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All About Dermatillomania

According to Psychology Today, around 1.4% of the population are affected by dermatillomania. Of these, 75% are female. This chronic condition is also known as skin picking disorder or excoriation disorder. It falls under the BFRB (body-focused repetitive behaviours) category of disorders, which is also classified under Obsessive-Compulsive and Related Disorders in the DSM-5. In this article, we’ll tell you everything you need to know about dermatillomania.

What is dermatillomania?

Dermatillomania is a skin picking disorder that is also known as excoriation disorder. It is a psychological condition that’s classified in the DSM-5 under Obsessive-Compulsive and Related Disorders. It is a type of body-focused repetitive behaviour (BFRB). This is a chronic condition that causes distress, dysfunction and often severe damage to tissue.

Those who have the condition have a persistent urge to pick, scratch or dig into their skin. They often spend a significant amount of time engaging in skin picking behaviour, which results in feelings of anxiety, guilt and shame. It can also interfere with daily functioning.

Feeling anxious with dermatillomania

Types of dermatillomania

There are two types of dermatillomania. These are automatic and focused.

Automatic dermatillomania

This type of dermatillomania involves picking skin unconsciously. This is often due to stress, boredom or another emotional trigger. People who have automatic dermatillomania are often not aware that they’re picking at their skin until afterwards. The most common places involved are the arms, legs, face and scalp.

With automatic dermatillomania, there can be a range of severity. It can be minor picking or rubbing right up to repetitive and intense picking that causes significant damage to the skin. People with automatic dermatillomania often experience negative emotions like guilt, embarrassment and shame, which then perpetuates the skin picking further in a cycle.

Focused skin picking

This type of skin picking is more intentional and is focused on specific parts of the body like the arms and legs. Those who have focused dermatillomania can spend hours picking at their skin. Unlike those with automatic dermatillomania, people with focused skin picking pick at their skin repeatedly and intentionally. They often have specific goals in mind, like removing perceived blemishes or imperfections. What’s more, they’re typically aware of their behaviour.

Like automatic dermatillomania, focused dermatillomania often occurs in specific areas like the arms, legs and face. It can involve a range of behaviours like scratching, rubbing and squeezing. It can also be associated with tools like needles and tweezers.

There are often intense feelings of guilt and shame with focused dermatillomania, but this doesn’t stop the impulsive behaviour.

What causes dermatillomania?

The exact causes of dermatillomania are not understood but it is believed that a complex interplay of biological, psychological and environmental factors is at play.

There is some research that suggests a potential genetic component to dermatillomania as it does tend to run in families. Additionally, abnormalities in the brain’s reward system and neurotransmitter imbalances, especially those involving serotonin, may also play a role in the development of the disorder.

Psychological factors like stress, depression and anxiety are commonly associated with dermatillomania. It’s believed that skin picking behaviours may serve as a coping mechanism or a way of relieving tension and anxiety in some people.

Environmental factors such as trauma, neglect or abuse may contribute to the development of dermatillomania. Skin picking could be a coping mechanism for individuals to help them cope with past trauma or to gain a sense of control in their lives.

Ultimately, the causes of dermatillomania are likely to be multifactorial and will vary from person to person. As such, treatment also needs to have a comprehensive approach.

Symptoms of dermatillomania

The main symptom of dermatillomania is recurrent and persistent skin picking that results in skin damage. This might be focused on specific areas like the arms, legs, face or scalp.

Besides this, there are other possible symptoms, which include:

  • Spending significant amounts of time picking at the skin, sometimes to the point of causing bleeding and scarring.
  • Feeling tense or anxious before engaging in skin picking.
  • Feeling pleasure or relief while skin picking.
  • Finding it difficult to stop or control skin picking, even though it causes emotional or physical harm.
  • Significant impairment or distress in daily functioning as a result of the skin picking behaviours.
  • Avoiding social activities or situations that involve exposing the skin due to shame or embarrassment about the skin damage.
  • Being preoccupied with perceived imperfections or blemishes on the skin, which leads to intense focus on skin picking.

The severity and frequency of symptoms vary from person to person and can fluctuate depending on emotions, stress and mental state. Some people might only experience mild skin picking behaviours while others may experience more severe and damaging behaviours that impact their daily life significantly.

Symptom of dermatillomania preoccupied with blemishes

Who does dermatillomania affect?

Anyone of any age, gender and background can be affected by dermatillomania. It is, however, much more common in adolescence and young adults and it tends to affect more women than men. Though research suggests between 1% and 5% of the general population are affected by dermatillomania, the exact prevalence of it isn’t known because many people choose not to seek help for their symptoms.

Dermatillomania frequently co-occurs with other mental health conditions like anxiety disorders, obsessive-compulsive disorder (OCD), eating disorders and body dysmorphic disorder (BDD), though it can occur alone.

What effects does dermatillomania have on someone?

There are a number of negative effects of dermatillomania on a person’s physical and emotional wellbeing.

Some of these effects include:

  • Skin damage: the repetitive picking at the skin can cause physical damage like bleeding, scarring and infections.
  • Pain and discomfort: skin picking causes discomfort and pain as well as chronic physical conditions like dermatitis.
  • Social isolation: due to shame or embarrassment about the skin damage they’ve self-inflicted, many people with dermatillomania will avoid social situations or activities that involve exposing their skin. This can impact their quality of life and can lead to social isolation.
  • Time: for many sufferers, skin picking is time-consuming, and it interferes with a person’s daily responsibilities like work or school. For some people, the compulsion to pick their skin means they neglect other areas of their life.
  • Emotional distress: skin picking causes significant emotional distress such as feelings of guilt, shame, anxiety and depression. Even though the skin picking is self-inflicted, this does not mean it can be easily controlled.
  • Financial burden: sometimes, people spend lots of money on products and treatments to try to improve the appearance of their skin, either because they’ve damaged it or because they perceive themselves to have imperfections. Sometimes people believe that if they didn’t have blemishes, they wouldn’t engage in skin picking.
  • Co-occurring conditions: dermatillomania often co-occurs with other mental health conditions like anxiety disorders, obsessive-compulsive disorder (OCD), eating disorders and body dysmorphic disorder (BDD), which impacts their overall wellbeing even more.

Overall, dermatillomania often has significant negative effects on a person’s physical and emotional health. It also affects their quality of life and relationships.

Effects on relationships

Skin picking behaviour can be difficult for others to understand and loved ones might become frustrated or upset with the person’s inability to stop. This can lead to strained and damaged relationships.

The negative self-image that often accompanies or contributes towards dermatillomania can also impact how the individual sees themselves and how they interact with other people.

There are also a lot of misconceptions regarding dermatillomania and many mistakenly believe that it is a sign of poor hygiene or a lack of self-control, which can lead to misunderstandings.

How is dermatillomania diagnosed?

This condition is usually diagnosed by a mental health professional like a psychiatrist or a psychologist. A thorough evaluation of the symptoms is needed in order to determine whether the individual meets the diagnostic criteria.

The criteria for diagnosis are outlined in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders).

To receive a diagnosis, an individual must meet the following criteria:

1. Recurrent skin picking that results in skin lesions.

2. Repeated attempts to stop or decrease skin picking.

3. The skin picking causes significant impairment or distress in social, occupational or other important areas of functioning.

4. The skin picking is not due to a medical condition or a substance.

5. The skin picking can’t be explained as a symptom of another mental health problem like hallucinations or delusions.

What’s more, the behaviour should be checked to see if it would be better accounted for by symptoms of another condition like OCD, major depressive disorder or BDD.

A mental health professional typically conducts a comprehensive assessment before diagnosis. This will usually include a clinical interview, a review of medical history and observation of skin picking behaviours. The mental health professional might have standardised questionnaires or scales to help determine how severe the condition is. Ultimately, diagnosing dermatillomania is based on carefully evaluating individual symptoms.

How is dermatillomania treated?

Treatment for dermatillomania is usually multifaceted and there will be a combination of self-help strategies, medication and therapy. The specific treatment will depend on each person’s unique needs and preferences.

Here are some examples of treatments for dermatillomania:

1. Cognitive-behavioural therapy (CBT): this is a type of therapy that focuses on changing the thoughts and behaviours that contribute to skin picking. In CBT, the person works with a therapist to identify triggers for skin picking and to develop strategies to manage urges to pick. The therapist might also help the patient to develop coping skills and improve self-esteem.

2. Habit reversal training (HRT): HRT is a type of therapy that focuses on replacing skin picking behaviours with alternatives like engaging in a relaxation exercise or squeezing a stress ball.

3. Medication: some medicines like selective serotonin reuptake inhibitors (SSRIs) might be helpful in reducing skin picking behaviours in some people.

4. Self-help techniques: useful self-help strategies to manage skin picking can be to use a diary to track triggers and behaviours. Developing a routine of self-care that includes healthy activities and stress-reducing techniques can also help. Things like fidget toys and other distractions can help people to manage their urges to pick.

5. Support groups: these provide a helpful source of encouragement and understanding for those with dermatillomania. These support groups can be online or in person.

Treatment can be challenging, and it can often take a few approaches and a lot of time to find something that works for each individual. However, with the right treatment and support, managing symptoms and improving overall wellbeing is possible.

Therapy treatment

Similar conditions to dermatillomania

If you’re unsure whether your symptoms (or those of a loved one) are dermatillomania, it’s important to know about other conditions that could be confused with skin picking disorder.

Here are some similar conditions:

1. Trichotillomania: this is a hair-pulling disorder in which individuals have an overwhelming urge to pull out their hair. This might be from their scalp, eyebrows or any other area of the body. Like dermatillomania, it is classed as an obsessive-compulsive and related disorder.

2. Body dysmorphic disorder (BDD): this is characterised by obsessive preoccupation with perceived flaws in appearance that are not noticeable to others. BDD can lead to skin picking behaviours as individuals attempt to remove their perceived blemishes or imperfections.

3. Obsessive-compulsive disorder (OCD): this is a mental health disorder that is often confused by the general public as a need to be excessively tidy. However, it is a condition that is characterised by obsessive thoughts and compulsive behaviours. In some cases, people who have OCD might engage in skin picking as a compulsion to relieve distress or anxiety.

4. Prurigo nodularis: this is a skin condition in which itchy nodules develop on the skin, leading to scratching and picking behaviours.

5. Delusional disorder: in some rare cases, individuals who have delusional disorder might develop preoccupations with the belief that there are parasites or other foreign objects under their skin. This can lead to excessive skin picking.

It’s important to note that while these conditions might have similarities to dermatillomania, they themselves are distinct disorders with different diagnostic criteria and treatment approaches.

Final thoughts on dermatillomania

Dermatillomania is a distressing condition that affects a range of people. If skin picking, either involuntary or deliberate, is becoming a problem, it’s important to contact your GP in the first instance. Treatment can be effective, though it might take some time to find the right combination of therapy, self-help strategies and medication.

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About the author

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Louise Woffindin

Louise is a writer and translator from Sheffield. Before turning to writing, she worked as a secondary school language teacher. Outside of work, she is a keen runner and also enjoys reading and walking her dog Chaos.

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