People suffering from compulsive skin picking may pick at normal skin variations such as freckles and moles, at pre-existing skin defects such as scabs, sores or acne blemishes, or in some cases imagined skin defects that are not actually visible by others. Individuals with compulsive skin picking not only use their fingernails to pick and scratch but may also use their teeth and/or other instruments such as tweezers, blades and pins. The compulsion to scratch, pick or peel pimples is called acne excorié and could be considered a subtype of compulsive skin picking. Although any part of the body may be attacked, often the face is the targeted area.
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In many sufferers of compulsive skin picking, skin picking is preceded or accompanied by a high level of tension, anxiety or stress and a strong urge to itch or scratch. Often certain events or situations trigger skin-picking episodes. For some, the act of skin picking provides a feeling of relief or pleasure. Skin-picking episodes can be a conscious/ focussed response to anxiety or may be done as an unconscious / automatic response to external stimuli.
Based upon the individual case, treatments to stop skin picking may involve therapy in cognitive and coping skills or in-depth psychological counseling. There is a growing body of evidence indicating picking behaviors are associated with anxiety and mood disorders. This type of disorder is often associated with an imbalance of the brain chemical, serotonin. For this reason, pharmacological therapy involving a selective serotonin reuptake inhibitor (SSRI) class of medication is frequently proving to be beneficial. In cases where acne blemishes trigger picking, surgical draining of the blemishes may help eliminate the targeted picking zone. Corticosteroids, antibiotics, and chemical peels may help to minimize outbreaks, allowing time to address the psychological issues involved and develop new habits so future acne flare-ups will be less tempting.
Where behaviors are evident that do not involve acne, such as scalp picking, nail biting, and scab picking, techniques concerning how to stop picking skin include avoidance or substitution therapies may be helpful. Avoidance therapies help the patient acknowledge the problem, identify the triggers, and teach coping skills that the patient can employ when the urge to pick strikes. Once the picker is able to recognize the problem, he or she can then choose to review the situation that triggers the urge to pick and psychologically work through those issues to eliminate or minimize the habitual behavior.
Once you have chosen a handful of ideas, begin to implement them.. Some individuals like to have a partner or friend subtly prompt them to use their skills (e.g., a look or a gentle shoulder tap), while others prefer to do this independently. Consider help when you need it. The following is a list of ideas, although it is not exhaustive: