The scope of the compulsion to pick includes scalp picking, or the act of picking the scalp skin on the head. This aspect of the compulsion falls under the diagnostic categories that include Obsessive-Compulsive Disorder (OCD) and Body Dysmorphic Disorder (BDD), which is indicative of a distorted perception of one’s own body. It is the problem of distorted perception that characterizes a diagnosis of neurosis. As with the entire spectrum of picking behaviors, scalp picking itself is manifested in several ways. Some people feel the compulsion to pick at the skin of the scalp itself while others seem to focus on the hair. Those subjects who target the scalp often find tiny imperfections, sometimes real but sometimes imagined, that they will pick, scratch, and pull until their head picking develops into a sore spot on the head. Of course, the sore spot becomes the perfect target for another round of picking and scratching. The cycle is self-perpetuating, making the prospect of ending the compulsion especially tricky. On a more painful and destructive level, some people pick the scalp ruthlessly, often to the point of creating noticeable bald spots. Sometimes the picking occurs during a state of agitation and serves as a means of releasing stress or quelling anxieties but other people pick their scalps to the point of pain and baldness, while in a state of languid relaxation and the activity is hardly even noticed by the subject.
Compulsive scalp picking is sometimes done as a means of self-inflicted punishment or as a method of deliberately causing the sensation of pain. The rationale behind the need to cause pain is that life has become so dull and uneventful that the pain is welcomed as a sign of actual engagement in the process of living. Another response to the need to inflict pain is the distorted sense of relief that is realized when the pain (the picking) stops. When this pain-inflicting behavior becomes a routine part of life, the relief from pain is felt only momentarily, at best. Oftentimes, psychological counseling during the course of treatment for scalp picking reveals the source of the internal pain that leads to the compulsion to pick the skin of the scalp or of anywhere else on the body. Now that the general public and the medical community alike are becoming more aware that compulsive scalp picking is a disorder that affects the body in both a mental and a physical way, more and more treatment options are becoming available. And some of them are designed especially for working on the distortion of thought that torments the CSP patient.