Dermatillomania is an obsessive compulsive disorder where a person has an intense urge and need to pick at their own skin. It is a disorder that consists of body focused repetitive behavior. For people with this disorder, the urge to pick at their own skin is so strong that often damage is done to the skin that doesn’t heal correctly or it leaves scars. Picking at their skin is a stress release and a coping mechanism for those with this disorder.
Those who suffer from this disorder often feel shame and are embarrassed by their behavior and they try to hide the evidence of their disorder. Individuals with this disorder 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 this disorder may avoid social situations in an effort to prevent others from seeing the scars, scabs, and bruises that result from skin picking.
Fortunately, there is a growing interest in understanding and treating the disorder. Several skin picking treatment options are becoming available but there is still much more being left unsaid, even undiscovered as yet, about this disfiguring and dangerous obsession.
Medications used to treat this disorder are also used to treat many obsessive compulsive disorders and anxiety related disorders. For example, artificial fingernails (acrylic or gel) have been found to be useful to some in stopping the picking behavior. It is recommended to never try any medications without first consulting a physician.
The primary treatment modality depends on the level of awareness the individual has regarding the problem. If the disorder 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 dermatillomania is frequently unaware of these triggers.
HRT challenges the problem in a two-fold process. First, the individual with this disorder 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.
In many cases, cognitive-behavioral therapy is most effective when combined with the use of mood-stabilizing medications. Hypnosis, self-hypnosis and meditation have also been useful for some patients.
There are a number of other therapeutic techniques that can be used as adjuncts to HRT. Among these are exposure and response prevention (ERP) and stimulus control techniques. ERP, which is the primary treatment for obsessive-compulsive (OC) disorders and many OC spectrum disorders, is most valuable if the individual with dermatillomania is already aware of the specific situations and events that trigger skin-picking episodes.
Stimulus control techniques involve utilizing physical items such as gloves or rubber fingertip covers to reduce the client’s ability to pick at his or her skin. Also, medications that are frequently used to treat OC disorders may be valuable adjuncts to cognitive-behavioral therapy in the treatment of compulsive skin picking.