Dermatillomania: What to Know About the Skin-Picking Disorder

It’s been estimated in studies that 1.4 to 5.4 percent of the population is affected by excessive skin picking — also known as dermatillomania — a type of self-grooming behavior where people pull, pick, scrape, or bite their own hair, skin, or nails, resulting in damage to the body.

Suzanne Mouton-Odum, a Houston-based psychologist, says skin picking is classified as related to obsessive-compulsive disorder, though it’s not exactly like obsessive-compulsive disorder (OCD). Generally, people with OCD perform compulsive actions to relieve anxious thoughts, but she says skin-picking is often more pleasure or sensory-based.

What are the symptoms of dermatillomania, and how is it diagnosed?

According to Mouton-Odum, to be diagnosed with dermatillomania, an individual causes themselves repetitive injury to the skin through scratching, picking, or biting that results in an injury, and involves an inability to stop.

That inability to stop skin picking, which Mouton-Odum says can cause the person to feel shame and also be physically painful, is the distinction between normal self-grooming and a diagnosable disorder. “Everybody picks, but when the intensity or duration of that picking affects people’s lives and makes them less capable of doing what they’d like to do, then it’s a disorder,” says Jon Grant, a professor of psychiatry and behavioral neuroscience at the University of Chicago.

While dermatillomania can cause physical pain, bleeding, and scarring, it’s also different from self-harm, which Mouton-Odum says is an action of creating pain to release an emotion: “Skin picking is really about trying to fix something, an attempt to fix a problem.”

Grant says skin picking can co-occur with other conditions, including body dysmorphic disorder, anxiety disorders, or as a symptom of drug use disorders. “One needs to do a thorough psychological assessment to know why people pick, what it is, and if it’s an independent skin-picking disorder,” he says.

Usually, Mouton-Odom says people with dermatillomania are drawn to abnormalities on their skin, like a bump, raised area, pimple, or ingrown hair. “There’s something that looks or feels different that attracts a person’s attention, and there will be a behavior to attempt to fix or remove it,” she says. But the attempt to remove the abnormality usually doesn’t work, which can result in bleeding, scabbing, and scarring.

“Often, the result isn’t satisfactory because the thing hasn’t been fixed, and then a bigger problem is created,” explains Mouton-Odum.

How is dermatillomania treated?

“There hasn’t been enough [research on] treatment to understand what would be the most effective,” says Grant. While he says there is no evidence SSRI medications (commonly prescribed for anxiety and depression) work for skin picking, Grant notes there have been some treatments that have shown some benefit. One treatment, N-acetylcysteine (NAC), has been shown in some studies to be effective for adults with dermatillomania, says Mouton-Odum. One theory, according to a study conducted by Grant and his colleagues, is that NAC can help modulate glutamate, a neurotransmitter that Mouton-Odum says “governs happiness.” So far, Grant says there haven’t been double-blind placebo trials yet for other dermatillomania treatments.

To help people with their skin-picking behaviors, mental health providers often use a form of cognitive-behavioral therapy that helps people identify their internal and external triggers.

Once they identify the trigger, the therapist can help the patient develop coping techniques — for example, if a person picks their skin when they’re stressed, they might work on stress management skills. The important thing is that people with dermatillomania know they’re not alone and that they engage with the process of overcoming the behaviors that cause them pain and, in some cases, Mouton-Odum says, feelings of shame.

“There’s help out there, and the treatment works if they engage,” she says. “People want to stop picking, but if they want their urges to go away. It’s a process of accepting that they’re still going to want to pick, and they’re going to have to use strategies for it to get better.”

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