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Skin picking is more than just a “bad habit”. Skin picking disorder (SPD), also known as excoriation disorder or dermatillomania, is a body-focused repetitive behavior (BFRB) where someone recurrently and compulsively picks at their skin to the point of injury. The urge to pick can be quite intense and seemingly without reason. But, where do these urges come from and just what do they mean? In a recent skinpick.com webinar, Dr. Vladimir Miletic takes a closer look at the urge to pick.
Meaning is central to the human experience. Our experiences and the meaning we assign to them shape who we are. When describing urges to pick, it isn’t unusual for someone to describe the urges as “irrational” or not making sense to them. Dr. Miletic suggests that rather than urges being irrational, they may be better understood in the context of meaning. What is the logic behind them? Thinking in this way can pave the way for progress.
Skin picking disorder (SPD) is a mental health disorder on the OCD spectrum that belongs to a group of disorders known as Body-Focused Repetitive Behaviors (BFRBs). SPD is characterized by repetitive and compulsive picking at the skin causing damage to the skin.
What causes someone to develop SPD and other BFRBs, like hair pulling, isn’t entirely clear. Research suggests that genetics may play a role. Skin picking, like other BFRBs, is more common in people who have family members with SPD, or related disorders such as OCD (obsessive-compulsive disorder) or another BFRB.
There is some evidence that suggests SPD is a neurological disorder, caused by underdeveloped motor-inhibitory control. Inhibitory control is an important element of executive function that allows for the suppression of actions and resistance to interference from irrelevant stimuli. Problems with inhibitory control have been found to be related to structural issues in the brain.
Tourette’s Syndrome is a neuropsychiatric disorder that generally appears in early childhood. It is characterized by tics or involuntary movements or vocalizations. Tics are sudden repeated twitches, movements, or sounds. People who experience tics cannot stop their bodies from doing them or, can only stop them briefly. The tics can change over time. Symptoms peak in early adolescence with most people becoming asymptomatic by early adulthood. It is quite common to see other conditions occur with Tourette’s. In fact, about 80% of people with Tourette’s Syndrome have at least one comorbid disorder. One of the most common of these comorbidities is Obsessive Compulsive Disorder (OCD), present in over 50% of people who also have Tourette’s.
Most of us have experienced the feeling of wanting something we’re doing to be “just right”. We might want our hair and make-up “just right” or our room arranged “just right”. Most people can reach a place of satisfaction. Sometimes, though, something is “not just right” becomes problematic. That phenomenon is known as “incompleteness” and for people with obsessive-compulsive disorder (OCD) and related disorders like skin picking, it can create problematic behaviors.
It has been a busy 2021 for the BFRB Precision Medicine Initiative! Even with the continuing impacts and restrictions resulting from the coronavirus pandemic, researchers have continued to pursue projects that are contributing to the goals of the BPMI and advancements in treatment of BFRB disorders. The first learnings from this research are now being published and we expect this work to lead to improved treatment outcomes. Some of the scientists in the BPMI gave an in-depth update on this progress at TLC’s virtual conference this past spring. Here are some of the highlights of that update:
When you think about compulsive skin picking, you probably don’t think about addictions, right? After all, Skin Picking Disorder (SPD) is classified as an Obsessive-Compulsive Related Disorder in the DSM5. It was previously classified as an impulse disorder. But not everyone agrees on how to classify SPD and in fact, some research has found that SPD actually shares a number of clinical features with behavioral addictions. Those features include:
• repetitive/compulsive engagement in the behavior despite clearly adverse consequences
• diminished control over the problematic behavior
• urges prior to engagement in the problematic behavior
• pleasant sensations during the behavior
We all avoid things. It’s our go-to when something is unpleasant, or we just don’t want to deal with something. But there’s avoidance and then there’s avoidance – the kind that can create emotional distress. In this SkinPick.com webinar, Dr. Vladimir Miletic talks about emotional avoidance and how avoiding difficult emotions and memories may lead to skin picking behavior.
According to Steven Hayes, the Father of Acceptance and Commitment Therapy, experiential avoidance occurs when a person is unwilling to remain connected to particular private experiences such as body sensations, emotions, or thoughts and takes steps to alter the form or frequency of these events and the contexts in which they occur. Dr. Miletic frames this behavior as the things a person is willing to do to minimize or change their experience so they don’t have to deal with it.
We use avoidance behaviors all the time. Some are relatively benign. Others, like skin picking, can have significant, often unintended, consequences. So, the question is, why do we avoid if we know that it causes problems?
There’s no doubt that the Covid 19 pandemic has been traumatic for many people in so many ways. Seemingly overnight, our world changed. Our way of life changed. The world has seen a level of suffering and loss most of us have not experienced in our lifetimes. While some would argue otherwise, it is safe to say that the pandemic has been a traumatic event on a global scale. To say we were not emotionally prepared to cope with such an event would be an understatement.
With the pandemic, there has been increased attention to those who live with skin-picking and other Body-Focused Repetitive Behaviors (BFRBs), and concern for the effects that this prolonged stressor may have on their symptoms. Eighteen months out, data is sparse but early indicators are that the pandemic is affecting some people who live with skin-picking and other BFRBs. Others have not experienced adverse effects. With the pandemic still in full force, just how this trauma has affected people is still being explored. It will surely be some months, maybe years, before we know the full effects. In the meantime, researchers continue to explore mental health issues and to understand how the pandemic may be affecting people.
If you’ve never heard of Morgellons Disease, you’re not alone. It is a skin disorder that is steeped in controversy and mystery. While first identified in 2002, a similar skin ailment was first mentioned in 1674 in a letter by English physician, Sir Thomas Browne in which he referred to “the Morgellons” and described several children as having a skin disorder characterized in part by “harsh hairs” protruding from their skin. Morgellons is a considered a lay term to describe an unexplained set of symptoms primarily involving the skin. It is not currently recognized as a distinct clinical disorder with established diagnostic criteria that are generally accepted by the medical community. In fact, some clinicians consider it purely a manifestation of a psychiatric disorder. Because Morgellons displays characteristics of other, more well-recognized conditions, it is often not the first consideration for diagnosis. But not everyone in the medical community agrees. And, therein lies the problem. So what do we know about Morgellons Disease and what does it have to do with skin picking? When it comes to diagnosis and treatment, a lot.
Seemingly overnight, the COVID pandemic changed our normal way of life. The resulting lockdowns, shutdowns, and distancing restrictions meant that people were faced with having to find new ways to access everything from basic needs to their jobs, their family, and even their healthcare. Being isolated from others meant being on your own to deal with whatever came about. It’s no surprise that as the pandemic wore on, mental health issues surged. Anxiety and depression rates escalated along with the demand for mental health care. Healthcare providers of all disciplines were left scrambling trying to balance safety with service provision.
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