Dermatillomania, commonly known as Skin Picking Disorder (SPD), is classified as a Body-Focused Repetitive Behaviour (BFRB). It is a serious disorder where a person is plagued with the urge to pick at skin on the legs, arms, chests or anywhere on the body including the face. This condition can go unnoticed for years as pickers often choose spots that can be hidden under clothing. Symptoms of dermatillomania include repetitive rubbing, touching, pulling, scratching, picking or even digging of the skin. For some it starts with the urge to remove irregularities or perceived imperfections in the skin. For others it is an obsessive compulsion driven by boredom, stress, excitement or anxiety. Patients have described the effect of pulling as not painful in itself, but as satisfying or even pleasurable.
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While this disorder affects both children and adults, onset is most prevalent in teenagers which supports a direct link to the onset of acne. For many sufferers, skin picking first began with picking at pimples. The urge to pick at this imperfection, led to compulsive picking, scratching or digging even after the acne had vanished. Teenagers are very aware of their physical appearance and are at a stage in their lives where they become acutely aware of the appearance of their skin. The slightest imperfection must be removed and the quickest way is to pick at it with fingernails, which leads to further imperfection which must also be removed. This turns into a vicious cycle of picking. The teen years are also a time riddled with low self esteem, insecurities and developing self identity. During this turbulant time in every person's life we are susceptable to extremes of emotion and it is our ability to develop healthy mechanisms to cope with these intense experiences that sees us through to adulthood. Unfortunately this is not the reality for everyone and instead many people employ unhealthy coping behaviours to help us through challenging times. With acne picking for example, the teen may find that while picking or popping pimples they experience a sense of release from tension or a distraction from emotional pain. This positive effect of picking at acne becomes a positive reinforcement for the behaviour so that the teen seeks out this effect the next time they endure emotional difficulty, for example due to bullying by peers, break-ups, stress around academic or sporting performance, etc. With constinuous repetition of this behaviour, a bad habit starts to form, and as the habit becomes more pervasive in the person's life, it starts to negatively impact their daily functioning. Damage to the teen's skin may cause him or her to socially withdraw out of shame and embarrassment. Social isolation in turn perpetuates the cycle of picking, and so the onset of compulsive skin picking unfolds.
The effects of skin picking are both emotional and physical. The person picking is often desperate to stop but is driven by the overwhelming urge to pick. It is a destructive and unhealthy coping behaviour for deeper issues that needs to be addressed, often through therapy. There are various treatment options such as support groups, cognitive behavioural therapy and pharmacological treatment. However they key is awareness and diagnosis. Skin picking is one of the most undiagnosed mental conditions, and without an individual being diagnosed or being aware of the problem, they will never seek the help they need. Key professionals that work with teenagers, such as student councillors, should be made aware of the signs and symptoms to look for and how to assist teens they suspect may have dermatillomania to get help.