Dermatillomania is a clinical condition where the patient gets regular uncontrollable urges to pick his or her skin. The picking can sometimes be so severe that it causes injury and scarring and can even sometimes lead to infection. People with compulsive skin picking disorder are unable to control the compulsion to pick his or her skin. The parts of the body that are mostly affected are the lips and the face. However, the other parts of the body are often affected too, such as arms and legs, cuticles, scalp and even the gums. Picking is often followed by a sense of relief, but this often follows shortly after with feelings of shame and embarrassment.
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It is widely agreed that Cognitive Behavioural Therapy (CBT) is the most effective form of intervention for body-focussed repetitive behaviors (BFRBs) such as dermatillomania (now known as excoriation disorder).Cognitive Behavioral Therapy focuses on making the patient aware of what they are doing and why they are doing it, as well as providing effective means to find positive alternatives to the harmful actions. Cognitive restructuring is a major component of CBT.
CBT is based on the principle that destructive habits are a response to faulty patterns of thoughts that lead to overwhelming negative emotions. So, the therapy helps to gradually correct the faulty thinking patterns of the patients. Cognitive restructuring for dermatillomania is divided into four steps:
Step 1: Identify the event or situation that triggered picking
Your therapist may require you to keep a picking log and thought record. Each time you pick you will the environment you were in, and what thoughts or feelings you experienced just prior to, during and after picking.
Step 2: Becoming Aware of our Automatic Thoughts
You and your therapist might spend some time discussing your picking record to identify patterns of thinking and internal self-talk.
Step 3: Identifying Faulty Thinking
Next you will identify faulty patterns of automatic thoughts and identify how your thoughts impacts on your emotions and behaviors. You will examine your thoughts to see if they are unrealistic or inaccurate, rather than just accepting them as being fact.
Step 4: Challenging Faulty Thoughts and Replacing it with Realistic Alternatives
The third step is a gradual rational disputation of these automatic thoughts. You will start by first writing down the thought and evidence that objectively supports it. Next, identify and write down evidence that contradicts the automatic thought. By this stage, you've looked at both sides of the situation. You should now have the information you need to take a fair, balanced view of what happened.
Our thoughts are constantly helping us to interpret the world around us, describing what is happening, and trying to make sense of it by helping us interpret events, sights, sounds, smells, feelings. Without even realising it, we are interpreting and giving our own meanings to everything happening around us. We might decide that something is pleasant or nasty, good or bad, dangerous or safe. Because of our previous experiences, our upbringing, our culture, religious beliefs and family values, we may well make very different interpretations and evaluations of situations than someone else. These interpretations and meanings we give events and situations, result in physical and emotional feelings.
There are different types of automatic thoughts:
Cognitive Restructuring is not an effective treatment for dermatillomania on its own, but rather an important component of a holisitic cognitive behavioral approach as it is a good starting point to understand the underlying influences on your picking behaviors.
Treatment Plans and Interventions for Depression and Anxiety Disorders by Robert L. Leahy and Stephen J. Holland. Copyright 2000 by Robert L. Leahy and Stephen J. Holland.