Dermatillomania Will Power

Tasneem Abrahams
Jan 29th, 2016

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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'.


What is willpower?

According to most psychological scientists, willpower can be defined as:

The ability to delay gratification, resisting short-term temptations in order to meet long-term goals.
The capacity to override an unwanted thought, feeling or impulse.
The ability to employ a “cool” cognitive system of behavior rather than a “hot” emotional system.
Conscious, effortful regulation of the self by the self.

Recovery in mental illness is complex. There is no quick fix and often requires a multi-faceted approach. The road to recovery is therefore long and arduous and often riddled with many obstacles and setbacks along the way. This is where willpower will play a significant role. So no you cannot stop picking your skin by willpower alone, but developing a strong willpower will play a significant role in any successful treatment program.

A Combination Approach

One of the preferred treatment modalities for BFRBs such as dermatillomania is the combined cognitive behavioral method where by classical cognitive behavioral therapy (CBT) methods such as cognitive diffusion is combined with habit reversal training, mindfulness and Acceptance and Comitment based therapy. In the online therapy program offered by we offer just such a program. Habit Reversal is introduced first. Taking this first step requires a commitment to avoid people, places or situations that are triggers to your skin picking. Practicing these stimulus controls will require willpower. As in the definitions willpower is about meeting long-term goals. So in order to be internally motivated to work toward those goals we need to have a clear understanding of what those goals are. This is where values-based therapy comes in. It is important that the life goals we pursue and the actions and behaviors we prioritise in life are in line with what we truly value for our lives.

Cognitive Diffusion

Dermatillomania sufferers often report that picking offers some kind of release either physically or emotionally in response to some unwanted negative thought or feeling. In order to override these unwanted thoughts and feelings cognitive diffusion is a useful skill taught where individuals can learn to look at their thoughts objectively and understand how these thoughts affect the way they feel and how this in turn impacts on behavior. This also provides the person the tools to deal with problems in a cognitive frame of reference rather than an emotional one, which may contribute to diffusing the urge to pick before it occurs.

Acceptance and Commitment

Another important aspect on the program is Acceptance and Commitment based therapy (AcT). The individual is guided to acknowledge and accept the existence of the urge to pick rather than try to resist in, but then make the choice to respond to the urge in a manner that is more in line with their values. An interesting study by Ibrahim Senay of the University of Illinois at Urbana-Champaign lends scientific support to the recovery concepts of surrender and openness. He found that people who kept their minds open were more goal-directed and more motivated than the people who firmly declared their objective. Having the freedom of choice seemed to create more intrinsic motivation—and thus, a greater likelihood of long-term abstinence—than feeling obligated to take a particular course of action.

Empowering the will- a collective effort

But what if you find intrinsic motivation hard to find? What then happens to the power of your will? This is where support is essential in the recovery process. Whether it be a close family member or friend, an online support forum or following the numerous vloggers and bloggers on the internet who share their personal experiences with dermatillomania, it is important that you have a place to go to when you are feeling like your efforts are hopeless. It is for this reason that our online therapy program, although text-based, comes with full therapist support. The therapist’s role is to support and encourage you during these difficult times and to help you exercise your will to put all the skills you will learn in the program into practice so that you may disempower the urge to pick and empower your own will instead.

Tasneem Abrahams

Tasneem is an Occupational Therapist, and a graduate of the TLC foundation for BFRBs professional training institute. Her experience in mental health includes working at Lentegeur Psychiatric hospital forensic unit (South Africa), Kingston Community Adult Learning Disability team (UK), Clinical Specialist for the Oasis Project Spelthorne Community Mental Health team (UK). Tasneem is a member of both the editorial team and the clinical staff on Skinpick, providing online therapy for people who suffer from excoriation (skin picking) disorder.

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