A recent study suggests that the use of n-acetylcysteine has had a remarkable effect in treating excoriation or compulsive skin picking disorder. At the study’s end point, of the 53 participants who completed the study, 47% receiving N-acetylcysteine were much or very much improved compared 19% receiving a placebo The n-acetylcysteine showed no side effects and seemed to be well tolerated and effective.
Skin picking may start with something mild and harmless but if not treated early it can escalate into a serious clinical condition. When it starts affecting a person’s physical health and/or emotional well-being, it means professional help is needed. There are many therapies and medications that can be used depending on the patient’s condition.
One of the methods we employ in out online therapy program is Mindfulness-based therapy. Many times people try to control discomfort coming from unwanted feelings, thoughts and urges. As a result they start picking their skin to eliminate the discomfort. Mindfulness-Based CBT (Cognitive Based Therapy) helps the patient understand how he can non-judgmentally accept psychological experiences that are uncomfortable. The patient realizes that he can experience uncomfortable thoughts without harming his skin. There are many exercises that have been linked to mindfulness such as yoga and meditation.
Until recently, there hasn't been a treatment for body focused repetitive behaviors (BFRBs), such as compulsive skin picking disorder. Dermatillomania, aka excoriation disorder, is the picking of one's skin repeatedly, which leads to damage. The face is the primary area where the skin picking occurs, but skin picking can happen at any part of the body. People with this disorder may pick at normal skin variations, such as moles and freckles, where there are pre-existing blemishes, sores, or scabs. These people with this disorder would use their teeth, fingernails, pins, tweezers, or other devices. And as a result, bruising, bleeding, infections, or permanent damage would occur.
Human behavior is complicated. Why people do certain things is often unclear. People engage in certain behaviors that may be detrimental to themselves in some way. One such known problem is that of skin picking. Picking at skin is a isn't neccesarily an abnormal behavior. Many people will idly pick at their skin now and then. However, this issue can cause problems for people when it becomes a compulsion they cannot resist even if it is harming their skin. A person may have a compulsion to pick at their skin in a way that can cause all kinds of pain, impede healing and leave serious and disfiguring scars. People can pick at their skin even when it means picking at an existing scar that has already healed over. This kind of disorder known as a body focused repetitive disorder or, more specifically, an excoriation disorder that has a specific meaning. In our present society, research and knowledge about body focused repetitive behaviors such as excoriation disorder has only recently advanced. Much work has been done so far to help determine the source of the problem and assist those suffering from it to avoid such injurious behavior that may cause serious harm.
Tanya Silva, suffered for years from Dermatillomania after she was diagnosed with an eating disorder. However once she overcame her Binge Eating, she was left with the skin picking. She has overcome her compulsive behaviours by healing her mind and shifting her thoughts, “your thoughts trigger your emotions and your emotions are what drive your behaviours”. If she can overcome two addictive behaviours, she believes that you can too. Her YouTube channel is for those who want to look, feel and be the best version of themselves.
Tanya suggests focusing on nourishment vs. destruction and recognizing your picking triggers. Firstly, acknowledge your habit of going straight to the mirror and distract yourself. Then ask “what else would create that same satisfaction or ‘high’”. For some people this comes in the form of a hobby spending time with a pet, for others it comes from the release of endorphins through exercise. Tanya focused on successfully overcoming her disorder and visualized her skin being healed. This positive thinking helped her develop a positive inner dialogue which she says had a great impact on her outer appearance.
One of the most effective CBT developments for the treatment of Excoriation Disorder is Mindfulness Based Cognitive Behavioral Therapy. The primary goal is to learn to non-judgmentally accept uncomfortable psychological experiences. From a mindfulness perspective, much of our psychological distress is the result of trying to control and eliminate the discomfort of unwanted thoughts, feelings, sensations, and urges. In other words, our discomfort is not the problem - our attempt to control and eliminate our discomfort is the problem. For those with Excoriation Disorder, the ultimate goal of mindfulness is to develop the ability to more willingly experience their uncomfortable thoughts, feelings, sensations, and urges, without picking their skin. Mindfulness is not necessarily only accessed through therapy though. There are many resources that encourages and helps people to practice mindfulness in their daily lives as it can be beneficial even for those who do not suffer from a mental illness. We round up some of the resources we could find on the web.
Annette Pasternak, Ph.D. is the author of the book “Skin Picking: The Freedom to Finally Stop”. She has honored us with a guest post around her personal experience helping others overcome skin picking and the attitudes and qualities one needs in order to do so. If you would like to contact Annette, you can contact her through her website -www.stopskinpickingcoach.com.
Originally, I learned from being in treatment myself and also from personal discoveries that helped me become free of the continually destructive cycle of skin picking. In my last four years as the “Stop Skin Picking Coach,” I have learned more and have especially developed a clarity about which attitudes and personal qualities will set you up for success in this endeavor. Have them or develop them; here they are:
Excoriation disorder does not develop overnight. It starts as a habitual behavior and over time develops into a full blown disorder. Every habit has three components: a cue (or a trigger for an automatic behaviour to start), a routine (the behaviour itself) and a reward (which is how our brain learns to remember this pattern for the future).
Habit Reversal Training (HRT) is a form of Cognitive Behavioural Therapy (CBT) which says that in order to reverse a habit, the old cue and reward needs to be diagnosed, followed by changing the routine. Instead of fighting the urge to pick, HRT helps the individual understand what motivates the urge. HRT has four main components:
An individual is taught to be aware of their picking. Once an understanding of the picking behavior is gained, the individual is better equipped to gain self-control.
In recent years we have seen an increase in awareness about skin picking disorder among those who are challenged by it and those in the medical and psychiatric fields as well. This has largely been due to the efforts of advocacy groups such as the then named Trichotillomania Learning Centre (TLC), now named the TLC Foundation for Body-Focused Repetitive Behaviors (BFRBs). The Canadian BFRB Support Network, with one of the earliest and most vocal advocates, a skin picker herself, Angela Hartlin in their corner, have also been instrumental in advancing the knowledge and awareness of compulsive skin picking across the globe. This increase in awareness has led to increased interest among the research community, leading to further advances in our understanding of these conditions and improved treatment methods. The TLC Foundation for BFRBs also provide training to professionals with an interest in treating skin picking and hair pulling. The advent of the internet has meant that finding resources and information from the privacy and comfort of your own home is much easier and there are many other resources such as these available online. We have researched some of the well-established trusted sources: