As with any condition of the body or mind, dermatillomania does not discriminate. Celebrities are often heralded by fans as being perfect and untouchable. Yet, celebrities also experience the trials and tribulations of human emotion, and are also vulnerable to stress and anxiety. Unfortunately conditions like dermatillomania evoke feelings of shame and embarrassment in the person challenged by it, and is therefore not a condition that is publicized, especially by those in the limelight. However, in 2012, a well known singer-songwriter became one of the first celebrities to publicly admit to having dermatillomania.
Putting dermatillomania in the spotlight
Tulisa Contostavios is famous in the United Kingdom for being part of the four-time platinum award winning hip hop group N-Dubz. She is more recently known for her role as a judge on the reality talent show X-Factor UK. In her autobiography titled “Honest: My Story So Far”, published in 2012, Tulisa provides a vivid account of her experiences with skin-picking disorder. Her memoires of her experiences with skin-picking shocked the celebrity gossip media, leading to interviews and gossip column articles quoting extracts from her book. Most of the extracts focussed on her description of the skin-picking behaviour she engaged in, which she describes quite graphically in the book. For example she describes picking at her face with nail clippers and tweezers “leaving gaping, weeping holes”. What the media fails to highlight though is her very real account of the immense anxiety and emotional anguish she endured that led to her skin-picking behaviour.
In her book Tulisa describes living with a mother with schizophrenia and enduring destructive personal relationships which left her feeling depressed and anxious. But perhaps the most important admission Tulisa makes are the feelings of guilt and shame she experienced because of dermatillomania. She describes finding out that she was not the only one who engaged in this behaviour and that it was a recognised as a clinical condition called dermaillomania, and that knowledge gave her the impetus to share her experiences with those close to her.
She says in her book, “I Googled the condition, sending links to my management and the people I was working with”, but explains that it was still difficult to come to terms with it because people still struggled to understand the behaviour.
Raising awareness and setting an example
Tulisa is one of the first celebrities known to publicize her battle with skin-picking, and it is hoped that if there are other celebrities out there who also struggle with dermatillomania, that they will be inspired by Tulisa’s courage and recognize the value a celebrity platform would add to raising awareness and support about and for Dermatillomania and those suffering with the condition.
Still an unnamed shame
Despite it being recognized as a clinical disorder, skin-picking is still undiagnosed in many who suffer with the habit in shame. There are other well known personalities who have alluded to the fact that they have in the past, or currently do have the compulsive habit of picking at their skin, most notably skin imperfections. In many cases their revelation describes the condition dermatillomania but it is not identified as such.
Another well known personality with dermatillomania is celebrated author of “I'm No Saint: A Nasty Little Memoir of Love and Leaving” – Elizabeth Hayt. Elizabeth describes her skin-picking habit for Elle magazine
Renée Rouleau is a celebrity esthetician who has also suffered from the condition for many years. Ironically it is because of her skin-picking that she has chosen her career path and is now recognized by the rich and famous as an expert in skin care. She talk frankly about her condition in this blog post.
There are rumours and unconfirmed reports of other, more well-known celebrities like Cameron Diaz being a skin-picker. However this cannot be stated as fact either because the celebrity is not necessarily aware they have the condition despite symptoms indicating so; or the reports are based on speculation based on past interviews or quotes from these celebrities.
Either way, it would not be surprising if there were many more famous or celebrated personalities with dermatillomania. The more awareness is raised about the condition, the more people, famous or not will come forward with their symptoms and receive the support and help they need.
One of the first and greatest hurdles to overcome to successfully be skin-pick free is to open up to someone who cares and to seek help and support. So imagine the courage it must take to stand up in from of hundreds of people, in front of a camera, and admit that you are a skin-picker. In this video clip, a brave woman named Caroline does just that.
Not only does she admit to being a skin-picker, but she also describes her skin-picking habits in detail and gives an emotional account of how skin-picking has impacted her life socially and academically. She describes the journey that so many with dermatillomania can relate to, in which the shame and guilt of her skin-picking habits drove her to engage in other destructive behaviours such as drug abuse. She describes a life spiraling out of control and failed attempts at managing her condition with therapy and support groups.
But there is joy to be found in Caroline’s story. She shares a lesson of hope and perseverance and most importantly the value of having the support of someone who understands you and understands your condition. Caroline does not dismiss the mainstream therapeutic approaches or support groups, describing them as having provided her with important tools that helped her on her journey to recovery. But it was having someone in her corner at her times of greatest need that helped her put those tools to effective use.
At the time of this clip, Caroline had gone from being an aggressive daily picker to having picked no more than 50 times within 6 months. Caroline is proud of what she has achieved and is so confident in her ability to manage her condition that she has chosen a strapless wedding gown in her upcoming wedding. But most importantly, Caroline has dispelled the feelings of shame and guilt, and has instead embraced confidence and hope for her future…a beautiful example of the possibility for all those suffering with dermatillomania.
Dermatillomania or excoriation (skin picking) disorder is not a very well known condition, primarily because the behaviours that manifests in this disorder are not often shared by people who engage in them. As a skin-picker you are often riddled with shame and guilt about your behaviour, covering up the ‘evidence’ to protect your closely guarded humiliating secret. Ironically the secrecy often isolates you from those you care about and, ironically, prevents you from receiving the much needed support and help you need to overcome it.
This short film (by Rhiannon Harris) called “She’s lost control” portrays just how lonely the shame of dermatillomania can be. In the film, a young beautiful girl is shown picking at sores (most likely created by her in the first place) until they bleed. She is disturbed by her mother knocking at the bathroom door asking her why she was taking so long. The film is very graphic, but it captures the urgency with which skin-picking engulfs the person while they are engaging in it. It also shows the distress the girl experiences when she hears her mother knocking at the door. In the audio you hear a therapist asking her questions about her skin-picking. In her answers you can hear that she doesn’t know how this habit came about or why she continues to do it, but she is clear that she does not want her mother to find out. In the end though, her secret is revealed. The humiliation felt as a skin-picker is one of the greatest hurdles one needs to overcome in order to deal with the condition. The loneliness and shame can lead to self-loathing. It is only through sharing ones experiences and gaining support will the burden feel lighter to bear and life as a skin-picker will feel far less alone.
What is Onychophagia
Onychophagia is a behavioral disorder characterized by compulsive nail biting. It is categorized with other disorders such as skin picking disorder (aka dermatillomania or excoriation disorder) and hair pulling disorder (trichotillomania) under the umbrella term body-focused repetitive behaviors (BFRB). These are compulsive habits that are automatic in nature and in its mildest forms are not perceived as socially unacceptable and therefore often not recognized by the individual as a clinical problem. Of the BFRBs, compulsive nail biting is the most socially accepted habits, viewed as simply a ‘nervous habit’. It is also commonly occurring in childhood with frequency tending to decrease by adulthood. However, the behaviour is known to intensify or persist through adulthood, and the severity of onychophagia can range from a very mild presentation to behaviours that are so severe that physiological complications occur.
Causes and complications
Onychophagia, as with other BFRBs are believed to be caused by feelings of anxiety and the individual’s inability to cope with these feelings in an effective way. The act of nail biting is believed to serve two functions:
1. Self-soothing: during times of stress, tiredness, or intense emotion, the human brain experiences sensory overload. Self-soothing is a mechanism human beings use to cope with these overwhelming sensory processes. However, sometimes people adopt unhealthy self-soothing behaviours such as nail biting. The act of nail biting provides immediate relief to the person, but it is short-term causing the individual to seek out its soothing effects more often resulting in the behaviour becoming repetitive and compulsive.
2. Stimulation: In contrast, human beings also crave healthy stimulation of the sensory processes. When the sensory pathways are under stimulated through, for example, inactivity or boredom, BFRBs such as nail biting provides the necessary stimulation.
However, nail biting is a destructive habit which can lead to a number of different physiological complications. If one considers the amount of germs the human hand comes into contact with throughout the day, nail biters are vulnerable to infections such as gastroenteritis and the spread of viral infections such as the Herpes. In other cases the nail biter may bite so close to the cuticle causing the cuticles to bleed and abscess to develop at the nail site.
Treatment of Onychophagia
There are two levels of treatment. On the one level one can treat the symptom of the disorder by taking measures to stop or guard against the actual act of nail biting. On another level one can try to address the underlying cause of the nail biting behaviour. A combined treatment approach is probably the most effective in achieving habit reversal. Treatment methods include:
Bitter varnish: bitter varnish made with a natural extract and is therefore harmless if ingested can be applied to the nails. This may deter the person from biting at the nails or reduce the severity of the problem
Manicures: beautifully manicured nails may offer the nail biter a visual reminder of the habit as nail biting is often an automatic response
Acrylic nails: the nail biter may not achieve the same stimuli from biting nails that are not their own so this may also reduce or deter the habit
Self-monitoring: This method can be employed as a physical deterrent as well as a psychological one. This method requires the nail biter to keep a log of their nail biting behaviour. Bringing the automatic habit into the conscious mind may interrupt the habit thereby reducing the habit. On a psychological level the individual may be encouraged to use the log to identify patterns in behaviour to identify what the stressors are that elicits the behaviour. This can then be linked with more intensive cognitive-behavioural therapy
Stimulus control: this method is used in conjunction with self-monitoring as it requires the person to identify triggers to the behaviour and to be aware of these triggers in their daily functioning. The person is then encouraged to develop alternate, less destructive coping mechanisms
Competing Response: the principle behind this method is to identify a competing habitual behaviour that provides a competing stimulus to biting the nails. These preferably should preoccupy the hands and/or the mouth e.g. chewing gum
Cognitive-behavioural therapy: CBT is a more intensive approach that addresses the underlying causes of the behaviour. The individual is made aware of how their thoughts impact on their behaviours, and how negative behaviours further reinforce negative thinking patterns. The individual is encouraged to adapt their thinking patterns and to adopt healthy coping and stress relieving behaviours. This method is used in conjunction with self-monitoring, stimulus control and competing response.
Pharmocological: When the underlying cause is primarily due to high levels of anxiety, it may be appropriate to treat the anxiety with anti-anxiety medications. These may be prescription medication or natural or homeopathic remedies to relieve stress and anxiety.
Onychophagia may not be perceived as a problem when the behaviours do not interfere with daily functioning. However the nature of the condition, being a body-focused repetitive behaviour is that the longer the habit is left untreated the stronger the habitual response becomes. This is particularly a risk when underlying causes of anxiety or stress are elevated in the person’s life. When the nail biting habit becomes so severe that it impedes functions like driving, typing, writing, cooking, or poses a physiological risk to the person due to some of the complications noted earlier, it has also reached a habitual level that is harder to break and therefore harder to treat.
Habit reversal training is best addressed when the automatic response is still weak. The principle behind habit reversal is the belief that the less the behaviour is enacted, the weaker the habitual response becomes, thereby eliminating the destructive habit completely. It is also vital that the nail biter has good social support and does not try to address the condition alone. Aside from family and friends, online support groups and websites can be a great source of support, information and motivation.
The Trichotillomania Learning Centre (TLC) was initially aimed at providing support to people with thrichotillomania (hair pulling disorder). However as TLC has grown it has come to recognised the links between trichotillomania and other conditions such as skin-picking disorder (SPD) which are classified as body-focussed repetitive behaviours (BFRB). They have since evolved into a prolific organization in the support of education, awareness and research into the cause and treatment of all BFRBs including skin picking. However, since skin picking, also known as dermatillomania or excoriation disorder, is still a growing community, resources and support to the skin-picking community is not at the same level as programs focused on hair pulling. As such TLC are conducting a survey to understand needs of the skin-picking community to guide them in creating and improving programs that will benefit those suffering from skin-picking disorder.
TLC therefore invites you or anyone you may know with skin-picking disorder to participate in a short 10 minute survey to share your views. Your responses will be anonymous, but you also have the option to enter into a draw with a chance to win a $100 gift certificate which is redeemable at the TLC online store.
There has been disagreement in the medical fraternity about the classification of skin-picking disorder (SPD) with some grouping it with obsessive compulsive disorders (OCD), while others categorising it as a body-focussed repetitive behaviour (BFRB). One might question what the importance is of classifying the skin-picking disorder into any specific category when they are all so similar. The importance lies in the advancement of knowledge and understanding of the causes and developing guidance of treatment of the condition. There are distinct clinical differences in the presentation of obsessive compulsive disorders and the underlying causes, and those of BFRBs. As such, there are also differences in the treatment approaches that are most effective within each category of disorder. In a recent 2012 internet study comparing the rates of problematic BFRBs in individuals with SPD, it was found that skin-picking disorder is associated with body-focussed repetitive behaviours.
What are BFRBs?
According to Angela hartlin's skin-picking support website, Body- Focused Repetitive Behaviours (BFRB’s) “is an umbrella term for any chronic behavior that causes a person to consistently cause physical damage to oneself unintentionally through a compulsive act in order to relieve anxiety.” The key difference between BFRB and other compulsive behaviours that cause harm to the body is that BFRBs are characterised by direct body-to-body contact. The website goes on to list other BFRBs such as: hair-pulling disorder (trichotillomania), hair eating disorder (trichophagia), skin biting disorder (dermatophagia), nail biting disorder (onychophagia), and nose picking disorder (rhinotillexomania).
The link between Compulsive Skin Picking and BFRBs
In the study linking skin-picking to BFRBs, it was found that there was a strong co-occurrence of the different BFRBs where individuals who skin-pick also tend to bite nails or pull hair obsessively. There was also a strong correlation between individuals with skin-picking disorder and a familial history of one or other BRFB. This suggests that the cluster of BFRBs may have familial traits rather than the specific behaviour itself. There are some other sub-categories of BFRBs that develop as an extension of the main habit. For example skin-pickers may also develop the habit of picking at scabs that form on healing sites where skin picking previously occurred. This can develop into the habit of eating the scabs. In the same vein, it is not uncommon for individuals with hair pulling disorder to develop the habit of eating hair which evolves into a BFRB on its own. From the research it is suggested that BFRBs are automatic habits in that there is no reflective awareness or cognitive awareness of deliberate harm to the body. Skin-picking disorder presents in a similar fashion in that the individual does not initially start out intentionally trying to harm or damage the skin. However the regulatory effect experienced by the person engaging in this behaviour on overwhelming emotions or cognitive thought patterns such as intense anxiety, causes the person to habitually seek out this effect through continued picking. This mounts to obsessive repetition of the behaviour without the person realizing until it has developed into a clinical condition. In this way skin-picking, as with other BFRBs respond well to similar treatment methods such as habit reversal.
Dermatilloma is a skin-picking disorder that not only leads to skin damage, but the severity of the behaviour is directly proportional to the social and emotional distress experienced by the person who engages in the behaviour. Anyone with a skin-picking disorder will testify to the shame and embarrassment the condition causes. People with dermatillomania (official term: excoriation disorder) often suffer in silence, unaware of how common the condition actually is. The explosion of web-based technology has given millions of people suffering from dermatillomania access to information and enabled individuals to seek support anonymously. One of the most common questions asked by people seeking information about skin-picking disorder is, “did I inherit it?”, or, “is it genetic?” Often people asking this question have noticed members of their immediate or extended family having similar habits, which leads them to conclude that they must have inherited the behaviour. This is also a concern for people who do not suffer with skin picking, but have witnessed the debilitating impact it can have on a relative’s life, and are concerned that there may be a possibility that they could inherit the condition. These concerns are not unwarranted as existing family history data seems to suggest that skin-picking disorder is familial.
Heritability of skin-picking disorder
In one study of 60 participants with skin-picking disorders, 28.3% of their first degree family members had the disorder. Skin-picking is also often associated with Obsessive-Compulsive Disorder (OCD). Scientists have identified a genetic marker for OCD, but the onset of OCD is also believed to be triggered by a combination of genetic and external factors. So the question remains, is the familial aspect of skin-picking disorder due to the genetic component of OCD, or are there independent genetic factors associated with skin-picking disorder? A study has shown that individuals with skin-picking disorder, without OCD, are more likely to have a first degree relative with the disorder than individuals with OCD. This suggests that there may be genetic factors associated with skin-picking disorders independent of the genetic contribution to OCD. However, the reality is that research into the condition is still very limited and its causes are unknown. A 2012 twin study examining heritability of skin-picking symptoms, found that skin picking was a relatively common problem, particularly among women and that it tends to run in families mainly due to genetic factors. However, the study also concluded that non-shared environmental factors were also instrumental in the onset of skin-picking symptoms. These findings are backed up by other similar prevalence studies that have found skin-picking disorder to be as common as many other psychiatric disorders, with the most recent suggesting it affects between 2% to 3% of the general population.
The age-old Nature vs Nurture Debate
The reality is that there is still very little hard evidence as to the cause of dermatillomania. There are experts who believe that there definitely is an underlying genetic component resulting in some people having a greater predisposition to becoming skin pickers than others. On the other hand there are many experts who view skin picking as a maladaptive behaviour associated with:
- poor coping skills
- obsessive and compulsive thinking
- poor frustration tolerance
By this definition, skin picking is an impaired response in times of high stress. Studies with mice do seem to suggest that there is a strong genetic component to the cluster of behaviour known as Body-Focussed Repetitive Behaviours (BFRB). In these studies, the removal of a gene led to the mice engaging in excessive grooming similar in presentation to hair–pulling and skin-picking, causing damage to the skin of the mice. This has led researchers to conclude that there is an underlying genetic cause for skin-picking and hair-pulling disorders, and that these disorders are a manifestation of excessive grooming. Genetic factors identified by animal studies include mutation of the Hoxb8 gene, and deficiency of the scaffolding protein SAPAP3. This was consistent with a human genetic association study that variation in the SAPAP3 gene is linked to the onset of grooming disorders.
Future Genetic Research
The good news is that research interest in Body-Focussed Repetitive Behaviours such as skin picking disorder has grown in recent years. The Trichotillomania Learning Centre (TLC) is at the forefront of such research. Trichotillomania, a hair pulling disorder, is clustered with skin picking disorder as a Body-Focused Repetitive Behaviour. The TLC is engaged in an international collaborative research project named the Trichotillomania International Consortium for Research. The ambitious project aims to gain a better understanding of the underlying risk factors for trichotillomania and dermatillomania through genetic research. Genetic information such as blood samples, DNA, and cell lines; as well as clinical data collected through in-depth interviews, will be collected and stored for use in present and future studies. The biological samples and clinical data will be stored in a biobank, which is a type of biorepository, and will become an important resource in hair-pulling and skin-picking disorder research. The biobanks will give multiple researchers in the scientific community worldwide access to data representing larger numbers of people than may be possible if they were to collect this data independently. It also enables multiple uses of the data. The Psychiatric and Neurodevelopmental Genetics Unit (PNGU) in the centre for Human Genetic Research and the Massachusetts General Hospital will be the coordinating site for data collection and management. Additional biobanks have also been established at the University of Cape Town and the University of Stellenbosch in South Africa, with plans to establish additional sites in the near future. It is hoped that this resource will facilitate the much needed research into this condition. However, it is important to recognize that even though research points to genetic influence, the role that neurological, behavioural and environmental factors play in the onset of the condition should not be minimized if effective treatment approaches are to be developed.
Dermatillomania or skin-picking disorder manifests in many forms. Common areas that are the focus of skin picking include the face, arms, neck, and scalp. Skin-picking disorder is part of a cluster of disorders known as Body-Focussed Repetitive Behaviour (BFRB). When dermatillomania presents as an obsessive-compulsive scalp-picking behaviour, it can often be confused with another BFRB called trichotillomania. Trichotillomania is a hair-pulling disorder, which leads to hair loss and sometimes baldness. However, scalp-picking is motivated specifically by the person’s urge to pick at the skin of the scalp, whereas hair-pulling is the urge to pull the hair out of the scalp.
Does picking scalp cause hair loss?
While hair-pulling directly removes hair from the scalp, causing immediate hair loss, scalp-picking does not directly target the hair strands or follicles. Unfortunately the hair strands and follicles inevitably become damaged with repetitive picking at scalp skin. Constant picking at the scalp skin can cause the area to become sensitive and sore, sometimes causing bleeding and open wounds on the scalp. This can result in the skin cells on sensitive areas losing its ability to heal efficiently, often leading to hair loss. Sometimes scalp-pickers do pull hair out in order to gain easier access to the scalp. The formation of scar tissue on the scalp after an area of skin has been picked open can exacerbate the picking behaviour, with the person resorting to picking at the scab. This further damages the skin tissue, reinforcing the cycle.
Can scalp-picking cause baldness?
Repeated picking at the scalp skin can also cause damage to the hair follicles. The damage occurs below the surface of the skin so it is not visible to the naked eye, apart from patchy hair loss or thinning of the hair that occurs. It is important to distinguish between scratching of the scalp due to a dermatological condition which may cause itching; and scratching or picking at the scalp skin due to an obsessive compulsion to fulfill the urge to pick or scratch. People who suffer with dermatillomania pick and scratch at the scalp regardless of the discomfort or pain that follows. In severe cases the picking can cause the open skin to become sensitive to shampoos, water, and even air, impeding the person’s daily function. Yet, despite this, the person cannot resist the urge to continue picking at the scalp. This can result in the removal of the protective covering on the individual hairs, from the hair shaft. This weakens the hair shaft, leading to permanent damage, breakage and hair loss. When the hair follicles are permanently damaged, and are replaced with scar tissue, this is known as scarring alopescia. Initially the person may experience gradual hair loss with no noticeable symptoms, and can go undetected for a long time. In some cases where follicles on the periphery of a bald patch are not completely destroyed, the hair is able to re-grow. However, if the person continues to engage in repetitive scalp picking, often all that remains are scars on the scalp to show where the follicles once were. When the follicles are damaged beyond repair, this can lead to baldness.
Cosmetics brand Dermablend Professional recently launched an advertising campaign on YouTube called the Camo Confession Campaign. The cosmetics industry is often slated for being superficial and encouraging women and girls to strive for the unrealistic ideal of perfection. Dermablend Professional hopes to challenge this view with the Camo Confession ad campaign. The campaign kicks off with a young model named Cassandra removing her make-up and sharing her personal story of shame and ridicule as a young teenager because of her terrible facial acne. Even though she is talking about acne, we thought the heart of the story is something that many who suffer with skin-picking disorder can relate to.
The clip is just over 2 minutes long, but it has a powerful message. For many patients, skin-picking started with the onset of acne as a teenager. Scratching and picking at the acne sets off a cycle of repetitive obsessive compulsive behaviours. Picking acne can cause permanent marks and scarring, which is a source of great embarrassment for the person, especially if it is in the face. Many skin-pickers therefore feel the need to camouflage these marks cosmetics. The teenage years can be especially traumatizing when aesthetics and appearance play such a big role in social acceptance and formation of self-identity.
Dermablend Professional’s corrective cosmetics are used by people with mild to severe skin conditions. The message from the ad campaign is that the Dermablend brand is not about vanity, but about having the freedom to express oneself positively, free from ridicule, and living a normal life. This is achieved through the heartfelt testimonials two women who describe their stories of shame and embarrassment because of a skin disorder that made them the centre of much ridicule. As they speak the make-up on their faces start to disappear and they leave us with a parting message that the Dermablend’s concealing products empowers them to reveal who they truly are, because their imperfections do not become the centre of distraction.
When a person bites their nails, it's considered a bad habit. But when they start biting the skin around the nails, causing bleeding, unsightly scars, and skin discoloration, it's a symptom of dermatophagia, an impulse control disorder related to obsessive-compulsive disorder.
People suffering from dermatophagia are sometimes called “wolf biters” because they bite off chunks of flesh. Unlike wolves, they bite off their own skin.
Dermatophagia can be cured, but the treatment varies based on the age of the person, as well as the severity of symptoms.
The first noticeable symptom of dermatophagia is bleeding because it is one of the first signs of the disorder. When somebody tries to bite off a bit of torn skin next to a fingernail, they can easily bite too deeply and cause bleeding. It can happen to anybody and it's not a reason for concern. But those who suffer from dermatophagia cause bleeding all the time and are not even bothered by it. Sometimes they don't even notice it. In fact, they may even find the pain pleasant because it offers a relief from feelings of boredom or anxiety.
This brings us to the second symptom: biting compulsively and constantly, especially under pressure. After some time, people often stop biting their nails and skin because the scars look ugly and feel embarrassing. Their friends and family members sometimes point out their hands look ugly and suggest them to stop. But when stress and anxiety pile up, they find it impossible to resist biting. And biting to reduce stress can cause even deeper wounds, even uglier scars, heightening feelings of embarrassment.
The result is the third symptom, skin damage. If you notice thin, discolored skin, scars around the nails, callouses or hangnails, you're looking at the hands of a wolf biter.
These symptoms are not just ugly to look at or damaging to a person's self-esteem. While these are, on their own, good reasons to quit biting, constantly biting nails and skin is simply bad for health. The constant exchange of bacteria between mouth and fingers, as well as having open wounds, can cause skin infections. Even worse, constant biting can result in tissue damage.
What Causes It?
OCD is a disorder characterized by obsessive thoughts (“did I lock the front door?”) followed by compulsive behaviors (checking if the door is locked). The behavior offers immediate relief, but feelings of anxiety soon return, repeating the cycle of checking and acting out. In this case, dermatophagia is a compulsive behavior that offers temporary relief for feelings of anxiety.
Body dysmorphic disorder is an unhealthy, pervasive obsession with one's imperfections. In this case, it would mean looking at flaws in one's nails or old scabs due to wolf biting. This would cause a person to bite a bit here and there, until the fingers are raw and bloody.
Whether the roots lie in OCD or BDD, there are many reasons that can trigger the onset of dermatophagia. Some reasons are definitely genetic - many people suffering from dermatophagia have family members affected by OCD or anxiety. Other factors include traumatic events in early childhood, stress, and even boredom. Some sufferers are aware of their condition, describing an urge to bite that can only be relieved by giving in. Others do it unconsciously, while they're busy doing something else.
Relation to Dermatillomania
Dermatophagia is classified as a Body-Focused Repetitive Behavior (BFRB), an umbrella term for impulse control behaviors, also containing dermatillomania (skin picking) and trich (hair pulling). All these conditions can generally be described as compulsive behaviors with similar traits. BFRBs tend to start in a period of life where a person experiences heightened anxiety and stress.
This nervousness is then reduced by compulsive behaviors - picking on skin in dermatillomania, pulling and sometimes eating hair in trichotillomania or biting nails and skin in dermatophagia. The compulsive behavior reduces anxiety, but causes physical harm. Physical damage in turn causes unpleasant thoughts and feelings that trigger the compulsive behavior again.
This vicious cycle of self-supporting behavior is why
Treatment of dermatophagia comes in several broad categories: preventing behavior, psychotherapy, and medication.
If the condition is not severe, a simple solution is to take steps to discourage biting. In this approach, a person can unlearn the behavior by making the experience of biting unpleasant or impossible. These simple measures include mouth guards, bitter or foul-tasting nail polish, fake nails, and even dipping fingertips in cayenne pepper extract. Distraction techniques or rewards can be especially effective with children.
One very popular product that often helps dermatophagia sufferers is Mavala Stop - Helps Cure Dermatophagia, Nail Biting and related disorders.
This is a transparent formula with a distinct bitter taste to discourage from nail biting and putting fingers in the mouth.
Some sufferers take matters in their own hands. They learn as much as they can about the disorder, and then quit “cold turkey”, without professional help or medication. It's important to note this method requires a lot of willpower. Looking at every split nail and every torn piece of skin, while resisting the urge to bite them off is hard. But it works for some.
As for psychotherapy, cognitive-behavioral therapy is particularly good for impulse control disorders. A therapist works with a client to find out which thoughts and feelings accompany the biting, when it typically happens, and why it persists. Then they determine a plan of action that includes methods for coping with stress and reversing habits.
In some cases, taking prescription medications may be necessary for severe cases of dermatophagia. Even then, it is advisable to start psychotherapy to take care of undesirable behaviors and ensure lasting changes.
There are many different approaches to therapy. But one of the most important steps a person suffering from dermatophagia can take on their own is to take a look at their life and see what causes them emotional disturbance that leads to biting. Eliminating this source of suffering will be of great help to reduce the motivation to bite.