Most people have on occasion engaged in nail-biting or even picked at a scab a little too much. But sometimes, these behaviors become too frequent and the urge too much to resist. Why does that happen?
Habitual nail-biting, hair pulling, and skin picking are collectively referred to as body-focused repetitive behaviors (BFRBs). These actions are recurrent, problematic, destructive behaviors directed toward the body and are thought to be triggered by some unpleasant emotional state. Many people engage in these behaviors from time to time (e.g., nail-biting) but do so at subclinical levels that create little or no functional impairment. For some people, they can manage their emotional triggers and responses in healthy, non-injurious ways. For others, however, their emotional responses somehow get misdirected and the result is destructive body-focused behaviors like skin-picking and hair-pulling.
How that works isn’t exactly clear and researchers have turned to various psychological models to try and understand how and why BFRBs occur. What seems to be clear is that these behaviors seem to emerge in response to emotional triggers and serve to help alleviate emotional distress.
For people struggling with skin picking, finding adequate treatment can be a challenge. While classified as an obsessive-compulsive disorder by the APA’s Diagnostic and Statistical Manual (DSM-5), the disorder also results in physical injury to the skin sometimes requiring medical attention. Deciding what type of clinician to see can be confusing. Is it medical? Is it psychiatric? Skin picking also carries a degree of embarrassment for many people. Asking for help can be hard, leaving many to choose to delay treatment. A new study published in The Journal of Obsessive-Compulsive and Related Disorders sheds new light on the attitudes and experiences of people seeking treatment for skin picking and offers recommendations for improving the treatment experience.
Researchers continue to explore mental health disorders known as body-focused repetitive behaviors (BFRBs). Less than 3% of the general population struggles with BFRBs like excoriation (skin-picking disorder or SPD) and trichotillomania (hair-pulling disorder or HPD). Researchers suggest that BFRBs, especially, HPD, are more common in women than men. They have also found that approximately 38% of people with SPD also have HPD. BFRBs are chronic conditions that last a lifetime.
Is COVID-19 affecting your mental health? If so, you’re not alone. According to a Mind.org study, approximately 68% of young adults and 60% of middle-aged and older adults have experienced a decline in mental health due to COVID-19 restrictions and lockdowns. But, COVID-19 isn’t the only thing that can impact your mental health. A variety of factors can throw your mental health into “free-fall” or aggravate mental health conditions.
In 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.
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)