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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.
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.
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.
Research suggests that yes, perfectionism makes mental illness worse. A recent report in the Harvard Business Review discusses the relationship between perfectionism and mental illness suggesting that young people today put incredibly high expectations on themselves, which leads to increased levels of depression and anxiety.
The definition of perfection changes based on who determines the qualifications. Therefore, perfection cannot be achieved; it is an impossible goal. As the article states, many young people have “excessive standards” for themselves, irrational ideals that can never be met followed by methods of punishing themselves for falling short. It goes on to explain three types of perfectionism, one directed at the self, one directed socially and the final version directed at others.
The study on perfectionism surveyed over 41,500 college students from the U.S., Canada, and the United Kingdom. They found that college students "are more demanding of themselves, perceive that others are more demanding of them, and are more demanding of others" with socially prescribed perfection twice as influential as the other two.
Throughout my experience as a therapist working in community health clinics as well as private practice, I worked with many clients who had a trail of therapists in their history and a jaded view about therapy’s effectiveness. Before giving you advice on finding a good therapist, understand that I am not criticizing therapy or those who provide it. Counseling is a noble profession and many people work in it out of a desire to help people. However, with that desire to help people comes the limitation that sometimes we think we can help anyone who comes through the door. Unfortunately, people who tend to seek mental health treatment tend to take the therapist to whom they are assigned when they call a clinic. They do not realize they have options and that they can ask for someone else. In this article, I’ll provide some tips about finding a good therapist as well as how to tell if a therapist is right for you.
To those outside the mental health profession, credentials do not mean much. However, when looking for a therapist, you should know that the educational and training backgrounds of the people who have letters after their name are important to the way they provide therapy.
Psychiatrist
The best advice comes from those who have been there and this month we have the pleasure of sharing the words of a client who went through the Skinpick.com program, which makes them an expert. As this client says, people are diverse, and everyone experiences skin picking disorder in a different way which means the treatment program needs to fit the client’s needs. No matter where you are in your recovery journey, Skinpick.com can help.
In the continuing quest for effective treatments for OCD and BFRB’s, a recent systematic review looked at ten studies that used biofeedback for a treatment intervention to determine if it is a viable treatment option.
Biofeedback is a process of learning how to control physiology to help people manage biosignal triggers of disorders. Biosignals include heart rate, body temperature, respiratory patterns, skin conductance, and muscle activity. Essentially, a person learns to self-regulate these processes first by recognizing physiological sensations and changes followed by learning techniques to manage them.
Anyone with excoriation disorder likely has gone to a dermatologist at some point. There are physical as well as psychological reasons for the development of skin picking disorder, yet for a long time, dermatology focused on the skin condition. With advances in science and technology, the field of psychodermatology is gaining more recognition.
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