Skin Picking: Diagnosis and Therapy of “Dermatillomania”

Skin picking causes those affected to injure themselves by pinching or scratching the skin. Once diagnosed, this obsessive-compulsive spectrum disorder can be treated. We’ll tell you everything you need to know about it.

Everyone probably pinches a pimple at some point. But when it becomes an irresistible urge to keep squeezing, scratching and squeezing at already damaged skin, experts speak of skin picking disorder (dermatillomania). It is a mental illness that is classified as an impulse control disorder.

Skin picking is particularly common in late childhood or early puberty. However, dermatillomania can also occur in adults. According to the medical journal, 60 to 90 percent of those affected are women. However, it is assumed that the number of unreported cases among men is very high.

What are the triggers of Skin Picking Disorder?

As the medical journal writes, triggers for harmful working, pinching and scratching of the skin can be, for example, a scab, sunburn, a mosquito bite, a rash or a pimple in connection with stressful situations (such as arguments, pressure to perform, grief) or trauma. Skin picking is intended to eliminate such unevenness. But not everyone who picks a scab or pops two pimples in a row suffers from skin picking.

According to a publication by Thieme Verlag, which specializes in medical literature, skin picking occurs when the aim of working on the skin is emotional control and stress reduction. Especially in situations that cause fear or pressure, skin picking can bring relief to those affected by the disorder. Getting rid of bumps on the skin is accompanied by a short-term feeling of happiness and relaxation, which makes those affected feel better and relieved for a moment.

With the help of skin picking you can block out stressful thoughts. In return, they accept that they will further destroy their skin through skin picking and this creates a vicious circle: the self-inflicted wound forms a scab that the affected person scrapes open again in the next skin picking episode. This can result in significant tissue damage to the skin, which can cause pain and be visually noticeable. Those affected are often ashamed of these visible consequences of their disorder. Therefore, even in summer, they hide the affected areas under long clothes, avoid social situations, or spend a lot of time making the scars less noticeable with makeup.

Dermatillomania occurs not only on the face, but also on the neck, shoulders, chest and hands. In severe cases, the skin is also sometimes trimmed with scissors or tweezers until it bleeds.

For some sufferers, skin picking is like a ritual that they practice, for example, in the evening in front of the bathroom mirror. But also in situations where they have to wait or when watching TV, many people who suffer from skin picking feel tempted to work on their skin. Skin picking often happens when there are no other people in the room.

Skin Picking: The Diagnosis

Even among doctors, the skin picking disorder is still a relatively unknown disorder. According to psychologist and psychotherapist Antje Hunger, the disease itself is precisely defined, which means that it can be diagnosed. The diagnostic criteria include:

• Those affected have tried several times without success to stop pinching, scratching or picking at their skin.
• Working on the skin has already caused visible damage.
• There is a high level of suffering.
• A doctor who has ruled out that the symptoms are due to another disease or disorder. It often makes sense to speak to a dermatologist in advance so that, for example, acne or a rash can be ruled out as the cause.

According to Thieme Verlag, this diagnostic clarification of the above-mentioned characteristics is carried out by means of a clinical discussion with the person concerned in an appreciative atmosphere. One of the screening questions is, for example: “Do you find it difficult to leave your skin alone or to stop picking?” Doctors can also use a self-assessment questionnaire to find out whether those affected actually suffer from skin picking.

Skin Picking: Therapy

Once the diagnosis has been made, there are various approaches to counteract skin picking. Therapy is one of the most important treatment options:

• According to Thieme Verlag, cognitive behavioral therapy is an important part of getting skin picking under control. This form of therapy consists on the one hand of self-observation, through which those affected learn to identify and document situations that trigger skin picking. Among other things, this can work via an app.
• This form of therapy also teaches those affected how they can replace skin picking in stressful situations with another activity with their fingers. Instead of scratching yourself, it can help to pop bubble wrap, clench your fists, or sit on your hands.
• The therapy also helps those affected to better understand their behavior. The goal is to consciously change thoughts that lead to skin picking.
• Relaxation exercises such as autogenic training or progressive muscle relaxation can support behavioral therapy. The exercises can help reduce the urge to pick skin, giving the skin time to heal.
• The exchange with other affected people also supports the healing process. In skin picking self-help groups, for example, there are tips on which activities with the fingers could replace skin picking. In many cities there are now such self-help groups, as a list of the skin-picking self-help group in Cologne shows.

Read more on Techzle.com:

• Scalp peeling: when to use it and how it works
• Chronic fatigue: These are the symptoms and the therapy
• Leisure stress can make you ill: How to protect yourself