There are many therapeutic interventions to help an individual focus on what is important to them. Values are those things which someone prioritizes as valuable. They can be things, ideas, people or activities and people make decisions consistent with what is important to them. Values-based therapy starts by setting up new values or reviewing existing values. This happens before discussing the problem because every step of therapy afterwards will use values as the foundation for decision making and treatment planning.
Driving is a prime environment for skin picking behavior, but competing responses can help. People who pick their skin fall into two categories:
Driving is one of those activities that many people do alone and as a private place, or it can become automatic allowing one’s thoughts to wander.
In habit reversal therapy, before considering replacement behaviors, you learn to recognize circumstances and locations that trigger picking. For many people, driving is a frequent location. Once triggers and behavior patterns are recognized, you learn and develop strategies to disrupt the behaviors you want to change. One of the strategies for disrupting behaviors is the development of competing responses.
Competing responses are movements that are incompatible with habitual behaviors like skin picking. Think of something that is the opposite of the behavior you want to replace. It should be something you can do for longer than a couple of minutes and will be more less unnoticeable by others. It may be something challenging that you do with your hands, or something easy to do that just keeps your hands occupied.
Examples of competing responses that can be used while driving include:
Skin picking disorder, more formally known as excoriation disorder, is considered an obsessive-compulsive related disorder, however it is not obsessive-compulsive disorder. Skin picking can also be a symptom of obsessive-compulsive disorder, so how does one tell the difference? First, we’ll talk about the basic diagnostic criteria for each disorder, then we’ll get more specific about how to tell the difference.
(Diagnostic criteria are taken from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition published by the American Psychiatric Association.)
1. OCD is marked by the presence of obsessions, compulsions, or both.
Obsession – Recurrent or persistent thoughts, urges, or images that are intrusive, unwanted, and cause significant anxiety or distress. A person attempts to ignore or suppress them or to neutralize them with some other thought or action. Actions usually take the form of compulsions.
Compulsion – Repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession or according to rigid rules. The behaviors and mental acts serve the purpose of preventing or reducing anxiety, distress or a dreaded event or situation. The behaviors and mental acts are not connected realistically with what they are supposed to neutralize or prevent, or they are clearly excessive.
Scabs on the scalp are a result of cracks in the skin of the head that bleed and dry. The dried blood forms a scab and helps the wound heal. Picking at a scab constantly reopens the wound, causing it to bleed again. Then it forms another scab. It can be tempting to pick at a scab because as it forms, the skin tightens and dries out, drawing your attention to it. There are several things you can do to help facilitate quick scab healing.
A little bit of prevention goes a long way. Scalp skin is tender, sensitive, and can be damaged easily. Regardless of the cause of scabs on your scalp, if you tend to get them or already have them, take some steps to prevent them from occurring and from getting worse.
Annette Pasternak's very first stop skin picking coaching client, Carly talks about her journey and the strategies that have been most helpful to her in the long-term. Number one is logging, tracking her picking daily. She uses different methods of monitoring picking, from the SkinPick app to a simple calendar tracking method.
Tracking daily skin picking activity is a mindful practice that can help in a number of ways.
A mindful practice
What do we mean by mindful practice? Mindfulness is the process of being present in the moment, aware of thoughts, feelings, and bodily sensations without judgment. Practicing mindfulness can help you separate of the behavior of skin picking from your identity and objectively evaluate where you are and where you want to be.
We think we know a lot about our habits, but tracking them provide revealing insights. In the early stages of treatment, identifying habits, triggers, and behaviors related to skin picking helps to formulate a treatment plan consistent with your goals. Think of tracking as a way to investigate how the skin picking disorder affects your life.
The Addictive, Compulsive and Impulsive Disorders (ACID) research/clinical group of the University of Chicago has a variety of treatment services and clinical trial opportunities available in the areas of substance addiction, impulse control, and obsessive compulsive disorder. Dr. Jon Grant, onle of the leading researchers in body focused repetitive behaviors such as dermatillomania, is the director of the group. ACID strives to better understand the biological underpinnings of conditions such as substance and behavioral addictions, including alcohol, drug, and tobacco dependency, pathological gambling, compulsive shopping, kleptomania (shoplifting), pyromania (fire setting), compulsive sexual addictions, obsessive-compulsive disorder (OCD), skin picking, trichotillomania (hair pulling) and body dysmorphic disorder. It is hoped that through understanding the cause and triggers, there can be better facilitation of treatments and quality of life for clients and their families. Currently they have two studies underway. One for hair pulling, and one for both skin picking and hair pulling.
Do you pull your hair or pick your skin?
For most, it’s only natural to assume that the longer you’ve had your problem (e.g. dermatillomania), the longer it has to take in therapy, etc., to fully cure. But is this really the case? The truth is, how long you’ve been struggling with dermatillomania, or how bad it’s been, has nothing at all to do with how long it has to take to get it handled once and for all. It is not about perfections, it’s about overcoming dermatillomania in the long run.
Most people would consider having high standards a good thing. Striving for excellence can show that you have a good work ethic and strength of character. High standards can also push you to reach your peak level of performance. Perfectionism, on the other hand, involves a tendency to set standards that are so high that they either cannot be met, or are only met with great difficulty. Perfectionists tend to believe that anything short of perfection is horrible, and that even minor imperfections will lead to catastrophe.
Compulsive skin picking will often be carried out after the individual has experienced a high level of stress which has caused an ‘itch’ or ‘urge’ to carry out the behavior. The skin picking is often accompanied by a feeling of relief or even pleasure due to the reduction in anxiety/stress levels. However, once the damage has been done, those affected will often be left with a feeling of depression or hopelessness. Although the damage that is caused can be very severe, the gratification experienced can lead the individual to carry out compulsive picking again and again.
Annette Pasternek is an authority on the subject of compulsive skin picking disorder. In a recent video, she takes a look at the history of body focused repetitive behaviors (BFRBs)in science, as detailed the BPM (BFRB Precision Medicine Initiative) brochure of the TLC Foundation for BFRBs. If you prefer reading, here is a summary of her video:
Compulsive skin picking (CSP) is an impulse control disorder. It compels people to damage their skin by picking at it repetitively. If you live with this challenging condition, you know exactly the kind of raw and painful toll it takes – both physically and emotionally. Also known by the tongue-twisting name dermatillomania, this form of self-mutilation affects as many as 1 in 20 people. Those who live with dermatillomania know that the negative effects extend far beyond the physical. They often have to limit or alter their daily activities. For example, someone who picks at their arms may wear long sleeves in the summer to hide fresh self-inflicted wounds or scabs. Someone who compulsively aggravates the skin around their fingers may avoid shaking hands or even resort to wearing gloves when around others. The compulsive picking may also cause physical pain or discomfort that also limits activities. For example, someone whose fingertips are raw from constant picking may find writing or typing too painful. However the most painful thing that dermatillomania suffers go through on a daily base is the guilt and shame.
It isolates you