Whoever created the saying “sticks and stones can break my bones but words will never hurt me” was either in complete denial or had no clue about the devastating effects of words. Things we hear in childhood echo in our minds for years to come, often shaping how we think and feel about ourselves. Some of it gets put there before we are conscious it.
Cognitive behavioral therapists work hard with clients to untangle words from beliefs that shape actions. One of my former clients, we’ll call her Jane, struggled with self-esteem and insecurity for most of her life. Growing up, she was told by her stepmother that her real mother didn’t want her over and over whenever she got in trouble, which was quite a lot. Jane was in her 30’s and coming to therapy for something else entirely, but through CBT work, discovered that those words shaped her entire life. She learned to believe that if her biological mother didn’t want her, then no one ever would. That shaped her destructive substance use, her emotional detachment in relationships, her distrust of others, her depression, anxiety, and eating disorder.
New research released this month about the prevalence of body-focused repetitive behaviors (BFRBs) suggests that these disorders are more common than previous research stated.
Prevalence? What’s prevalence?
Prevalence is a term used in epidemiology to describe a proportion of a population that has a condition. Mostly, it refers to the commonality of something. The numbers usually represent a fraction of a percentage of cases per 100,000 people but are specific to a given period.
While prevalence often suggests that the percentage provided is a real number, it is based on a sample population. Sample populations are smaller versions of the entire population which mean that even if there is the prevalence of 10% indicated for a condition, it does not mean that 10% of people have it. Instead, it means 10% of a sample population has it which implies that percentage reflects the general population.
The 26th Annual Conference on BFRBs will be held May 2-5, 2019, in Chantilly, VA.
The Annual Conference on Body-Focused Repetitive Behaviors brings together people of all ages affected by BFRBs and their families, treatment providers, researchers, and salon and service providers for a "life-changing" weekend of education and community.
We specifically seek workshops that:
For more information or to submit a presentation proposal, CLICK HERE.
Still a misunderstood condition, research is providing more ways for clinicians to diagnose excoriation disorder and its subtypes accurately. There are several ways to refer to compulsive skin picking including dermatillomania or excoriation disorder. They all mean the same thing and are often used interchangeably. No matter what it is called, there are many negative connotations with the word “diagnosis,” but there are also benefits to diagnostic accuracy.
Therapists have mixed feelings about the diagnostic process. Some believe it is essential and imperative for accurate treatment while others look at it as a means to facilitate treatment but not as important as what a client experiences. Some will require a client to participate in multiple types of assessments and tests to get the diagnosis right, while others will only rely on client self-report and then pick an appropriate label out of the DSM-5. Regardless of one’s therapeutic perspective, an accurate diagnosis is key to selecting evidence-based treatments for clients. For people with skin picking disorder, diagnosis can be even more important due to the prevalence of misdiagnosis which does not help clients at all.
Everyone has heard of sleepwalking, a phenomenon where a person walks around while sleeping with no memory of the event upon waking. A similar phenomenon can happen to people with excoriation disorder and trichotillomania. Additionally, bedtime can provide a picking-friendly environment either because of boredom triggering automatic picking or because picking is relaxing and helps a person go to sleep. A recent study looked at the relationship between sleep quality and compulsive skin picking and hair pulling as compared to a nonaffected control group as well as picking behaviors before bed and during sleep.
The first thing the study found was the participants with body-focused repetitive behaviors reported greater sleep disturbances than the control group. While the authors surmised this might be due to the depression and anxiety that often accompanies compulsive skin picking, they also found sleep disturbances were rated worse with people whose symptoms were severe. Another thought from the researchers is that because body-focused repetitive behaviors take up large quantities of time, those participants had less time available for sleep. Unfortunately, this study did not explore those questions further.
According to diagnostic categories, compulsive skin picking is considered to be on the spectrum of obsessive-compulsive disorders, yet it is not OCD. Sometimes, it co-occurs with OCD or other body-focused repetitive behaviors such as compulsive hair pulling, and researchers sought to determine whether the body-focused repetitive behaviors were one disorder. Secondarily, if body-focused repetitive behaviors were separate disorders, the researchers wanted to know if there was an underlying factor they all had in common to determine whether these behaviors could be predicted.
Over 2,700 participants agreed to answer questions in an online survey regarding their grooming habits. Of those, 36% intentionally pulled hair, 85% bit their nails, and 44% picked at their skin. Not only were their self-grooming habits evaluated, but the survey also assessed self-control, impulsive behavior, impatience, the presence of mental health and personality disorders, as well as contingent self-esteem which is self-esteem derived from outside sources.
Excoriation disorder is a debilitating and traumatic mental health disorder that commonly begins at the onset of puberty. Young tweens are likely to experience their first episodes accompanied by fear, shame, embarrassment, and the desire to hide the habit and the physical evidence at all costs. Approximately 1.4%-5.4% of the population experiences the compulsion to pick at their skin which is triggered by a variety of things. Skin conditions such as eczema, rashes, itching, or acne often inspire skin picking, but emotional triggers such as stress, anxiety, depression, anger, boredom, and fatigue can trigger it as well. People who pick at their skin in a disordered way may start with something innocuous like picking at a scab, but then they cannot stop resulting in severe skin damage.
A study is being done in Yale School of Medicine, which aims to understand the relationship between genes and BFRBs. Here’s a description on the study:
Description for Potential Research Participants:
You are invited to be part of a study of people with body-focused repetitive behaviors n(BFRBs) and related disorders. The purpose of this research is to understand the relationship between genes and these disorders. Our study is being done in part to try to find out why some members of your family are affected with BFRBs and others are not. Therefore, unaffected members of your family are important to this study. Eventually, we hope that this research will enable us to identify a genetic factor or factors that cause certain individuals to have BFRBs.
We would like to obtain a saliva sample from individuals with BFRBs and both of their parents for genetic analysis. This equires that you fill a small tube with saliva. This will allow us to perform genetic sequencing on your family to find whether there are DNA variants that are shared or different within your family. We will also look to find DNA variants that are shared or different when compared to unrelated individuals without BFRBs.
This is a guest post by a research team from the University of Wuppertal in Germany, who are
conducting a survey about a new questionnaire related to Skin Picking.
In 2013, pathological skin picking has gathered the status of a specified diagnosis in the diagnostic manual of the American Psychiatric Association. This important step has fostered new psychological research on skin picking. More and more clinical psychologists now initiate research projects that shall help to better understand skin picking behaviors and, as result, improve treatment options for skin picking.
Together with the German skin picking self-help collaboration, our clinical psychology research group at the University of Wuppertal in Germany contributes to this development, for example with questionnaire development. At the moment, there are already some good questionnaires that examine the severity and impact of skin picking. However, we identified a serious lack of questionnaires that also focus on possible backgrounds and triggers of skin picking in a sufficiently detailed way. So, it is hard to assess skin picking in its entirety and paint a holistic picture on the basis of the existing assessment instruments.
People who compulsively pick at their skin have different triggers and behavior patterns. Treatment attempts to identify the triggers and behavior patterns to create new, healthier behavior patterns. The assumption is that if the factors contributing to picking behaviors can be successfully addressed, then the behaviors will decrease or go away. For example, many people with skin picking disorder report picking more when they are stressed or anxious. In treatment then, the goal is to decrease stress and anxiety, and the picking behaviors will decrease as well. Then, there is the guilt, shame, anxiety, and stress that follow skin-picking episodes which sometimes trigger additional episodes. Therefore, a person’s ability to regulate emotions may impact skin picking behavior severity.