face is the primary location
for skin picking. However CSP, also known as dermatillomania or
neurotic excoriation, may involve any part of the body. Individuals
with CSP may pick at normal skin variations such as freckles and
moles, at actual pre-existing scabs, sores or acne blemishes, or at
imagined skin defects that nobody else can observe. Individuals
with CSP may use their fingernails, as well as their teeth,
tweezers, pins or other mechanical devices. As a result, CSP may
cause bleeding, bruises, infections, and/or permanent disfigurement
of the skin.
Sometimes skin-picking is preceded by a high level of tension and a
strong "itch" or "urge". Likewise, skin-picking may be followed by
a feeling of relief or pleasure. A CSP episode may be a conscious
response to anxiety or depression, but is frequently done as an
unconscious habit. Individuals with CSP often attempt to camouflage
the damage caused to their skin by using make-up or wearing clothes
to cover the subsequent marks and scars. In extreme cases,
individuals with CSP may avoid social situations in an effort to
prevent others from seeing the scars, scabs, and bruises that
result from skin picking.
As demonstrated above, CSP has obsessive-compulsive features that
are quite similar to OCD, BDD and Trichotillomania. It is sometimes
found in individuals with these disorders, as well as in patents
with certain medical conditions. In fact, a recent study found that
23% of those with OCD, and 27% of those with BDD, also had CSP.
Though not currently listed in the Diagnostic and Statistical
Manual (DSM-IV) published by the American Psychiatric Association,
some researchers believe it merits distinction as a separate
diagnostic entity.
The primary treatment modality for CSP depends on the level of
awareness the individual has regarding the problem. If the CSP is
generally an unconscious habit, the primary treatment is a form of
Cognitive-Behavioral Therapy called Habit Reversal Training (HRT).
HRT is based on the principle that skin-picking is a conditioned
response to specific situations and events, and that the individual
with CSP is frequently unaware of these triggers. HRT challenges
the problem in a two-fold process. First, the individual with CSP
learns how to become more consciously aware of situations and
events that trigger skin-picking episodes. Second, the individual
learns to utilize alternative behaviors in response to these
situations and events.
There are a number of other therapeutic techniques that can be used
as adjuncts to HRT. Among these are Stimulus Control techniques and
Exposure and Response Prevention (ERP). Stimulus Control techniques
involve utilizing specific physical items as "habit blockers" to
restrict an individual's ability to pick at his or her skin. ERP,
which is the primary treatment for OCD and many OC Spectrum
disorders, is most valuable if the individual with CSP is already
aware of the specific situations and events that trigger skin
picking episodes, and has already made significant recovery using
HRT. To learn more about ERP, click here. Also, medications that
are frequently used to treat OCD may be valuable adjuncts to CBT in
the treatment of Compulsive Skin Picking.
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