Dermatillomania is a mental health disorder that is often misdiagnosed and not understood. Those who struggle with it tend to go untreated which makes the psychological and physical effects more severe.
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Dermatillomania lasts a lifetime, but treatment can help people learn to understand the compulsions behind it and manage the impulsivity and behaviors. Then, the disorder does not hold as much power over a person, reducing the feelings of helplessness. Those who struggle with dermatillomania all have different experiences. Treatment needs to apply to those individual differences, and qualified experts can help determine the best options.
Those with compulsive skin picking disorder also tend to struggle with other mental health disorders with some people becoming suicidal. Therefore, comprehensive treatment, or treatment for the whole person, will help address everything at one time.
There are no medications that specifically treat dermatillomania. However, there are some that research suggests handling some of the impulsivity, anxiety, depression, or stress that contributes to skin picking behaviors. By treating some of the things that make picking behaviors worse, people can experience a positive difference in treatment. Caution should be exercised with medications because some of them produce side effects that make picking behaviors worsen and each person reacts to medications uniquely. Therefore, even though a drug may work for one person with dermatillomania does not mean it will work for another.
One example is a class of medications known as selective serotonin reuptake inhibitors (SSRIs). Some people with OCD who take them report positive results, as do some people with dermatillomania. Examples that work include doxepin, clomipramine, naltrexone, olanzapine, and pimozide, but the evidence from research is not conclusive because there have not been randomized clinical trials for treating dermatillomania.
Another class of medication that can help are anti-itch creams or eczema and acne medications. These options can help people who pick at their skin because of itching or other physical sensations that prompt the behaviors.
Again, when considering medications, do so under the supervision of a trusted, qualified health professional who understands and treats patients who have body-focused repetitive behaviors.
The most common mode of treating body-focused repetitive behaviors is CBT (Cognitive Behavioral Therapy). This method has the most research supporting it and the best outcomes. However, CBT is a broad category of treatment and within that category are many specific interventions. The commonality between them is the assumption that thoughts, feelings, and behaviors are related to one another and therefore influence one another. For example, the thought of getting pulled over for speeding may trigger a feeling of fear. Therefore the person’s behavior complies with posted speed limits. While this is a simplified example, in reality, the process is complicated, and most people are not aware of the relationships between thoughts, feelings, and behaviors. A therapist trained to provide CBT can help people sort out the mess. For example, a person feels the compulsion to pick at their skin (behavior), however, after picking, they think “this is not good” which triggers feelings of shame and embarrassment, but the feelings trigger the compulsive behavior again. A person in this situation may feel helpless and unable to control the behavior.
However, CBT also counts on the idea that if a thought, feeling, or behavior changes, it will change the entire system. Therefore, in therapy, a qualified professional will guide someone through a process of becoming aware of the thoughts, feelings, and behaviors involved with picking and tackles a part of the system. For example, skin picking is a mental health disorder but does not define someone as a person. Acceptance of the disorder as a small part of oneself can help someone remove the judgment which causes the shame and embarrassment. Getting those feelings under control may prevent worsening of the cycle of picking behaviors. When the compulsions slow down, a person feels more in control of the behavior and then can make choices.
One type of CBT intervention targets behavior. Developed in the 1970’s, Habit Reversal Training has three parts:
HRT is an evidenced-based practice. Research shows positive outcomes in short-term treatment but does not provide evidence of long-term success. Mixed results are partially because there is not a lot of studies specific to dermatillomania and long-term treatment outcomes.
When all of the available CBT treatment options are combined in a way that meets an individual’s needs, it is referred to as Comprehensive Behavioral Treatment. Therapists who use comprehensive behavioral treatment have access to many types of interventions which are then customized based on an individual’s particular disorder. There are four parts to this kind of therapy.
Comprehensive behavioral treatment occurs fluidly in that a person does not go from one stage to the next. While assessment needs to occur at the beginning to derive an understanding, the assessment also occurs throughout treatment as a way to evaluate what sensory substitutes work and which don’t, as well as if environmental alterations are effective or ineffective.
Another form of therapy for dermatillomania is Acceptance and Commitment Therapy (ACT). Pronounced ‘act,’ it is different from CBT because the goal is to learn how to accept thoughts and feelings as they are, even the negative ones. Where CBT teaches people how to control or change them, ACT does not. The process involves noticing, observing, experiencing, and accepting without judging oneself. One of the primary practices in ACT is mindfulness which helps people increase self-awareness as well as acceptance of negative and uncomfortable feelings. After acceptance, one can choose behaviors that coincide with what is important to them.
ACT treatment for people with dermatillomania involves allowing oneself to experience the urge to pick, accepting its presence, and then choosing not to do anything about it. As someone experiences the negative emotions that accompany picking, he or she can choose how he or she wants to respond, even if it means just accepting the negativity.
In hypnosis therapy, a qualified trained professional enters the unconscious mind of someone with dermatillomania to draw out ways to help them managed the urges to pick. There is very little research to support hypnotherapy, but some people report positive outcomes. Additionally, this method could help people discover initial triggers of the disorder or help them deal with traumatic events that contribute to picking behaviors.
Many people with dermatillomania experience the disorder in isolation which can make behaviors worse. Group therapy is led by a therapist-facilitator and can be a viable option for those who want to engage in social support in a formal setting. One can participate in group therapy as the sole method of treatment or as an addition to individual therapy. Support groups are a less formal version of group therapy and are usually led by people who are not trained therapists.
Benefits of group therapy and supports groups:
Research provides options for treatment. However, there are other methods available. Dermatillomania is not fully understood by the medical or psychiatric field, therefore, many of these alternative treatment methods come from anecdotal evidence, or they are supported in some way by research that may or may not support their use.
USE CAUTION AND IN CONSULTATION WITH YOUR HEALTHCARE PROVIDERS.
Alternative therapies can interfere with medication or create unintended side effects or make picking behaviors worse.
Reminder- Alternative therapies can cause unexpected side effects depending on a person’s neurochemistry and physiology. Discuss options with your healthcare providers first and report changes immediately.
Every manifestation of dermatillomania is different which means treatment needs to meet one’s individual needs. Comprehensive treatment considers the physical, emotional, and psychological aspects of compulsive skin picking. No matter which treatment intervention helps, there are ways to deal with having the disorder throughout the treatment process.
Dermatillomania is chronic which means lasts throughout one’s lifetime. Treatment helps people manage the picking behaviors, but the urges do not go away. People who report success in treatment say that it helps them choose not to pick so the behaviors no longer interfere with their lives. Recovery is a journey that involves awareness, resilience, and perseverance, but sometimes the behaviors return. When that happens, some people refer to it as “relapse,” but that word can be reframed.
First, “relapse” has connotations associated with it that incite judgment, failure, fear and the definition in the dictionary does not help.
Relapse - suffer a deterioration after a period of improvement
However, consider the word “lapse…”
Lapse - to pass gradually into an inferior state or condition
Which has a more positive connotation to it? Just because someone reverts to picking does not mean he or she failed or deteriorated, it means they gradually went back to what they used to do. Language is important because it contains literal and nonliteral meanings. For example, someone with a medical condition like diabetes is not accused of having a “relapse” when their blood sugar spikes and people with dermatillomania do not deserve accusation either. Recovery is a challenge, and sometimes things happen. What matters is what you do when setbacks occur.
Get back up and take a step forward.
As people age, life and environments change. What worked at the beginning of treatment may not work later. However, with recurring assessment, awareness, education, support, and perseverance, new ideas can support the treatment strategies you need for success.