Occupational Therapy for Skin Picking

Tasneem Abrahams
Dec 21st, 2016

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Compulsive skin picking is not merely a harmless habit. From infections that can hurt your health to embarrassment about simply shaking hands, CSP has serious effects for those challenged by it. Typically, individuals with excoriation disorder find that the disorder interferes with daily life. Hindered by shame, embarrassment, and humiliation, they may take measures to hide their disorder by not leaving home, wearing long sleeves and pants even in heat, or covering visible damage to skin with bandages. Activities such as typing may be painful for those who pick at their fingers or hands, or walking for those who pick at the soles of their feet.

What is Occupational Therapy?

Occupational therapy is the use of activities that are meaningful to a person's life roles and values to aid in the rehabilitation or restoration from physical or mental illness. Occupational therapy (OT) treatment concentrates on assisting individuals with physical, neurological, or psychological disability be as independent as possible in all aspects of their lives. OT is a multi-faceted therapeutic modality that uses sees the individual as an individual, whilst recognizing the contribution the external environment plays in a person's life. It therefore treats individuals holisitically as a sum of parts rather than focusing on only the area that is problematic. Cognitive behavioral therapy (CBT) has been shown to be the most effective method of treatment approach to body focused repetitive behaviors (BFRBs) such as compulsive skin picking. Whilst CBT is the realm of psychology, it is also just a frame of reference that offers principles that guides the professional approach to psychological problems, and occupational therapists in mental health settings often apply CBT priniciple in these settings. 

How can OT help with skin picking

Whilst there is no known definitive cause for compulsive skin picking disorder, evidence shows there is a link with sensory processing disorder as one possible catalyst or trigger. There are many occupational therapist who specialise in sensory processing disorder, and can help people with skin picking disorder understand and select appropriate treatment methods that addreswses any underlying sesory issues that might be triggering the urge to pick. In addition, the core philosophy of OT is that engaging in meaningful occupation can be healing and thus lead to wellness. In occuoational therapy the word 'occupation' refers to anything that occupies ones time. It is the belief that the activities and tasks we engage in are informed by our roles, values and beliefs. So while cleaning the cat litter may not be an enjoyable task, it is a small part of the larger more valued role of being a good carer to your cat. This framework of thinking about human wellness is congruent with one of the key CBT techniques used with BFRBs and is a core component of the our online therapy program - Values Based Therapy. 

Occupational therapists apply the following underlying beliefs to their interaction with patients:

  • Occupation has a positive effect on health and well-being.
  • Occupation creates structure and organizes time.
  • Occupation brings meaning to life, culturally and personally.
  • Occupations are individual. People value different occupations.

Applying CBT in treatment

Treatment of compulsive skin picking disorder depends on the level of awareness the individual has regarding the problem. The primary treatment is a form of Cognitive-Behavioural Therapy called Habit Reversal Training (HRT). HRT is based on the principle that skin-picking is a conditioned response to specific situations and events, and that the individual with Dermatillomania is frequently unaware of these triggers. The individual with Dermatillomania learns how to become more consciously aware of situations and events that trigger skin-picking episodes. He/she also learns to use alternative behaviours in response to these situations and events.

Regardless of which treatment you and your advisor/therapist pick, remember that CSP is an intricate disorder that may require a few distinctive methodologies. No single treatment is ideal for every individual, so don't be demotivated if one choice doesn't work. While a few cases are effectively treated within a couple of weeks to a couple of months, others require numerous months to a year or more to achieve satisfactory management of the behavior.

To find out more about Occupational Therapy in your region or country, visit your country specific association such as the American Occupational Therapy Association or if you don't know what they are called you can find this out via the World Federation of Occupational Therapists.


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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