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.
Food fuels your body and just like any machine that requires fuel, those with the highest fuel tend to perform best. Pardon the human to the car analogy, but most people would not put contaminated gas into their vehicle on purpose for fear of the vehicle breaking down. Our bodies are similar. Sometimes the body reacts immediately to a contaminant such as in cases of food poisoning or allergies, other times, the body reacts slowly in the form of oxidative stress and inflammation which wreaks havoc in the body in ways we do not always attribute to food.
Since skin is the largest organ in the body, it seems reasonable that would take a lot of fuel to remain healthy. Skin needs multiple types of vitamins and nutrients to be at its best. For people with skin picking behaviors, eating right can facilitate healing and might contribute to reductions in picking.
NOTE: The following list is not prescriptive, only suggested. There is no guarantee that the claims made will work because each person’s body is different. For dietary recommendations specific to your skin needs, consult with a registered dietician or registered nutritionist.
When a person bites their nails, it's considered a bad habit. But when they start biting the skin around the nails, causing bleeding, unsightly scars, and skin discoloration, it's a symptom of dermatophagia, a body-focused repetitive behavior. People suffering from dermatophagia are sometimes called “wolf biters” because they bite off chunks of flesh. Dermatophagia benefits from treatment, but the treatment varies based on the age of the person, as well as the severity of symptoms.
The first noticeable symptom of dermatophagia is bleeding. When somebody tries to bite off a bit of torn skin next to a fingernail, they can easily bite too deeply and cause bleeding. It can happen to anybody and it's not a reason for concern. But those who suffer from dermatophagia cause bleeding all the time and are not even bothered by it. Sometimes they don't even notice it. Or they may even find the pain pleasant because it offers relief from feelings of boredom or anxiety.
An official diagnosis of dermatillomania (also called skin picking or excoriation disorder) should be completed by a qualified healthcare professional. Keep in mind that although awareness of body-focused repetitive behaviors (BFRBs) increased in recent years, there are still many healthcare providers who are not trained to differentiate BFRBs from related disorders. However, preliminary self-diagnosis can be helpful for determining next steps.
First, it is important to understand that skin picking is not a problem because occasionally removing flaky skin or old scabs is normal. It only becomes a problem when a person finds it difficult to stop and the picking causes wounds. Therefore, it is useful to look at different skin disorders and their symptoms. Second, there are official diagnostic criteria specified in DSM5. Third, a person can use an online questionnaire as a means of self-diagnosis. Then, confirm the diagnosis with a physician, dermatologist, psychiatrist, or qualified mental health provider.
Dermatillomania or excoriation disorder is not a well-known or well-understood mental health condition. Unlike other disorders popularized in entertainment such as obsessive-compulsive disorder portrayed by Leonardo Di Caprio in “The Aviator” or bipolar disorder portrayed by Claire Danes in “Homeland.” Other disorders with widespread awareness include anxiety, PTSD, depression, autism spectrum and ADHD not only because they are more common, but because they often affect children. However, dermatillomania involves picking at the skin until it bleeds, causing wounds and scare, behaviors which carry a lot of stigma. Therefore, people who struggle with the disorder tend not to talk about it nor do they seek treatment.
As a superhero fan and former therapist, I love finding positive messages in comics, movies, and pop culture characters. The best part is connecting mental wellness themes with characters that people can relate to. An overall uniting theme in superhero character development stories is overcoming barriers and setbacks. During treatment for mental health issues, people tend to experience multiple setbacks which are clinically called “relapses.” While relapse connotes a negative, each setback provides an opportunity to overcome. The chronic pursuit of overcoming obstacles is what turned Carol Danvers into Captain Marvel.