‘Baar Baar Misli Tulun’: Is Picking at Your Skin a Mental Health Issue? 

By Wasim Kakroo

DO you have a habit of picking at rough surfaces on your skin such as at face, arms, legs, hands, feet etc. especially when you feel distressed? Have you developed visible scars as a result of skin picking? Do you feel a need to keep the scars of skin picking hidden from others? Do you find that picking at your skin interferes with your social or professional life? Do you hesitate going to the gym because your scars might be visible? Or do you spend a lot of time before work or social gatherings covering up sores?

You may have a skin-picking disorder, also known as Compulsive Skin Picking, Dermatillomania, or Excoriation Disorder, if you can’t seem to quit.

What Is Skin-Picking Disorder?

Skin picking or dermatillomania is a mental health issue characterized by an urge for picking, scratching, and poking at one’s own skin, followed by a sense of relief in the tension but accompanied by guilt for picking the skin and by frequent, futile attempts to stop doing so.

Excoriation disorder can be physically and emotionally distressing if left untreated. Picking at all areas of the skin, including the skin, scalp, cuticles, face, and back, is common in people with the illness, causing open sores that are painful and embarrassing. As a result, the patient frequently feels guilty and ashamed.

Skin-picking activities may be done mindlessly and unintentionally, or they can be deliberate. The intervals between picking behaviors could be as short as a few minutes or as long as many hours every day.

Why Do People Pick Their Skin?

Average people without illness pick at their skin in the hope of smoothing it out, eradicating dry skin, or getting rid of scabs, however, individuals with skin picking disorder, on the other hand, find it difficult to break the habit, which often makes the skin worse and prevents it from fully healing. When a person is anxious or disturbed, they may pick at their skin to relieve the anxiety. Skin picking and other body-focused repetitive habits are believed to bring a sense of relief during stressful situations. Individuals with excoriation disorder may also pick skin merely because they feel bored. Many of these people aren’t even conscious that they’re picking at their skin in the first place.

What are the signs of Skin-Picking Disorder?

Unlike other mental illnesses, the symptoms of skin picking disorder are observable. Scratches, scabs, sores, scars, and lesions in one or more places of the skin are the most evident indications. Because the picking is still going on, these places will be in various degrees of recovery.

Although the signs of excoriation disorder are clear, it is unusual that anybody will witness the event. People with skin-picking conditions often only pick in secret or in the presence of close friends or family members due to emotions of shame and guilt. While it might be difficult to distinguish excoriation from common injuries, recurrent injuries in the same location are a hallmark of the illness.

The following are some other symptoms of excoriation disorder:
• Spending a lot of time thinking about or discussing skin blemishes or conditions
• Frequently squeezing, popping, cutting, or lancing skin with various tools
• Covering scars with clothing that isn’t appropriate for the season
• Being secretive or lying more about one’s activities
• Mood swings that aren’t predictable
• Scabs or fragments of skin are held, played with, or collected.
• Because skin-picking behaviors can take up a lot of time, the person may be late for work, class, or appointments. They may be failing in school or struggling to keep up with the demands of their employment, and as a result, they may become increasingly isolated.

It could be a symptom of skin picking disorder if the person frequently seeks medical consultation from a dermatologist for open sores or to treat skin infections because of skin picking. Picking, in more severe situations, can result in disfigurement that requires surgery to correct.

What are the causes and triggers of skin picking disorder?

Skin-picking behavior can be caused by genetic or environmental triggers. Heredity appears to be the most major risk factor for skin picking disorder. Those who have a close relative with OCD or a related disorder such as Body Dysmorphic disorder, hoarding disorder or hair pulling disorder are more likely to develop skin pulling disorder.

Other common risk factors include:

Being a woman: Women make up about 75% of those who suffer from skin picking disorder.

Being an adolescent: Many cases of the illness start when a child is in the early stages of puberty.

Having acne: Often, skin picking disorder gets triggered with a dermatological condition, like acne, that becomes a focus for the individual.

What is the treatment of Skin-Picking Disorder?

Habit reversal training and stimulus control are two of the most common therapies used by psychologists to help people for body-focused repetitive behaviors such as skin picking. When these strategies are used together, people can find new ways to cope with anxiety or engage in behaviors that do not cause harm to the skin (e.g., squeezing a stress ball or wearing gloves that make picking difficult).

Skin picking disorder frequently necessitates seeking professional help from a trained psychologist due to its chronic nature, as symptoms rarely go away on their own. Skin-picking conditions can be helped with specialized behavioral treatment and medications that provide the client instruction and direction to change their thoughts and actions.

Psychotherapy for excoriation is an excellent first-line treatment for limiting symptoms safely and efficiently. It has been demonstrated that meeting with a counsellor, social worker, or psychologist in an outpatient setting to discuss the problem, its impact, and potential remedies is beneficial.

Psychotherapy:

Skin-picking disorder is commonly treated with the following therapies:
• Acceptance and commitment therapy: Acceptance and commitment therapy (ACT) is a type of psychotherapy that focuses on teaching mindfulness skills to accept the unpleasant aspects of life while simultaneously committing to changing unwanted ideas, attitudes, and emotions.
• Cognitive Behavioral Therapy (CBT): Cognitive Behavioral Therapy (CBT), is a wide therapeutic approach based on the interconnectedness of thoughts, feelings, and behaviours. CBT is used to stop skin picking behaviors by changing thinking and moderating feelings related to skin picking.
• Habit reversal training (HRT): Habit reversal training (HRT) is a type of cognitive behavioural therapy (CBT) that has become the golden standard treatment for skin picking disorder and other body-focused repetitive behaviours. Habit awareness training, competing motor responses, relaxation techniques, and social support are used in this form of therapy.

Because skin-picking disorder is a chronic illness, it might take a long time to completely eliminate symptoms; however psychotherapy can achieve noticeable results rapidly.

Pharmacotherapy: 

Psychiatrists sometimes utilize a combination of psychotropic drugs to treat skin-picking symptoms rather than just one. To reduce the possibility of adverse effects, it is critical to take all drugs as recommended and have clear communication with your psychiatrist.

Skin-picking disorder is treated with a variety of medications, including:

• Antidepressants: This family of medications has shown some success in decreasing picking by targeting the brain’s serotonin system. Fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), and sertraline (Zoloft) are some of the medications available.
• Opioid antagonists: Skin Picking can be treated by medications commonly used in treatment for patients with substance use disorders. One commonly used example is naltrexone.
• N-acetylcysteine (NAC): N-acetylcysteine (NAC) and other medicines that interact with the brain neurotransmitter glutamate have been shown in studies to help with OCD and related disorders.

Some helpful ideas to deal with Skin Picking Disorder:

1. Stress management:

Skin-picking is common among persons who are under a lot of stress. A person might get motivated to lessen their desire to pick their skin by managing their stress. undoubtedly stress reduction is a complicated and multi-factorial endeavor, so people should concentrate on both prevention and damage control. A person who practices mindfulness, relaxation, or physical exercise on a daily basis is taking preventive action. Damage control is when a person takes deep breaths to deal with current stress. Both techniques are necessary for lowering stress and reducing picking behaviors.

2. Recognize and Manage Your Emotional Triggers

Excoriation can be triggered by a variety of emotions, including stress, but there are other emotions that can lead to a larger desire to pick. Even minor levels of anger, boredom, annoyance, shame, or sadness might make some people pick their skin. Sometimes even happiness may trigger a desire to pick then skin. Triggers are unique to each individual. The idea is to recognize these emotions, recognize warning signs, and take appropriate action.

3. Recognize Your Physical triggers

Physical triggers are equally as important to recognize as emotional ones. Physical triggers can include a specific skin condition (such as acne), location, temperature, or other physical/environmental cues, rather than specific feelings. Each person should take some time to write down the times, locations, and circumstances that trigger unpleasant behaviors so that they can avoid them and plan accordingly.

4. Share your distress

Excoriation disorder is largely centered around acts of secrecy, isolation, guilt, and shame. People may hide their illness for fear of being judged or being stigmatised because of their mental illness, but those who take the risk of sharing the knowledge will be rewarded. They should understand that, the trusted empathizers in and outside the family will most likely rally around him or her to offer reassurance, direction, and love. Second, telling people might assist to reduce feelings of shame and guilt associated with skin picking.

5. Manage the Triggers

After a person has identified and studied their triggers, they can engage in situations and surroundings that do not trigger picking. If they only pick in their bedroom, they should use bedroom only for sleeping. If they only pick when they are alone, they should make an effort to spend as much time as possible with their family and friends. It becomes more difficult to engage in compulsive skin-picking when a person has control over the situation. Emotional triggers are more difficult to control, but the same concepts apply in handling such triggers also.

6. Seek out skin-care products

Because an occurence of acne can trigger excoriation, doing everything you can to improve your skin’s health can help you avoid developing long-term skin-picking habits. Skin care routines that are both healthy and simple, as well as a consultation with a dermatologist, can help you avoid or lessen excoriation while also increasing your self-esteem and confidence.

7. Seek Counseling

When skin picking symptoms are mild, a person can regulate the illness by making minor behavioral modifications. However, when symptoms are moderate to severe, patients will require the guidance, techniques, and interventions that can only be provided by a trained mental health therapist. Experts such as counsellors, psychologists, and psychiatrists are some of the professionals who may help with this problem.

8. Talk to a psychiatrist

As discussed above, psychiatrists can help the person to deal with the impulsivity and emotionality related to skin picking by providing medications. Although medication is not appropriate for everyone with excoriation disorder, it does help some people, especially with severe symptoms. Medication can help alleviate symptoms on its own, but it can also help therapy function more effectively.

In conclusion, skin-picking disorder has the potential to cause severe unpleasant feelings as well as dangerous medical consequences; therefore people should take this mental health issue seriously. Skin picking is a well-treated mental health issue, therefore there is reason to be hopeful. That means you or a loved one can get care quickly and effectively.

The author is a licensed clinical psychologist (alumni of Govt. Medical College Srinagar). He works at Kashmir Life Line, a free mental health counseling service. Author can be reached at [email protected]

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