STOP PICKING - START LIVINGSTOP PICKING - START LIVINGIn this month’s webinar, Dr. Vladimir Miletic provides an overview of the current research into skin picking disorder. The research summary includes biological and neurological findings as well as what the research says about treatment. The full webinar is available on the SkinPick.com YouTube channel.
When a clinician considers a client’s presenting problems, the first thing they do is try and fit the client’s experiences into a model or theory from which treatment options come. Models and theories, then, become a lens through which we conceptualize the problem. Once we have the lens, then we have a plethora of evidence-based practice to consider for treatment options. Just as in medicine, not knowing the cause or how the symptoms manifest means you can’t really treat the problem effectively.
One of the challenges of treating compulsive skin picking is that it often co-occurs with other mental health issues such as anxiety, depression, and other body-focused repetitive behaviors. Sometimes, people with skin picking disorder will present to therapy for other issues and can be missed. Originally, the Rothbaum model of cognitive-behavioral therapy was developed to treat trichotillomania that co-occurs with anxiety and depression. A new study shows that it can be adapted and used successfully for skin picking disorder as well.
This therapy protocol uses cognitive-behavioral techniques with habit reversal training that targets not only skin picking disorder but also anxiety and depression. In this study, the treatment lasted 8 weeks with 45-minute sessions each week for individual therapy and 90 minutes for group therapy.
The treatment protocol begins with psychoeducation about skin picking disorder, identifying triggers, and learning self-monitoring. Then, the treatment moves into habit changing strategies and coping skills as well as thought-stopping and cognitive restructuring. The last part of the protocol involves changing internal dialog, creating positive reinforcement, and role-playing different scenarios. The therapy ends by developing a relapse prevention plan.
In reading forums lately, I came across two posts that struck me as requiring comment. The first comment is for people who do not struggle with skin picking disorder, and my second comment is for people who do.
Our behaviors and the way we interact with people profoundly impact others. While this statement might seem like common sense, magnify that by several hundred percents when it comes to people who struggle with mental health disorders. Then, think about the magnified levels of fear and anxiety someone experiences when they struggle not only with a mental health disorder, but a mental health disorder perceived by the rest of society as undesirable and unattractive. Therefore, any small amount of attitude or judgment you carry about people who are different in any way will be received as if heard by a loudspeaker.
Keep this in mind. No one knows what someone else goes through. Instead of trying to figure someone out by looking at them and making assumptions, turn on your compassion. Maybe that person could use a word of encouragement or someone to say hello without a pained expression and concerned tone. Maybe that person just wants to be seen and not just seen as someone with scars.
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Webinar will last about 1 hour, with a 45-minute presentation and 15 minutes Q&A time, where we can discuss anything you might be curious about. All participants will get handouts and links to additional resources.
The webinar is anonymous for participants. Participants will not see each other, they will only see the host.
The webinar will be hosted by Vladimir Miletic (Psychotherapist, MD).
The webinar will take place on Wednesday , Apr 1st. 18:00 PM EST (US Eastern Time)
People who struggle with body-focused repetitive behaviors (BRFBs) like skin picking are often misdiagnosed with non-suicidal self-injury (NSSI). Despite being two completely different categories in the DSM, many clinicians confuse the two because they do not know how to properly distinguish between the two.
People who pick at their skin cause intentional damage, which looks as if a person is harming his or herself. NSSI is a form of self-harm where someone purposefully causes themselves injury and pain. But that is where the similarities end.
Recent research examined the clinical differences in over 1,500 participants. The results indicate that people who engage in NSSI do so more often for a social-affective purpose like getting attention or to get out of doing something. They were also more likely to harm themselves to satisfy an emotional need, to regulate tension, or to experience pain. Furthermore, people who engage in NSSI report that hurting themselves either relieves emotional distress or helps them feel pain in contrast to their emotionally numbed state.
Anxiety and depression closely relate to skin picking disorder. Not only does anxiety and depression act as a trigger for 
picking, but the damage that results from picking creates additional anxiety and depression that feeds back to making picking worse. Additionally, people end up feeling ashamed, embarrassed, and helpless to make changes in their lives.
Although the treatment has been used by NASA since the 1970s for astronauts who return from space Pulsed Electro-Magnetic Field (PEMF) therapy is only recently coming into the public consciousness for anxiety and depression. Had someone asked me several weeks ago if I thought a magnetic frequency could affect the body as miraculously as practitioners claim, I would have laughed. However, research and real-life experience tell me otherwise.
The first time I heard about PEMF, a friend of mine told me how it helped her 8-year-old son who has a rare genetic disorder that causes severe arthritis, gastrointestinal issues, and depression. She told me that after receiving treatment, the swelling in his legs decreased significantly and he went from curled up on the couch in pain to bouncing around the house in typical joyful kid fashion. I looked at the research and it sounded great, almost too good to be true.
I met Mandy several years ago, a friend of a friend. She was (and is) delightful, funny, quirky, and well-read. We really only saw each other at my friend’s parties, so after a year or so at a Christmas party, I asked Mandy if she’d like to go out and see a movie with me or get a drink. I could always use another quirky, well-read friend.
“I don’t go out,” she told me, smiling nervously.
“But you’re here,” I said.
“That’s different.” She nervously scratched her head and made a hasty exit.
I asked my other friend why she bolted so suddenly...was it me? Did she think I was weird? Did she think I was trying to pick her up, like a date?
“Oh, no,” my friend said as she rinsed plates shiny with ham, and macaroni and cheese remains. “She has trichotillomania.”
I had to admit, I didn’t know what it was. But when she explained, I understood: a condition where a person picks at her hair, eyebrows, pulls them out. It often causes bleeding, sometimes infection, depending on the severity.
“But she has hair,” I said, still puzzled.
Research reveals that personality and skin picking severity may be linked and that cognitive reappraisal is an effective strategy for reducing behaviors.
The study published in the Journal of Obsessive-Compulsive and Related Disorders considered the influence of personality on skin behaviors in a non-clinical sample. First, the non-clinical sample is important because it means the 240 adult participants were “normal people” and not only people who presented for treatment of skin picking disorder. Also, this sample was much larger than other research on excoriation disorder, so the results may apply to a broader spectrum of people.
The results indicate a connection between personality profile and skin picking severity. In people with an Impulsive profile have the highest severity of behaviors. Additionally, those with a Pro-Social profile responded very well to the use of cognitive reappraisal by showing reduced skin picking behaviors.
As uncomfortable it is to talk about suicide, increasing knowledge about its risk and protective factors help with awareness. The more people aware of the risk and protective factors, the more likely they will recognize when someone needs help.
A recently published research study suggests that people with body-focused repetitive behaviors are at higher risk than the general population.
Research has established that people with obsessive-compulsive disorder have a greater risk of suicide than the general population. However, previous research did not consider the spectrum of disorders within the OCD category. What makes this study unique is that it looked for research studies that specifically looked at suicide with people diagnosed with skin picking disorder and trichotillomania in addition to the other OCD related disorders.
Even though there were few studies included in this research, the data suggest that suicide attempts among people with skin picking disorder and trichotillomania are low, with 3.7-12% of participants attempted suicide in their lifetime. However, suicidal ideation is higher with 40% of participants reporting they think about suicide.
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