Dermatillomania
Dermatillomania is a mental health condition where a person compulsively picks or scratches their skin, causing injuries or scarring. Also known as excoriation disorder or skin-picking disorder, this condition falls under the category of obsessive-compulsive disorders (OCDs). When it leads to significant scarring and injuries, this condition can severely affect a person’s mental health, well-being and quality of life. Q: What is the difference between dermatillomania and obsessive-compulsive disorder?
A: Obsessive-compulsive disorder (OCD) is a specific condition that also lends its name to a category of mental health conditions. While dermatillomania falls under the overall category of obsessive-compulsive disorders, it still has some key differences from the specific condition of OCD.
Obsessions. OCD involves obsessions, which are thoughts or urges that a person can’t control and doesn’t want. Those kinds of obsessions don’t happen with dermatillomania.
Feeling of reward. When people with dermatillomania pick at their own skin, they often feel relief or other positive emotions. That doesn’t happen with OCD.
Damage. OCD rarely involves any kind of self-damage or self-injury. With dermatillomania, that kind of self-injury is extremely common.
Q: Who does it affect?
A: In years past, experts believed this condition was much more common in women. However, recent research shows that only about 55% of people with this condition are women. Women are also more likely to seek treatment for this problem.
The condition usually starts during puberty but can happen at any age. The condition is also more likely to happen to people who have “triggering” conditions like acne or eczema.
Q: How common is this condition?
A: Dermatillomania is an uncommon condition, with an estimated 2% of people having it at any time and up to 5.4% of people having this condition at some point in their life.
Q: How does this condition affect my body?
A: Dermatillomania causes a person to pick at their skin compulsively. For some people, picking is an automatic movement, and they might not even realize they’re doing it. Others are aware that they’re doing it but can’t stop themselves.
For some people, picking focuses on areas of skin that are rough or already have some kind of blemish or irregularity. Examples include picking at pimples, patches of dry skin or scabbed-over cuts and scratches (those wounds can come from picking or from other causes).
Picking can create new wounds or reopen old ones, leading to bleeding and scarring. When this condition is severe, it can lead to skin damage that’s extensive enough that it may need surgery, such as skin grafting, to repair the damage. Infected wounds may also need antibiotic treatment.
In rare cases, infections from these wounds can spread throughout your body, leading to an overwhelming immune system overreaction. That overreaction, a condition called sepsis, is a life-threatening medical emergency.
Mental Health Effects
Often, people with this condition feel embarrassed or ashamed of the visible injuries, trying to hide them with clothing, makeup or other means. Because of that, this condition can be a source of anxiety, depression or social isolation. This condition can also affect people’s work or social lives. Other conditions that happen with dermatillomania
People with dermatillomania are more likely to have other mental health or medical conditions. Some of these include:
OCD or other OCD-related disorders like hair-pulling (trichotillomania) or nail-biting (onychophagia).
Depression.
Anxiety disorders.
Bipolar disorder.
Prader-Willi syndrome.
Symptoms
The main symptom of dermatillomania is compulsively — meaning, the impulse or urge is impossible or incredibly difficult to resist — picking at your skin. Experts also describe the act of skin-picking using the following words:
Scratching.
Digging.
Squeezing.
Rubbing.
Picking usually involves fingernails and fingertips but can also include biting with your teeth (especially when the skin surface affected is on your lips. It can also involve sharp items like tweezers or pins.
----Types of picking----
This activity usually happens in one of two ways, “automatic” or “focused.”Automatic: This kind of picking often happens without a person thinking about it. Experts sometimes call this “scanning” because it tends to involve running hands or fingertips across areas of skin to find any areas that feel different, which might then become an area for focused picking.
Focused: This kind of picking is “focused” on a specific area, and the picking can go on for hours. This kind of picking tends to be more severe and is more likely to cause damage to your skin.
----Where it happens on your body----
Picking tends to focus on certain areas of your body. Those areas are the ones that you can most easily reach with your hands, including:
Head: Face, scalp and neck.
Arms: Fingers, hands and forearms.
Legs: Thighs, calves, feet and toes.
Treatment Options
Treating dermatillomania usually involves a combination of medication and therapy. Research shows that combining the two tends to help more than just one type of treatment alone.
----Medications----
The most common medications that healthcare providers prescribe to help treat this condition include:
- Antidepressants. The most likely medications for this are selective serotonin reuptake inhibitors (SSRIs).
- Anticonvulsants. Lamotrigine is a medication that helps with uncontrollable muscle movements. Research shows it can help in some cases of dermatillomania.
- Antipsychotics. These medications help by modifying the balance in your brain chemistry. These medications commonly treat many conditions like dementia, bipolar disorder and schizophrenia. Researchers are also continuing to look into how they can help treat conditions like dermatillomania.
- Nutraceuticals. These are nutrition-related products that can also affect medical or mental health conditions. For dermatillomania, research has found that the amino acid supplement N-acetylcysteine can help reduce the urge to pick.
-----Therapies-----
Psychotherapy can help treat this condition in various ways, depending on the therapy method used.
- Habit reversal therapy. This method involves helping you become more aware of your behaviors and activity patterns. By helping you become more aware, this therapy teaches you to break habits like skin picking.
- Group therapy and peer support. People with dermatillomania may benefit from specific types of group therapy or support.
- Cognitive behavioral therapy (CBT). This method involves teaching coping mechanisms and strategies to help change behavior.
- Acceptance and commitment therapy. This therapy method helps people change behaviors like skin picking by accepting negative feelings that fuel the behavior. Mindfulness and other positive coping mechanisms also play a role.
----Other treatments related to Dermatillomania----
People with severe damage to their skin or their tissue underneath may need additional medical treatment and care. Your healthcare provider is the best person to explain the treatments they recommend, which might include surgery and skin grafting, antibiotics and more.