The most effective forms of therapy for body focused repetitive behaviors (BFRBs) like skin picking, has been found to be a combined approach, using various methods of cognitive behavioral therapies. In our online therapy we subscribe to this practice by incorporating habit reversal training, mindfulness, acceptance and commitment therapy and cognitive diffusion. In one aspect of the program we spend an extensive time with the client exploring and reflecting on their ‘values’. Everybody values something, it’s what defines us as human beings. However, our values are often not always overt to us as it is not necessarily something we reflect on, and therefore sometimes we make choices or engage in behaviors that are not congruent or aligned with these values. For example, "I hold spending time with my dog to be important". This is one of my values in life. However, my action is not consistent with my value if amidst my job and family responsibilities, I spend a lot of time skin picking and thus neglects my dog.
The very first clinically recognized case of skin picking was documented by French dermatologist Brocq in 1898, in the Journal of Practitioners, Clinique Generale and Therapy Review. Brocq identified the disorder in a young girl who compulsively picked her acne. Since then the disorder has been referred to by many different names: Skin Picking Disorder, Chronic Skin Picking, Compulsive Skin Picking, Neurotic Excoriation, Acne Excoriee, Pathological Skin Picking and even Pyschogenic Excoriation. But for many years the most recognized name has been Dermatillomania. The term Dermatillomania is from Greek origin meaning:
Derma – skin | Till - pull | Mania – madness
There is nothing funny about mental illness. Millions of people worldwide suffer from conditions like depression or anxiety disorder. For many the difficulty is compounded by having more than one mental illness at the same time. Research has shown that certain mental illnesses are more prone to co-occur that others. Dermatillomania has often been seen to occur comorbidly with depression, anxiety and OCD, although no causal link has been found. Although stigma is rife across all conditions of the mind, conditions like depression are far more well known and has been to focus of an abundance of clinical research and advancements in treatment and therapy.On the contrary, dermatillomania and other body-focussed repetitive behaviors (BFRBs) are considered of the most under-diagnosed mental illnesses, primarily due to the lack of awareness by those sufferring with dermatillomania that it is a clinically recognized condition.
Picking the scalp and face are believed to be the most common focal areas in dermatillomania, however compulsive skin picking can affect any area of the body. One of the lesser spoken about areas that people sometimes feel compelled to pick are the gums. Gum picking can entail a variety of actions on the gums from picking, scratching, excessive flossing and brushing, or pressing at the gums. Although these actions can cause pain and bleeding, and even damage to the gums, it is often precisely these sensations that the individual craves when they continue to pick. When browsing through support forums and tumblr blogs around the subject od compulsive skin picking, it is not uncommon to come across desperate pleas for help from individuals asking why they can't stop picking at their gums and whether there is something seriously wrong with them.
Do you have any tips for quitting gum-picking? I'm addicted to poking my gums, and to the nausea and bleeding that comes with it. It's scaring me and I want to stop.
A large part of the stigma around body-focussed repetitive behaviors (BFRBs) such as dermatillomania is the perception that is is just a bad habit and therefore there is the expectation that the person just has to have the will power to stop. Thus the person who is not able to refrain from this behavior is perceived as 'weak' or not strong-willed by others as well as by him or herself. However, we know that one of the key characteristics in the diagnosis of skin picking disorder is that the person recognizes they need to stop picking and have tried, but have not been able to stop. This then often contributes to feelings of deep guilt and shame. In order to discuss whether it is possible to use will power to overcome compulsive skin picking, it is important to first define the term 'Will Power'.
According to most psychological scientists, willpower can be defined as:
During treatment for skin picking disorder there is always a large portion of the program that focuses on the indidual developing an awareness of the skin picking behaviors and being able to identify the triggers before picking in order to implement strategies to prevent or detract from picking before it occurs. However this requires constant introspection and self-monitoring. This can be challenging at best when you are already plagued by self-doubt and harsh self-judgement. One way to stay on track with behavior chance is through the use of the buddy system.
For many dermatillomania sufferers, the face is a target of compulsive skin picking. This can often result in severe scarring and an in severe cases permanent damage to the appearance of the skin. Dermatillomania is already a disorder that causes the individual immense shame and guilt, but these negative feelings are further perpetuated by the physical consequences of the picking behavior. This can lead to the person avoiding social situations for fear of being harshly judged for their appearance, fears of bullying, or for fear of people asking too many questions about the condition of their skin. Many people, women in particular use cosmetics as a way to overcome this difficulty, particularly when going out in public is not an option, such as going to work or school. However applying cosmetics to cover scarring in a natural way is skill that needs to be learned. This video is of a young woman who shows you ste by step how to cover up scarring and scabs from acne and picking, as she herslf sufferes from dermatillomania.
As discussed many times, cognitive behavioral therapy has been shown to be the most effective intervention in the treatment of body-focused repetitive behaviours (BFRBs) such as dermtillomania. There are many methods within this treatment framework that can be applied in isolation of each other or together as a holistic and comprehensive whole. In individualized therapy your therapist may apply the methods he/she assesses to be most relevant to you. However, in an online therapy program like the one we offer here at skinpick.com, we have designed the program to be more comprehensive in its approach. Regardless of the primary method of CBT employed by your therapist, one fundamental principle of CBT is the developing of awareness by the patient of the behavior they are trying to change and the contexts in which they occur.
Dr. Tammy Fletcher is a Marriage and Family Therapist who is an expert in the treatment of body-focused repetitive behaviours (BFRBs) such as compulsive skin picking disorder or dermatillomania. She has a YouTube channel called Talk Therapy where she shares general information about various conditions and some of the strategies that can be used to manage these disorders. In this video she talks about the strategies that can be used for BFRBs such as dermatillomania.