STOP PICKING - START LIVINGSTOP PICKING - START LIVING
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.
Keratosis Pilaris is a common skin disorder characterized by bumpy skin accompanied by redness. It tends to show up on the upper arms, legs, buttocks, and sometimes the face. Often described as “chicken skin” it is harmless, non-contagious, and cycles through periods of mild to severe outbreaks.
When the skin is dry, skin cells flake off, however, in people with Keratosis Pilaris, the small dry skin particles called keratin clump up in the openings of hair follicles. The redness that sometimes appears with the bumps results from the dilation of the small blood vessels under the skin. Everyone experiences the sloughing of dead skin cells, but medical science does not have an answer for why some people develop keratosis pilaris and why others do not. Some theories suggest it is a hereditary condition since it tends to run in families. Other theories suggest it is related to dry skin conditions and allergic inflammation conditions.
Skin picking disorder is a compulsive body-focused repetitive behavior with neurobiological similarities to attention deficit hyperactivity disorder (ADHD). Methylphenidate is a psychostimulant used to treat ADHD yet may also serve to trigger skin picking disorder.
People with skin picking disorder repeatedly pick, poke, squeeze or lance the skin resulting in injury and emotional distress. It is a compulsive act, and many people try to stop on their own but cannot. Researchers have discovered neurobiological mechanisms that contribute to skin picking disorder as well as physical reasons for worsening symptoms, but the exact biological mechanism remains unknown. For example, skin picking disorder appears to have a genetic link. People with a family history of the obsessive-compulsive disorder are more likely to develop to skin picking disorder. People with skin picking disorder are also more likely to have family members with other body-focused repetitive behaviors.
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.
One of the questions asked of those who struggle with compulsive skin picking is, “doesn’t it hurt?” Despite all the research available on excoriation disorder, none examined the pain thresholds of people who compulsively pick at their skin, until recently.
Excoriation disorder is a body-focused repetitive behavior where people compulsively pick at their skin to the point of doing extensive damage. Sometimes picking starts to rid oneself of blemishes and imperfections, while other times it serves as a self-soothing behavior. The triggers are different for each person, and the cause is unknown. Most people spend a significant amount of time picking, sometimes hours per day. Also, many hours go into covering up wounds and caring for damaged skin. The stigma attached to this disorder leads to significant psychosocial impairment, and many with this disorder end up with co-occurring mental health problems.
Skin picking disorder is a chronic condition that lasts a lifetime, which means it never goes away completely. However, it is possible to live without picking, and many people do so successfully. People in recovery from skin picking disorder learn to manage the urges and behaviors similar to the way people with asthma learn to manage their condition. It takes awareness, perseverance, and resilience but even then relapse can happen.
The concept of relapse is most associated with addiction. The word itself connotes dread, fear, or failure. The dictionary definition does not inspire confidence either “suffer a deterioration after a period of improvement.” Contrast the definition of “lapse” which is to “pass gradually into an inferior state or condition.” How would you like refer to a setback?
Dermatologists are physicians who specialize in treating conditions of the skin. Skin picking disorder tends to result in visits to a dermatologist to help with problems from chronic skin damage. But how often do dermatologists recognize a compulsive body-focused repetitive behavior and refer to a patient to a therapist or psychiatrist for help?
When dermatologists are trained, they are made aware of the interconnectedness between the skin and the nervous system. Not only do some skins condition worsen during periods heightened nervous system activity such as stress and anxiety, but skin conditions often provide fuel to heighten the nervous system. In dermatology, the interconnection between the skin and the psychosocial dimension of skin conditions is referred to as psychocutaneous medicine (Gould, 2004). Despite receiving initial training, many dermatologists neglect the role psychology plays.
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