The bracelet project is all about making a bracelet in order to encourage the many who struggle with the urge to pick or pull when they are sitting watching TV or talking on the phone, to rather keep their hands busy for a good cause. In addition it promotes the connection with others who share your struggles and spreading awareness to the broader community. This great bracelet project that ran successfully last summer is the initiative, yet again, of the Canadian BFRB Support Network!
The American Psychological Association (APA) describes hypnosis as a cooperative interaction in which the participant responds to the suggestions of a hypnotist. The technique has been clinically proven to provide medical and therapeutic benefits, most noticeably in the reduction of pain and anxiety. Many skin picking sufferers report going into a trance-like (hypnotic) state when picking at their skin. Hypnosis is sometimes used as a tool to understanding this behaviour and bringing it under control.
Hypnosis speaks directly to your subconscious and makes you more aware of what you are doing when you pick or scratch your skin. Rather than automatically indulging the behavior, hypnosis makes you become very mindful of what you are doing. This means that you notice your hand reaching towards your mouth, or that you are clenching your jaw and grinding your teeth, or rubbing the skin to feel for imperfections, rather than just automatically doing it. Using hypnosis in conjunction with an existing treatment program has been shown to increase treatment success.
Cognitive-Behavioural Therapy (CBT) is a form of therapy that seeks to alter behaviour by identifying the precise factors that trigger picking and then learning skills to interrupt and redirect responses to those triggers. Broadly stated, CBT is based on learning theory which has shown that as we practice new behaviours and thoughts in response to familiar emotions or situations, our brains physical structure actually changes too. We develop neural pathways and, with repetition, the new behaviour becomes an automatic response. CBT should be performed by a mental health specialist trained in this method and well versed in treatment of these behaviours – something that may be easier said than done as there is not an abundance of professionals who specialize in body-focussed repetitive behaviors (BFRbs). The therapist will encourage pickers to develop an increased awareness of the times of day, emotional states, and other factors that promote picking, as an important precursor to being able to control the behaviour.
Autism Spectrum Disorder (ASD) and autism are both general terms for a group of complex disorders of brain development and are characterized by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviours. One of the most distressing aspects of Autism is the occurrence of repetitive self-injurious behavior such as head banging, hair pulling, face slapping, and skin picking, scratching or pinching. So is there a link between autism and excoriation disorder? Psychiatric comorbidity certainly is common in ASD with one study finding that 24.7% of their study sample of autistic subjects had comorbidity with another disorder of Tourette syndrome, chronic tics, trichotillomania, enuresis, or encopresis. But the reverse correlation does not hold true in that for the most part those with skin picking disorder have no direct or genetic link with ASD. So why then do so many with ASD engage in this same compulsive behavior and can this provide some clues as to why those without ASD do the same?
Image: Mütter Museum of The College of Physicians of Philadelphia
The Mütter Museum of The College of Physicians of Philadelphia began as a donation from American surgeon Thomas Dent Mütter, MD (1811-1859), who was determined to improve and reform medical education. The aim of the museum is to help the public gain insight into the the mysteries and the beauty of the human body to learn about the history of medicine, diagnosis and treatment of illness and disease. Today, the Museum enjoys a steadily rising reputation with annual attendance exceeding 130,000 visitors, and has been featured on countless TV programs and specials and is the subject of two best-selling books.
We have previously discussed NAC or N-acetyl cysteine and its benefits in the management of compulsive skin picking behaviors on this blog, describing what NAC is and how it works. We discussed the 2009 study conducted by Dr. Jon Grant, one of the leading experts on body-focussed repetitive behaviors (BFRBs), which showed that 56% of the subjects reported “much or very much” reduction in hair pulling in subjects with trichotillomania (another BFRB) on NAC compared to 16% on a placebo. However, till now there has been no research to our knowledge of any research into its effectiveness with excoriation disorder specifically. So we were very excited to stumble across an academic article published just this month detailing a study, in which the researchers experimented with two antioxidant supplements—N-acetylcysteine and glutathione—to treat mice with skin-picking disorder.
Critical Voices (CV) is part of a growing movement to understand medicine, health and wellbeing as subjects which demand ethical judgements, empathy and wisdom, with insights from science and the arts. By bringing together health professionals, patients, researchers, artists, writers, campaigners and the wider public they aim to provoke challenging insights, conversation and debate on some of the most critical areas of our lives.
In July, Critical Voices hosted Liz Atkin, a visual artist based in London, who has been challenged by skin picking disorder for more than 20 years. In September last year we featured a post about an interview by BBC radio’s Felicity Finch with Liz Atkin, who talks about her disorder and the impact her art has had on her journey to recovery. According to Liz, her art has helped her heal in a very huge and powerful way. She has been able to express very deep feelings that she previously did not have the language to express.
In May 2013 excoriation disorder, or compulsive skin picking disorder was added to the revised Diagnostic and Statistical Manual (DSM5). This is a significant, positive step for those suffering from this condition as it acknowledges that there is a clinical component to the behavior. This recognition by the American Psychiatric Association (APA) is largely due to the efforts of those health professionals who have identified the sore lack of research and understanding of body-focussed repetitive behaviors (bfrbs). It is the recent upsurge in research that has led to the inclusion of these disorders in the DSM5 and it is research that will lead to improved understanding of the causes and treatments for compulsive skin picking.
Excoriation disorder does not discriminate. Research into compulsive skin picking seem to indicate that this disorder has no boundaries with regards to age of onset, gender, race or nationality. There does not seem to exist a set pattern of onset, with age of onset varying greatly from one individual to the next. According to one study, a staggering 47.5% of their 40 subjects reported onset of skin picking before 10 years of age. Research also seems to suggest that the younger the age of onset, the less likely it is for the person to seek or receive treatment. This is not surprising given insight into self and the need to seek help is an abstract cognitive skill that only develops later in life. Children are dependent on their caregivers to identify when all is not well and take ensure that they receive the care they require.