Compulsive Skin Picking

• What is it?
• Could you be affected?
• Treatment
• Recommended reading

What is compulsive skin picking?

Compulsive skin picking (CSP) is characterised by the repetitive picking of the skin to an extent where damage is caused. It is usually the face that skin picking starts, however it can be carried out on any part of the body. Individuals affected by CSP may start by picking at normal blemishes such as freckles or moles, pre-existing existing scabs, sores or even acne blemishes. They may also pick at imagined skin defects that nobody else can see. CSP can also be known as 'dermatillomania' or 'neurotic excoriation'. It is often categorised as an impulse control disorder under the Obsessive Compulsive Disorder (OCD) Spectrum as the skin picking is often repetitive, ritualistic and tension reducing. It can also be linked to Body Dysmorphic Disorder (BDD) as some suffers will feel that picking at acne or what they see as skin abnormalities (such as moles or freckles) will make them look more 'normal'. The picking can create pronounced abnormalities that lead to a vicious cycle.

Those who are affected by CSP may use any number of ways to carry out skin picking. These can include fingernails, teeth, tweezers, pins or any other devices. As a result CSP can lead to bleeding, bruising, and infections. In extreme cases, permanent damage and skin disfigurement can also be experienced.

CSP will often be carried out after the individual has experienced a high level of tension which has caused an 'itch' or 'urge' to carry out the behaviour. The skin picking is often accompanied by a feeling of relief or even pleasure due to the reduction in anxiety levels. However, once the damage has been done, those affected will often be left with a feeling of depression or hopelessness. Although the damage that is caused can be very severe, the gratification experienced can lead the individual to carry out CSP again and again.

While CSP can be the result of a conscious response to feelings of anxiety and depression it can also be an unconscious reaction. Sufferers can enter a trance like state and pick at the skin without being fully aware of their behaviour, only to be confronted by the results of what they have done afterwards. Many suffers will feel that they need to create pick able surfaces that will allow them to satisfy their compulsions. This can lead to a type of self harm where the individual will undertake self mutilation or cutting behaviours in order to produce scabs which can then be picked. A practice that is linked to CSP is Dermophagia which involves swallowing the skin or scabs that have been picked.

People who are affected by CSP will go to great lengths in an attempt to camouflage the damage they have caused through the use of make up and clothes that cover marks on the skin. In severe cases, individuals affected by CSP may even start to avoid any social situations in an attempt to prevent others from seeing the marks caused by CSP. They will also often refuse to see doctors for fear that marks in the skin will be detected. As a consequence, CSP for the most part, goes be unreported and therefore untreated.

Skin picking is often exacerbated by feelings of stress as it tends to increase the number of times an individual will pick and the length of time they will pick for. Other changes that can cause an increase in CSP behaviour could be a change in accompanying conditions such as a bad bout of acne or (for women) during PMT.

Are you affected by CSP?

• Do you recurrently pick the skin of your face, lips, scalp, arms, legs or body?
• Do you find that you skin pick more when you are anxious or stressed?
• Do you find that skin picking leads to feelings of pleasure, gratification, tensions decrease?

Treatment

Treatment for CSP has mostly been centred on Cognitive Behavioural Therapy (CBT). CBT can be particularly useful if the skin picking is carried out as a conditioned response to a specific situation or event. The triggers that lead to the skin picking will often not be known by the individual and CBT helps to raise aware of what these triggers could be.

Emotional freedom technique (EFT) can also be used to treat compulsive skin picking. Applying the mechanical steps of EFT will usually work to assist the individual to reduce the behaviour. EFT can also work to address the underlying cause of the compulsion, as the compulsion will often be carried out in an attempt to “tranquilise” anxiety.

Recommended reading