Not Just a Scab-Picker: The Truth Behind Dermatillomania

Introduction

The skin is the largest organ in the human body, a beautifully constructed barrier between your internal workings and the outside world.  The outermost layer, or epidermis, keeps bacteria and other irritants from making their way into your body.  The dermis, which is the middle layer, contains oil and sweat glands as well as lymph and blood vessels.  Finally, the hypodermis, or subcutaneous fat layer, helps to protect and insulate.

Having skin inevitably means that you will also have blemishes, such as acne, scabs, moles, and other trouble spots.  Most people are able to leave these areas be, allowing them to either heal on their own or exist without any significant distress.  However, others may experience difficulty to do so, sometimes to the point of requiring medical or psychiatric intervention.

What is Dermatillomania?

Skin-picking disorder, dermatillomania, and excoriation disorder all define the inability to stop picking at skin.  It is a body-focused repetitive behavior (BFRB) and is oftentimes related to obsessive-compulsive disorder (OCD), which involves obsessive thoughts that lead to compulsive behaviors.  People who struggle with dermatillomania may use their fingers or tools, such as tweezers, to pick at imperfections, often to the point of bleeding or bruising. Commonly affected areas are the scalp, face, and arms.

Onset of dermatillomania typically occurs in adolescence, between the ages of 13-15.  It is most common in female-identifying individuals, affecting approximately 1.4-5.4% of adults in the United States.  It is considered a chronic condition and usually waxes and wanes, with periods of no picking followed by more intense episodes.

Diagnostic criteria for dermatillomania include:

• Recurrent picking leading to lesions

• Repeated efforts to cease the behavior

• Notable emotional distress as a result of picking

• Not better explained by alternative psychiatric conditions, or other issues such as opiate withdrawal or a dermatological disorder.

Dermatillomania is often comorbid with other mental health conditions, some of which may include depression, anxiety, bipolar disorder, or OCD.  It may also coexist alongside other BFRBs, like hair pulling or nail biting.

Causes and Symptoms

Dermatillomania has a multitude of causes, and the origin will vary from person to person.  For some, the impetus is negative emotions such as stress or anxiety, or perhaps even mere boredom.  For others, it is driven by the presence of blemishes that they wish to “perfect”.  Other factors include genetics and brain structure anomalies.

Regardless of the motivating factors, skin picking can pose an extreme emotional burden.  Shame and embarrassment are common emotional responses to the behavior, and great lengths may be taken to camouflage scabs.  Time management may also be an obstacle because the picking itself is oftentimes time-consuming, as well are efforts to conceal ensued damage. The financial burden of dermatillomania is also something to consider as the cost of bandages and medication may also pose a challenge. Therefore, it may be difficult to participate in social interactions, engage in everyday activities such as getting a haircut, and asking for medical attention necessary to prevent infection and maintain overall health.

Treatment

Treating dermatillomania typically includes utilizing psychotherapy, such as cognitive behavioral therapy (CBT), to identify and cope with triggers, underlying emotions, and consequent behaviors.  Patients may take psychiatric medications such as selective serotonin reuptake inhibitors (SSRIs) to reduce symptoms.  Medical intervention may also be necessary in order to heal open wounds and prevent disfigurement and infection.  

Some strategies that may be helpful in limiting the frequency and intensity of picking include:

• Keeping hands busy with a fidget or craft

• Wearing gloves and/or trimming nails as short as possible

• Limiting access to tools such as tweezers, razors, and scissors

• Resisting the urge for longer and longer periods of time, with the goal of waiting out the peak of the urge until it subsides

• Practicing vulnerability with loved  ones to increase awareness and limit feelings of shame

• Practicing skin care, such as applying moisturizer to the affected area, when the urge to pick is strong

• Keeping skin clean to avoid medical complications

Conclusion

If you or someone you love is facing challenges associated with dermatillomania, there are resources available.  Contact your general practitioner, or consider visiting a psychotherapist or psychiatrist to discuss your experience and gain access to treatment options.  

Resources

DeMaio, K. B. (2023, July 11). 10 surprising things about your skin. The Skin Cancer Foundation. https://www.skincancer.org/blog/10-surprising-things-about-your-skin/

Excoriation Disorder (skin picking disorder). OCDUK. (n.d.). https://www.ocduk.org/related-disorders/skin-picking/

Excoriation disorder (skin picking or dermatillomania). Mental Health America. (n.d.). https://mhanational.org/conditions/excoriation-disorder-skin-picking-or-dermatillomania/

Mayo Foundation for Medical Education and Research. (2023, December 21). Obsessive-compulsive disorder (OCD). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/syc-20354432

NHS. (n.d.). Skin picking disorder. NHS choices. https://www.nhs.uk/mental-health/conditions/skin-picking-disorder/

Skin picking. The TLC Foundation. (n.d.). https://www.bfrb.org/skin-picking 

Assessed and Endorsed by the MedReport Medical Review Board