Annette Pasternek is an authority on the subject of compulsive skin picking disorder. In a recent video, she takes a look at the history of body focused repetitive behaviors (BFRBs)in science, as detailed the BPM (BFRB Precision Medicine Initiative) brochure of the TLC Foundation for BFRBs. If you prefer reading, here is a summary of her video:
Compulsive skin picking (CSP) is an impulse control disorder. It compels people to damage their skin by picking at it repetitively. If you live with this challenging condition, you know exactly the kind of raw and painful toll it takes – both physically and emotionally. Also known by the tongue-twisting name dermatillomania, this form of self-mutilation affects as many as 1 in 20 people. Those who live with dermatillomania know that the negative effects extend far beyond the physical. They often have to limit or alter their daily activities. For example, someone who picks at their arms may wear long sleeves in the summer to hide fresh self-inflicted wounds or scabs. Someone who compulsively aggravates the skin around their fingers may avoid shaking hands or even resort to wearing gloves when around others. The compulsive picking may also cause physical pain or discomfort that also limits activities. For example, someone whose fingertips are raw from constant picking may find writing or typing too painful. However the most painful thing that dermatillomania suffers go through on a daily base is the guilt and shame.
It isolates you
Trichotillomania (hair pulling disorder), and Dermatillomania (compulsive skin picking), are two of the many Body-Focused Repetitive Behaviors (BFRBs), in which a person can cause harm or damage to themselves or their appearance. Other BFRBs include biting the insides of the cheek and nail biting.
Other body focused repetitive behaviors such as compulsive skin picking, compulsive nail biting, cheek biting and nose picking are very similar to trichotillomania in their effect on the family and the sufferer’s self-image. They often co-occur with trichotillomania. These disorders are understood to be similar to trichotillomania and the same treatment approach that is used for trichotillomania is used for these disorders.
As with trichotillomania, people with skin picking disorder experience some type of distress because of the disorder.
They may feel ashamed because they seem unable to stop themselves from engaging in this harmful behavior
Both hair pulling and skin picking can be done subconsciously, or automatically.
It is not uncommon for people to subconsciously rub, touch, or scratch at their skin, just as it is a common practice for many people to pick at skin imperfections such as acne or blackheads. However, for some, this practice becomes so consuming that it is classified as a skin picking disorder known as excoriation disorder or dermatillomania. Picking your skin becomes problematic when the picking is repetitive and it becomes difficult for the person to voluntarily stop engaging in the behavior, and impacts negatively on daily functioning. This poorly understood problem often goes undiagnosed and therefore untreated.
Picking is particularly common in the teen years when skin problems like acne often surface. There are three types of teen picking:
Determining your values is practically useful in your daily reality as what you perceive to be 'missing' will become what seems to be 'important'. So this is why our private voids give rise to your public values. Although determining your values can be practically useful in your daily reality, in actuality, nothing is void or missing in the first place, it is only in another unrecognized form. But what you perceive to be 'missing' will become what seems to be 'important'. So this is why our private voids give rise to your public values. You fulfill a void and value through either a perception or an action.
As an important first step, it is important to understanding what is triggering the urge to pick. Often times the tension and pressure you may be feeling is stress, and your worries, fears and physical feelings result in everyday anxiety. Once you can identify and name the problem, you can begin dealing with it.
No matter what type of anxiety problem you are struggling with, it is important to understand the facts about both stress and anxiety:
People suffering from compulsive skin picking may pick at normal skin variations such as freckles and moles, at pre-existing skin defects such as scabs, sores or acne blemishes, or in some cases imagined skin defects that are not actually visible by others. Individuals with compulsive skin picking not only use their fingernails to pick and scratch but may also use their teeth and/or other instruments such as tweezers, blades and pins. The compulsion to scratch, pick or peel pimples is called acne excorié and could be considered a subtype of compulsive skin picking. Although any part of the body may be attacked, often the face is the targeted area.
In many sufferers of compulsive skin picking, skin picking is preceded or accompanied by a high level of tension, anxiety or stress and a strong urge to itch or scratch. Often certain events or situations trigger skin-picking episodes. For some, the act of skin picking provides a feeling of relief or pleasure. Skin-picking episodes can be a conscious/ focussed response to anxiety or may be done as an unconscious / automatic response to external stimuli.
Anxiety is one of the many triggers for skin picking. Everyone will experience anxiety from time to time. The demands and stress of life may even make experiencing anxiety more frequent. So it can be tough to tell the difference between everyday anxiety and a clinical anxiety disorder. If anxiety is affecting you or someone you know, it’s important to learn the difference.
It depends on the type of anxiety disorder, but general symptoms include:
Skin Picking is very common in the general population but has received limited research attention therefore the onset of the disorder still remains a mystery. It is viewed as a chronic condition which is often associated with high levels of psychological distress. People who suffer from it repetitively touch, rub, scratch, pick at or dig into their skin. Repetitive skin picking appears to be a way for some people to increase their activity levels when they are bored, or to control their emotions when they are feeling anxious, tense, or upset. The fact that some individuals can actually regulate their emotions by picking their skin maybe why they develop this problem in the first place.
Therapy can help you handle emotions from problems or stressors, even if they aren't dramatically life-altering or traumatic. Therapy is well-known for its problem-solving techniques and reputation as a tool for overcoming anxiety, depression and addiction. This article summarizes the therapy process as it was formed and structured by Dr. Vinod, one of the first members of our counselling team when our online therapy program was first launched.
In the process of decision making, two parts of us having opposite views surface in our conscious mind and get into a dialogue. Successful therapy requires a resolve of the conscious mind to fully engage in the counselling process.