Dr Miriam Stoppard: Stop torturing yourself – remember you can’t fix everything

Are you someone who’s quick to be self-critical and blame yourself when things go wrong?

Do you torture ­yourself by going over and over ­problems until you’re trapped in a web of negative thinking?

Once in this downward spiral do you despair of even climbing out of it?

Well, a new theory says simply ­questioning why you’re fretting could be all it takes for you to snap out of it.

Research led by Dr ­Yoshinori Sugiura, from the department of behavioural sciences at Hiroshima University, Japan, reported: “People with OCD [are] tortured by repeatedly occurring negative thinking and they need some strategy to prevent it.”

Obsessive compulsive disorder (OCD) is an anxiety disorder that causes obsessions – thoughts that repeatedly pop into your head, such as thinking your hands are always dirty and need to be washed. It affects around one in 10 people in the UK.

General anxiety disorder (GAD) is also a very pervasive type of anxiety.

It is a long-term condition that causes a person to feel anxious about almost anything, not just one specific issue or event.

It’s thought to affect more than one in 10 people at some point in their life, according to charity Anxiety UK.

All of us have the odd OCD-like behaviour, such as repeatedly checking if a door is locked or the gas is switched off.

But it can go from a harmless habit to a disorder if the action is irresistible and frequent.

The researchers figured the anxiety of OCD and GAD stems from thinking you’re responsible for everything, which they call ‘inflated responsibility’.

They identified three instances where a person thinks they must take personal responsibility.

The first was a perceived responsibility to prevent or avoid harm; the second was blaming yourself for negative outcomes; and the third was thinking you’re ­responsible for solving a problem.

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Dr Miriam

An online questionnaire sent to university students in the US revealed the students who reported often taking the blame or mulling over ­problems were more likely to have OCD or GAD.

Dr Sugiura suggests a simple, quick and easy way people can overcome inflated responsibility before it becomes a problem, to realise it’s your feelings of responsibility that are making you worry.

He says if you can ask yourself why you worry so much, and realise you can’t help it, you relieve yourself of feeling responsible.

Just realising this, Dr Sugiura believes, will open up some space between your burden of responsibility and your behaviour.

It’s worth a try.

Cannabinoids Could Help Treat OCD, Researchers Suggest

In a new review study, researchers examined evidence that suggests the endocannabinoid system (ECS) may play a role in helping relieve symptoms of obsessive-compulsive disorder (OCD) and other similar conditions.

OCD is a complex psychological condition in which patients have uncontrollable, recurring thoughts (obsessions) and behaviors (compulsions) and the urge to repeat actions over and over. In the United States, 2% to 3% of the adult population and according to a study published in May 2015 in the Archives of Disease in Childhood, up to an estimated 4% of children and adolescents have OCD.

The condition is difficult to treat. According to the International OCD Foundation, the most effective treatment is cognitive behavior therapy (CBT) combined with psychiatric medications such as antidepressants and anti-anxiety remedies. Only about 10% recover completely from OCD and just half improve with treatment, noted a Harvard Medical School publication in March 2009. 

Current Research

The study,The Endocannabinoid System: A New Treatment Target for Obsessive Compulsive Disorder?noted that there is a growing body of research showing the ECS plays a role in anxiety, fear, and repetitive behaviors.

The ECS is involved in regulating our neurotransmitters, the chemical messengers that carry signals between our nerve cells and other cells in the body, and affects just about all of our physical and psychological functions. 

“The research we reviewed in our article indicates that cannabinoids could one day play a role in the treatment of OCD and related disorders,” said lead author and psychiatrist Dr. Reilly Kayser of Columbia University/New York State Psychiatric Institute (NYSPI).

“We examined the complex workings of the ECS and found evidence from animal and human studies supporting a link between OCD symptoms and the ECS,” Kayser said. 

Promising Results 

NYSPI and Weill Cornell Medical College in New York performed the study, which noted: “[S]ome patients with OCD who smoke cannabis anecdotally report that it relieves their symptoms and mitigates anxiety, and several case reports describe patients whose OCD symptoms improved after they were treated with cannabinoids.”

In a pilot study analyzed by the team, 16 severe OCD patients who underwent therapy and received nabilone a synthetic form of THC that acts on the brain’s ECS — had nearly twice the reduction in symptoms after four weeks compared with their counterparts who received nabilone alone, or those who received cognitive therapy alone.

Kayser explained that nabilone works similarly to THC but does not have all of the chemical components of cannabis.

He noted that animal models and human imaging studies have suggested that cannabinoids can also enhance fear extinction learning, which involves creating a response that counters the fear response.

“People who have fears — like flying, PTSD [post-traumatic stress disorder], or OCD — have problems with fear extinction learning,” Kayser told Weedmaps News. “We know that CB1 receptor can boost that form of learning and help alleviate those fears.”

As the cannabinoid-1 receptor (CB1) is found throughout the body’s entire central nervous system, Kayser explained that there are high concentrations in regions of the brain that are implicated in OCD. 

“This is not direct evidence that the endocannabinoid system (ECS) is involved in the pathology that underlies OCD, but is one clue which suggests that such a link may exist,” he said.

Research so Far 

Kayser reiterated that there is an urgent need for new treatments as current medications are ineffective for many people.

“Fortunately, there have recently been a number of promising developments that researchers are actively pursuing,” Kayser said, “but at our site, we are continuing to study how cannabinoids impact OCD symptoms.”

Because research has shown that medical cannabis oil is effective in treating other neurological conditions, including reducing epileptic seizures and treating autism symptoms, scientists are broadening their look into the role of the ECS in a variety of conditions.

“OCD is a complex condition that shares features with other illnesses,” Kayser said. “Thus, we looked into studies that explored the role of the ECS in these related conditions as well.”

Expert Perspectives

Dr. Daniele Piomelli, Ph.D., director of the University of California, Irvine, Center for the Study of Cannabis, said the ECS may help regulate psychiatric conditions and provide therapeutic benefits — and his institute aims to prove it. 

“Our growing understanding of the ECS confirms the extraordinary interest of this signaling system in the control of many brain functions and in the regulation of human behavior in health and disease,” Piomelli said in an email.

“After a long absence, we are seeing a rebirth of pharmaceutical interest in the therapeutic potential of this system,” said Piomelli, who is the Editor in Chief of Cannabis and Cannabinoid Research in which the review article was published on June 14, 2019. 

“This review article offers a critical assessment of the evidence, focused on obsessive-compulsive disorder, and clues to future research,” Piomelli added. “I am optimistic that important advances will take place in the near future.”   

The Bottom Line 

Which cannabinoid agents to test and how to measure their effects will be among the important questions to consider in designing future studies.

“We need to do well-designed, placebo-controlled studies in humans to help us understand more about how cannabis and related substances impact symptoms of OCD and other psychiatric conditions,” Kayser said.

“At the moment, we have the results from two studies that are currently under review and will hopefully be published in the next few months, so stay tuned.”

 

TMS can offer relief from anxiety

Image of Lindsay Israel

by Lindsay Israel, MD

Transcranial magnetic stimulation, or TMS, is an FDA-approved, noninvasive treatment for major depression using magnetic pulses targeted at a specific location on the brain.

TMS is a completely outpatient procedure and is gaining momentum in the behavioral health community as an effective alternative treatment for medication-resistant depression.

However, even more statistically significant than depression, anxiety leads as the most commonly diagnosed mental illness in the United States, affecting more than 18% of the adult population every year, according to the Anxiety and Depression Association of America.

It has long been established that depression and anxiety are typically seen together in presentation. In fact, approximately half of the patients diagnosed with depression have some type of anxiety disorder as well.

Why TMS for anxiety should work

If TMS is an effective treatment for depression, and depression and anxiety are so interconnected and likely the result of a dysregulation of the same neurocircuit in the brain, then would TMS be an effective treatment for anxiety? The simple answer is yes. There is evidence.

Symptoms of mood and anxiety disorders are thought to result in part from disruption in the balance of activity in the emotional centers of the brain. The accepted TMS treatment protocol for depression utilizes rapid, stimulatory, high-frequency pulses on the left side of the head, targeted at the prefrontal area of the brain.

If depression and anxiety go hand in hand, then anxiety symptoms should follow suit and improve along with depression symptoms.

With TMS, often they do, and patients feel relief from the stimulatory pulses because the areas of the brain that are underactive in depression and anxiety are brought back to normal reactivity levels, as seen on functional imaging.

However, anxiety can have a life of its own.

Anxiety is thought to be the result of a misfiring of the electrochemical signaling, due to both hyperactive areas and hypoactive areas of the brain, triggering a feeling of excessive worry or fear, leading to physical symptoms including racing heart, shortness of breath, GI upset and muscle tension.

The theory for treating anxiety specifically with TMS was based on the understanding that the right side of the brain is known to send inhibitory signals to the left. Therefore, if the right side of the brain is subjected to repeated slow, inhibitory, low-frequency pulses, would that slow down the areas of the brain that are also overactive, having a calming effect on an anxiety-riddled brain?

Studies on treating anxiety with TMS

After hundreds of small studies conducted all over the world with very positive results, there is now more confidence that TMS can be an effective treatment for various anxiety disorders, including generalized anxiety disorder, panic disorder, and obsessive compulsive disorder.

There is still more to be known, and more consistency between the studies is needed to come to a consensus for an accepted protocol for anxiety, better defining treatment target location, number of pulses and number of treatments needed to achieve remission from anxiety symptoms.

Take-home Message

The uplifting message for those who are struggling with debilitating anxiety is that there is a cutting-edge technology available to them.

TMS can offer an approach to treating their symptoms where traditional methods, including psychotropic medications, have failed them.

TMS can bring them hope that they are not out of treatment options, and that they can get relief and resume their lives anxiety-free.

References:

Facts and statistics. Anxiety and Depression Association of America. Available at: https://adaa.org/about-adaa/press-room/facts-statistics.

Lindsay Israel, MD, is a board-certified psychiatrist. She specializes in TMS at Success TMS in Palm Beach Gardens, Florida.

Here’s When Hair-Pulling, Skin-Picking, or Nail-Biting Becomes a Disorder

You’re not alone if you find some “bad” habit weirdly satisfying: freeing an ingrown hair, plucking a stray gray, popping a pimple, gnawing off a pesky hangnail, or whatever else you might do in the privacy of your home (and maybe other places, too) Even if you know it’s probably not the best for you, you might derive some satisfaction from this habit all the same.

What you may not know is that when done often enough and in a way that causes harm, these habits can actually be what experts call body-focused repetitive behaviors (or BFRBs). If you don’t know that BFRBs are a thing, these behaviors might make you feel especially alone or ashamed, Nicholas C. Crimarco, Ph.D., clinical psychology instructor in the Division of Child and Adolescent Psychiatry at Columbia University, tells SELF. Most important, you might not know help is out there. Which, FYI, it is! But more on that in a bit. Let’s start by going over the basics of BFRBs.

What exactly are body-focused repetitive behaviors?

Body-focused repetitive behaviors are disorders that make people touch their hair and/or bodies repeatedly in ways that cause physical damage and psychological distress, according to the TLC Foundation for Body-Focused Repetitive Behaviors, a research and education organization.

BFRBs are categorized as “obsessive-compulsive and related disorders” in the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (also known as the DSM-5), the classification and diagnostic tool of the American Psychiatric Association. But BFRBs and OCD have a few important differences that we’ll explore later.

The major BFRB conditions are:

Trichotillomania, also known as hair-pulling disorder

This is when people compulsively pull out hair from their scalps, eyelashes and eyebrows, pubic areas, or other parts of their bodies, according to the Mayo Clinic. While a habit of overplucking your eyebrows might lead to your brows looking more like cousins than sisters, someone with trichotillomania who pulls at their eyebrows is more likely to wind up with sparse, patchy brows. Trichotillomania doesn’t always lead to bald patches, though.

In fact, the diagnostic criteria for trichotillomania has loosened a little bit with the release of the DSM-5 in 2013. To be diagnosed, you used to need to cause visible hair loss, like bald patches. Since so many people go to great lengths to hide their hair loss or pull from parts of their bodies that they can cover easily, the DSM-5 changed that requirement. Now, trichotillomania is diagnosed in part by repetitive hair-pulling that results in hair loss along with multiple failed attempts to decrease or stop pulling. The hair-pulling can’t be related to any other mental or physical health condition.

Excoriation, also known as skin-picking disorder or dermatillomania

This is compulsive manipulation of the skin that leads to some sort of damage, like scarring, discoloration, or mutilation. One major diagnostic criterion is when a person has attempted repeatedly to stop the behavior, according to the TLC Foundation for BFRBs.

Even though it’s also called skin-picking disorder, excoriation can also take the form of touching, rubbing, scratching, scraping, or digging into the skin anywhere on the body. Some people pick at acne, blemishes, dry or chapped skin, but others will focus on a spot that might otherwise seem pretty arbitrary. As with trichotillomania, these behaviors can’t be better explained by some other condition or disorder.

Other specified obsessive-compulsive and related disorders

This diagnosis accounts for compulsive behaviors that aren’t hair-pulling or skin-picking. “It’s an umbrella term for nail-biting, nail-picking, lip-biting, cheek-biting, lip-picking, skin-chewing, [and] any other kind of picking or biting behavior,” clinical psychologist and member of the Scientific Advisory Board of the TLC Foundation for BFRBs Suzanne Mouton-Odum, Ph.D., tells SELF. Like trichotillomania and excoriation, physical damage and a person being unable to stop on their own are key markers of this condition.

In some cases, BFRBs can lead to further physical problems. For example, skin-pickers and nail-biters might leave themselves prone to infection, says Crimarco. And, in some cases, trichotillomania can have medical—not just aesthetic—side effects. According to the TLC Foundation for BFRBs, around 5 to 20 percent of people who have trichotillomania also swallow the hair, which in severe cases can result in serious intestinal blockage.

While the physical actions and repercussions involved can vary with different BFRBs, one overarching symptom is emotional distress or life impairment. Most people with BFRBs feel a strong sense of guilt and embarrassment around their behaviors, which can be almost as debilitating as the behaviors themselves, says Mouton-Odum.

On top of being isolating and awful to deal with, this shame can also interfere with a person’s life in a lot of ways, whether that’s personally, socially, academically, or professionally. Maybe you find yourself turning down invitations after going on a pulling spree that left you with half an eyebrow, you don’t date out of fear of judgment of your excoriation scars, or you shy away from work in the public eye that you might otherwise enjoy. If you sink a lot of time into the behavior itself or on dealing with the damage—like applying makeup to cover up scars or styling your hair to hide bald spots—that’s another good indicator of a BFRB, says Crimarco.

BFRBs can contribute to other mental health conditions like depression and anxiety, the Mayo Clinic says, and many people with at least one BFRB engage in multiple picking or pulling behaviors.

The overall cause of BFRBs is unknown.

We don’t know a ton about what causes BFRBs, but according to experts, there seems to be a genetic component. (Plus, watching someone you’re close to engage in these behaviors might make you more likely to mimic them in some way.) “We regularly see BFRBs in the family members of people with a BFRB that we’re treating,” says Mouton-Odum. That said, it’s not always the same behavior. Where you might be a hair-puller, your dad might be a nail-biter, or your mom might be a chronic pimple popper.

Beyond that, experts know more about what BFRBs are not. For example, they’re not an intentional form of self-harm, which is a complicated coping mechanism meant to purposefully to produce pain or discomfort. Unlike self-harm, BFRBs can actually feel pleasurable, says Mouton-Odum. That’s one of the things that distinguishes BFRBs from OCD, a condition marked by compulsive rituals and obsessions (which are persistent, unwanted, and intrusive thoughts often associating behaviors with preventing harm or danger). Many people with OCD loathe their compulsions, says Mouton-Odum, whereas people with BFRBs typically find some part of it soothing, enjoyable, entertaining, or otherwise pleasant.

Finally, BFRBs are not automatically a sign of trauma or abuse, says Mouton-Odum. While someone with a history of trauma or abuse might experience a BFRB disorder, there’s currently no known correlation between the two, according to the TLC Foundation for BFRBs.

BFRBs tend to happen in response to certain triggers.

In the absence of a known cause, mental health professionals tend to focus on what triggers a BFRB, which can inform treatment. Although specific triggers are not required for diagnosis, Mouton-Odum describes five main groups of triggers that BFRB patients typically report:

Sensory triggers: Any of the five senses—sight, smell, hearing, taste, and touch—might give you the urge to pull or pick. “You might see something that triggers it, like a gray hair or a blemish,” says Mouton-Odum. “You might feel something with your fingers, like a hair that feels different or out of place.” Smell, taste, and sound are also possible—like the sound you might hear when digging at your scalp—but those are less common, according to Mouton-Odum.

Cognitive triggers: These are thoughts or beliefs you have when engaging in your BFRB (or being about to), like, “I need to pull out my gray hairs so no one notices them,” or “If I pop this pimple, it will heal.” (These thoughts are a lot less intense than obsessions that come with OCD.)

Affective triggers: These are triggers of the emotional variety. According to Mouton-Odum, some people pick, pull, or perform another BFRB in response to feelings such as “anxiety, tension, fear, anger, or boredom, or to increase positive feelings such as gratification or relaxation.”

Motor triggers: This involves certain movements, postures, and unconscious behaviors that can kick off your BFRB. For example, maybe you typically rest your chin on your palm while working, which makes you more susceptible to noticing a rogue facial hair or zit.

Setting triggers: Finally, factors like where you are, what you’re doing, what time it is, and things in your environment could prompt you to engage in your BFRB. “For example, in the bathroom, late at night, by yourself, door locked, magnifying mirror, bright light, and tweezers,” says Mouton-Odum.

Professional treatment can help curb BFRBs.

According to Crimarco, the go-to treatment for BFRBs is cognitive behavioral therapy (CBT), specifically habit reversal training, which involves helping a person to be aware of their habit and its triggers, as well as helping them to develop what experts call “competing responses” to replace the BFRB.

Through habit reversal training, you and a therapist can discover the underlying function of your BFRB (for example, if it’s a distraction from emotional triggers or maybe a response to boredom) and work to address the root of the issue.

If you’re trying to find a therapist for help with a BFRB, it’s worth taking the time to seek out someone who is familiar with treating these disorders in particular, says Crimarco. The TLC Foundation for Body-Focused Repetitive Behaviors has a list of TLC Professional Members who have identified themselves as mental health providers familiar with treating BFRBs, many of whom have completed the TLC’s Professional Training Institute. It’s not an exhaustive list, but it may be a good place to start if you’re looking for someone who has, at the very least, a professional interest in BFRBs.

For resources in the meantime, Mouton-Odum is the co-owner and lead developer of the interactive websites StopPulling.com and StopPicking.com, which are both full of helpful information.

Unlike for OCD, medication isn’t a go-to treatment for BFRBs. But depending on what usually triggers your behaviors or what other mental health disorders you may have, your doctor might suggest medication, too. For example, if the trigger for your skin-picking is feeling anxious, your doctor might prescribe an anti-anxiety medication to see if that helps reduce the picking behavior. Similarly, while BFRBs and OCD are separate disorders, some people with OCD deal with BFRBs and vice versa, so if someone takes medication for their OCD, it might also help reduce their BFRBs. What might work for you really depends on your specific situation, so talk to your doctor or therapist.

The most important thing to keep in mind is that you can seek help whenever you want, even if you don’t hit the official diagnostic criteria for a BFRB or if you worry your behavior isn’t “bad enough.” If a habit is affecting you physically or getting in the way of how you live your life and you want help moving past it, professional help is out there.

“It’s always better to seek help for something you’re experiencing than it is to wait for it to get worse or to tell yourself you need to handle it on your own,” says Crimarco. “Too many people see BFRBs as a weakness or the result of lack of willpower, but we know [they’re conditions] in which people need to learn very specific strategies to manage them. That’s nothing to be ashamed about.”

Related:

Experimental Drug For OCD Could Give Patients Much-Needed New Treatment Option

PHILADELPHIA (CBS) — There is new hope for people with obsessive compulsive disorder. A new drug is being tested in the Philadelphia region to treat the mental illness that can be disruptive and impacts an estimated 2% of the population — or one in 50 people.

Drugs that are currently used to treat OCD don’t work well for many and often have side effects. That could be changing.

Every time Ted Nichols, who lives in Perkasie, passes the door, he has to check that it’s locked.

“It’s an irrational thought I know that I’ve locked the door,” he said, “but I just continue to check it anyway.”

He does the same thing with washing his hands.

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“For no reason, I feel dirty. I have to wash really thoroughly, not just like a one-and-done wash your hands. I have to do it three times,” Nichols said. “It seems ridiculous, but I can’t stop.”

Nichols has OCD and he gets fixated on something like locking the door and then compulsively checks it.

“My wife says, ‘You know what you’re doing, just stop.’ I would if I could, I really would but I can’t,” he said.

Traditional medications for OCD target brain chemicals serotonin and dopamine, but they’ve been only marginally helpful.

“So a good percent of the patients do not get relief with the current medication,” Dr. Shivkumar Hatti said.

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Hatti, a psychiatrist in Media, is a principal investigator for an experimental OCD medication made by Biohaven Pharmaceuticals.

The medicine targets a different brain chemical called glutamate.

“The drug works on the symptoms of anxiety. If the anxiety comes down, compulsion to perform an activity will also come down,” Hatti said.

Limited early results have been positive.

“It would dramatically change my life,” Nichols said.

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Nichols is thinking about enrolling in the trial to test the drug, hoping for a more effective treatment for the disorder that interferes with his life every day.

The pharmaceutical company is looking to enroll 226 people at 59 test centers around the country.

The drug is tested for a period of three months, but it can be extended if it’s determined to be helpful.

Anyone who would like more information about the trial can do so by visiting ocdtrial.org.

New Medicine Promises Better Relief For People With Obsessive-Compulsive Disorder

NEW YORK (CBSNewYork) – There could be new hope for people with obsessive-compulsive disorder.

An estimated 2% of the population, or 1 in 50, has OCD. Treatments currently available don’t work well for many and often have side effects.

As Stephanie Stahl reports a new experimental drug could change that.

Every time he passes a door Ted Nicholas has to check that it’s locked.

“It’s an irrational thought, I know that I’ve locked the door but I just continue to check it anyway,” he said.

Same thing with washing his hands.

“For no reason, I feel dirty,” said Nicholas. “I have to wash really thoroughly, not just like a one and done wash your hands. I have to do it three times… it seems ridiculous but I can’t stop.”

Nicholas has obsessive-compulsive disorder and gets fixated on things like locking the door, then compulsively checking it.

“My wife says, ‘You know what you’re doing, just stop,’” he said. “I would if I could, I really would but I can’t.”

Traditional medications for OCD target brain chemicals serotonin and dopamine, but they’ve only been marginally helpful.

“So a good percent of the patients do not get relief with the current medication,” said psychiatrist Dr. Shivkumar Hatti, a principal investigator for an experimental OCD medication made by Biohaven Pharmaceuticals.

The medicine targets a different brain chemical called glutamate.

“The drug works on the symptoms of anxiety,” said Shivkumar. “If the anxiety comes down, compulsion to perform an activity will also come down.”

Limited early results have been positive.

“It would dramatically change my life,” said Nicholas, who is thinking about enrolling in the trial to test the drug and hoping for a more effective treatment for the disorder that interferes with his life every day.

The pharmaceutical company is looking to enroll 226 people at 59 test centers around the country. To find out more information and sign up, visit the website at OCDTrial.org.

Experimental Drug For Obsessive Compulsive Disorder Showing Promising Results

PHILADELPHIA (CBS) — There is new hope for people with obsessive compulsive disorder. A new drug is being tested in the Philadelphia region to treat the mental illness that can be disruptive and impacts an estimated 2% of the population — or one in 50 people.

Treatments that are currently available do not work well for many and often have side effects. That could be changing.

Every time Ted Nicholas, who lives in Perkasie, passes the door, he has to check that it’s locked.

“It’s an irrational thought I know that I’ve locked the door,” he said, “but I just continue to check it anyway.”

He does the same thing with washing his hands.

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“For no reason I feel dirty. I have to wash really thoroughly, not just like a one-and-done wash your hands. I have to do it three times,” Nicholas said. “It seems ridiculous, but I can’t stop.”

Nicholas has OCD and he gets fixated on something like locking the door and then compulsively checks it.

“My wife says, ‘You know what you’re doing, just stop.’ I would if I could, I really would but I can’t,” he said.

Traditional medications for OCD target brain chemicals serotonin and dopamine, but they’ve been only marginally helpful.

“So a good percent of the patients do not get relief with the current medication,” Dr. Shivkumar Hatti said.

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Hatti, a psychiatrist in Media, is a principal investigator for an experimental OCD medication made by Biohaven Pharmaceuticals.

The medicine targets a different brain chemical called glutamate.

“The drug works on the symptoms of anxiety. If the anxiety comes down, compulsion to perform an activity will also come down,” Hatti said.

Limited early results have been positive.

“It would dramatically change my life,” Nicholas said.

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Nicholas is thinking about enrolling in the trial to test the drug, hoping for a more effective treatment for the disorder that interferes with his life every day.

The pharmaceutical company is looking to enroll 226 people at 59 test centers around the country.

The drug is tested for a period of three months, but it can be extended if it’s determined to be helpful.

Anyone who would like more information about the trial can do so by visiting ocdtrial.org.

NUTRITION TIP OF THE WEEK: Can healthy eating really go too far?

People with orthorexia are preoccupied with finding and eating the “perfect” diet. The National Eating Disorders Association explains that people with orthorexia will fixate on eating foods that give a feeling of being pure and healthy. Many people with orthorexia are of normal weight, so the eating disorder can be hard to recognize.

It’s good to eat a healthy diet, but for some people, a fixation on healthy eating becomes an unhealthy obsession. Strict food rules of any kind can develop into an eating disorder in some people. The term “orthorexia” was coined in the late 1990s to describe an obsession with eating only healthy or “pure” foods. This disordered eating behavior has become more prevalent, likely fueled by conflicting dietary advice, confusing food marketing and social media.

People with orthorexia are preoccupied with finding and eating the “perfect” diet. The National Eating Disorders Association explains that people with orthorexia will fixate on eating foods that give a feeling of being pure and healthy. Many people with orthorexia are of normal weight, so the eating disorder can be hard to recognize. Common behavior changes that may be warning signs of orthorexia include:

Obsessive concern about the relationship between food choices and health concerns, such as digestive problems, mood, anxiety or allergies

Avoiding foods with artificial colors, flavors or preservatives, as well as anything that is genetically modified or has possibly had pesticides or other chemicals used in its production

Noticeable increase in the use of supplements, herbal remedies or probiotics

Irrational concern about food preparation techniques; perhaps refusing to eat out due to lack of control

Classifying foods as “good” or “bad,” with “good” foods providing a feeling of virtue and self-esteem and “bad” foods associated with being inferior or unclean

Spending an excessive amount of time planning meals; prepping food; or reading books or social media sites about diet

Undergoing cleanses or detoxes

Refusing to treat oneself to a favorite food, even for a special occasion

Feeling guilty after deviating from self-imposed diet restrictions

A drastic reduction in acceptable food choices, often due to “allergies” that are not diagnosed; this can lead to the elimination of entire food groups, such as animal or dairy products, and a list of “acceptable” foods that is quite small

Distancing from friends or family who do not share similar views about food

Avoiding eating foods bought or prepared by others

Rigid eating patterns

Compulsive checking of ingredient lists and nutrition labels

Orthorexia symptoms are serious and go beyond a simple lifestyle choice. Obsession with healthy food can crowd out other activities and interests and impair relationships. It can also become physically dangerous when the list of acceptable foods dwindles, resulting in calorie restriction and severe weight loss. Malnutrition is also a real possibility due to limited diet variety. Cardiac problems also can arise.

Treatment for orthorexia usually involves psychotherapy, much like the treatment of other eating disorders, including anorexia and bulimia. The variety of food is gradually increased as the person learns to accept foods that had been shunned. Balance and moderation to life and diet is restored, using coping mechanisms to reduce the power of food.

Orthorexia often starts as a positive way for someone to improve their health, but for those who have the biological, social and psychological precursors for developing an eating disorder, these lifestyle changes can become an obsession. Common disorders that co-occur with orthorexia include depression, obsessive-compulsive disorder, bipolar disorder, panic or anxiety disorders, substance abuse disorder, and post-traumatic stress disorder.

Anita Marlay, R.D., L.D., is a dietitian in the Cardiopulmonary Rehab department at Lake Regional Health System in Osage Beach, Mo.

Genomind Launching Enhanced Mental Health Biomarker Test

Genomind will launch an enhanced version of its mental health genetic test that will feature a new, more focused report and set of services, all designed to help clinicians better understand a patient’s genetic profile and its implications for mental health treatment. [© ktsdesign/Fotolia]

Genomind said today it will launch an enhanced version of its mental health genetic test that will feature a new, more focused report and set of services, all designed to help clinicians better understand a patient’s genetic profile and its implications for mental health treatment.

Genomind Professional PGx Express, set to be launched on Saturday, is designed to furnish physicians with what the company says is the most comprehensive information available on the variants of an individual’s genetic profile known to impact mental health treatment. The format of Genomind Professional PGx Express has been restructured to provide context on genetic profiles and how they impact a patient’s journey, the company added.

Using a cheek swab administered in the physician’s office, Genomind Professional PGx Express analyzes 24 genes associated with mental health, and includes access to new technology and consultative services intended to help medical providers understand the role those genetic biomarkers may play in the treatment of mental health disorders—including depression, anxiety, attention deficit hyperactivity disorder (ADHD), autism, bipolar disorder, chronic pain, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), schizophrenia, and substance abuse.

Genomind said it is doubling its pharmacogenomic expert counseling resources, and will also soon add real-time chat capabilities to its clinician portal. The expanded suite of resources will also include:

  • A new allele frequency chart, which serves as a basic genomic backgrounder listing the possible combination of alleles for each of the genetic variations in the report as well as the frequency of these variations in different ethnic populations;
  • An Rx MetaType Card compatible with electronic medical records (EMRs) that provides the individual patient’s genotype and the expected impact (phenotype) for certain genetic variants related to drug metabolism; the ‘metatype’ can have a critical impact on the effects of drugs on that individual patient;
  • Access to NeuroFlow, a progressive collaborative care digital platform of behavioral health smart phone apps to help the care team and patients better track compliance with treatment plans and enable remote monitoring and measurement-based care.

Genomind’s ‘express’ reporting and consults are intended to enable a broader range of practitioners involved in mental health to use individual genetic profiles in making treatment decisions, including primary care and OB/GYN providers.

“We consider it essential that all mental health clinicians, including psychiatrists, primary care providers, and nurse practitioners, can obtain the most up-to-date scientific knowledge of patients’ genetics and how they can affect their mental health journey,” Genomind CEO Shawn Patrick O’Brien said in a statement. “Genomind Professional PGx Express will provide this complex but valuable information, which will help build the individual clinical picture and, ultimately, help physicians manage their patients.”

He said understanding of how genetics impacts disease and wellness continues to grow exponentially, particularly in mental health, which is 10 years behind other diseases, such as cancer.

Genomind noted that UnitedHealthcare has issued a positive coverage decision for the use of multi-gene panel PGx testing, including Genomind’s service, in some patients being treated for major depressive disorder (MDD) or anxiety. Coverage will be effective October 1, 2019.

UnitedHealthcare’s decision followed studies showing cost savings when therapy decisions were guided by PGx. In a study published in May 2018 in Depression Anxiety, patients treated following Genomind’s test lowered their costs by $1,948 in the first 6 months following therapy, had 40% fewer emergency room visits for any cause, and 58% fewer hospitalizations for any cause.

“Pharmacogenetic testing represents a promising strategy to reduce costs and utilization among patients with mood and anxiety disorders,” the study concluded.

PGx Express was launched, according to Genomind, following positive clinician feedback and growing market demand. Another factor in expanding its suite of services was a recent FDA request to eliminate references to medications and medication classes on mental health pharmacogenomic reporting.

More than 260 FDA-approved medications must carry pharmacogenomic biomarker information on their labels, including more than 30 used in the treatment of mental health.

“Genomind will continue to meet and partner with FDA to develop the path forward to communicate pharmacogenomic information to health care professionals, for the benefit of their patients with mental illness,” O’Brien added. “That productive dialogue is ongoing as we collaborate on the best path forward to realize the benefit of pharmacogenomics.”

The Boxing Champion Who Battles O.C.D.

Another day at the gym, her teammate Mikaela Mayer put her shoe on Fuchs. “Ginny freaked all the way out,” Shields said. “She ran to a shower and we didn’t hear from Ginny for a couple hours.”

Mayer, a 2016 Olympian and Fuchs’s best friend, noticed something was amiss the first time they shared a hotel room. Fuchs wouldn’t get out of the bathroom.

“Within two hours, there was no toilet paper, all the towels are on the floor and dirty,” Mayer said. “She didn’t even shower and all the soap was gone. I was like, ‘Are you kidding me?’ I started to spy on her. I would watch her do these routines. I would bust in the door and be like, ‘What did I just see?’”

What people don’t know, Mayer said, is that as soon as Fuchs leaves the gym, she remembers exactly where blood spattered, snot flew and precisely where an armpit touched her shoulder.

“She uses her shower time scrubbing those parts of her body and remembering that,” Mayer said.

Unlike other O.C.D. cases, Fuchs’s cleaning rituals aren’t dictated by a fixed number of repetitions. “It’s a feeling,” she said. “I’m always searching for that perfect clean feeling.”

Yet she is not a neat freak.

Far from it, Mayer said, because Fuchs’s idea of clean is completely different. “To her, it’s not visual; it’s all about germs and contamination,” Mayer explained. “So you’ll walk into her room and there are clothes all over the floor, but it’s a ‘clean’ area.”

Mayer and Koroma are really the only ones who see Fuchs struggle up-close, on a daily basis.

My religious OCD convinced me God would never love me

When I was a kid, I read my scriptures every night. Not because I wanted to, but because I had to. I believed that if I skipped even one night, God would blind me for my disobedience.

After watching The Chronicles of Narnia: The Lion, the Witch, and the Wardrobe, I also worried that I’d sell my soul to the devil by accident. Edmund sold his to the White Witch, the villain who imprisons Edmund the moment he succumbs to temptation, for something as simple as Turkish Delight. What if I damned myself, too, without realizing what I’d done?

Sometimes I’d accidentally think, I’m giving my soul to the devil. The mind is frustrating like that, always letting the thoughts we fear the most stick around the longest. Whenever that happened, I’d have to repeat the following phrase in my head, I just want to follow God. I just want to follow God. I just want to follow God.

Three times. Three was important. Three was a holy number.

But my mind never felt clean, and I worried that when I died, I’d go to hell. Most people from my religious background don’t grow up with this fear. Members of the Church of Latter-Day Saints — Mormons — don’t believe in hell as such. Our doctrine teaches that pretty much everyone, even the wicked, goes to heaven. But the fire and brimstone still felt like a real threat to me.

I was devout from a young age. Part of that is because I grew up in St. George, a city in Southern Utah where Mormonism is the cultural majority. But I also suffered from a psychological condition that amplified my beliefs to unhealthy levels: a subset of obsessive-compulsive disorder called scrupulosity.

Though relatively uncommon, scrupulosity can take a significant toll on a person’s beliefs and overall wellbeing. It can cause intrusive thoughts about religion or morality that the sufferer alleviates by giving into compulsions. These compulsions could be physical, like feeling a need to go to confession or frequently seeking assurance from others that they’re not going to hell. But sometimes they’re internal, like excessive prayer.

In 2012, John Dehlin, doctoral candidate studying scrupulosity in Mormonism at Utah State University, noted that the cause isn’t religion itself so much as the importance a person places on their faith. “OCD tends to attack the things that you care most about,” he said in an interview. “So if you care about your faith — you can be more vulnerable to scrupulosity in some cases.”

Once, when my mom picked me up from preschool, I asked her on the ride home, “So how did we all get here to Earth? Did we go down a slide or something?” Clearly, trying to understand the purpose of life is something that I’ve cared about for a long time. It’s one of the driving forces in my life to this day. I saw the world as a frightening, uncertain place as a kid. Religion provided structure but, because of my OCD, it also gave me a whole new set of fears.


The history of scrupulosity is as old as spirituality itself. It’s been documented in most faiths, though it’s most common in orthodox religions. Various scholars have retroactively diagnosed a number of major Christian historical figures with the disorder, including St. Ignatius of Loyola (the co-founder of the Jesuits), St. Alphonsus Liguori (the patron saint of confessors), and Protestant reformer Martin Luther. As a young monk, Luther was tormented by intrusive thoughts about blaspheming Jesus and images of “the Devil’s behind.” He went to confession so much that it annoyed the priests, and he practiced compulsive rituals to the extent that he wrote, “If I had kept on any longer, I should have killed myself with vigils, prayers, reading, and other work.”

Later, Martin Luther would spearhead the Protestant Reformation, a movement that placed faith in God as more important than good works. If I were in his place, I imagine that this belief would have eased my troubled mind. Scrupulous OCD can often make a person feel so guilty that no matter what they do, God will never forgive them.

Certain Christian historical figures have been retroactively diagnosed with scrupulosity — like Martin Luther, who went to confession so much he annoyed the priests.

When I attended counseling in college, I would divide my life into two parts: “before OCD” and “after OCD.” If I reflect, though, I showed signs of it all my life. But during my teen years, when I discovered parts of my identity that conflicted with my religious upbringing, my OCD started to take over my life.

Not all of my obsessions or compulsions were religious; since OCD is such a pervasive disorder, sufferers often fixate on a few different concerns. For me, health was a major obsession. I worried that I’d have a heart attack after reading about them online and would compulsively monitor my pulse. I also had to tap the books on my shelf in a specific order every night or, I thought, I would get cancer.

But my biggest obsession revolved around religion and my sexual orientation. The more time I spent around my best friend, whom I’ll refer to as Natasha, the more I realized that the feelings I had for her weren’t platonic. And as I entered puberty, I also felt a dissonance between my gender identity and my body. I wouldn’t have the name for the latter feeling — transgender — until I was 16, but I obsessed over whether my feelings for Natasha were sinful.

In the middle of this crisis, an eighth-grade teacher gave an unprompted talk to our class about how LGBT people would bring about the downfall of society “like in ancient Rome.” Comments like this weren’t — and still aren’t — unusual in my religious community; just last October, Mormon leader Dallin H. Oaks said that advocating for LGBTQ people is a temptation that comes from Satan during the church’s international conference.

Religion provided structure but, because of my OCD, it also gave me a whole new set of fears.

I don’t think those saying stuff like this always realize how traumatic they can be for queer members of the church. They think they’re talking about “the gay agenda,” an external adversary that threatens their way of life, but really, they’re talking about closeted loved ones who already feel alienated. Hearing something so damning from someone you love can have painful, long-lasting effects on a person’s well-being.

I’d grown up hearing people who I admired and respected referring to gay people as sinful or mentally ill, but this time in particular, the timing seemed too uncanny. I felt like God was talking to me through her and I became so consumed by my OCD that I couldn’t function anymore. I stopped going to school and lost 10 pounds in a month because I couldn’t eat and hardly slept. When I returned, I broke down and told a friend that I didn’t want to live anymore.

My parents enrolled me in a counseling program recommended by a therapist and friend of my mom. Though I felt too ashamed to tell them about my attraction to Natasha at that time, they knew that I felt suicidal and needed help. After a few sessions, I received a diagnosis — obsessive-compulsive disorder. In some ways, I felt relieved to have a name for the rituals and intrusive thoughts that had controlled my life.

But it would take years for me to change my spiritual beliefs. Growing up, religion felt like a two-sided coin: hope on one side and shame on the other. I wanted to believe that God loved me, but when I thought about my feelings for Natasha, I didn’t think that anyone ever could. I longed for religion to give me the comfort it seemed to provide for others, but as I threw myself into my religious rituals, I felt even more miserable.

Around this time, my compulsions took a new form: making promises with God. Since I couldn’t get rid of my attraction to women or gender dysphoria, I worried that God would punish me. So my prayers started to sound like this: Dear God, please don’t hurt me for my feelings towards Natasha. I promise that if you don’t hurt me, I won’t have crushes on girls anymore.

Or, when I realized that I was transgender, Dear God, please forgive me for reading an article about transitioning to male online. If you don’t punish me, I promise to be happy with the body I have and never do that again.

I longed for religion to give me the comfort it seemed to provide for others, but as I threw myself into my religious rituals, I felt even more miserable.

I’d always end up breaking them. No matter how hard I tried, I couldn’t change my sexual orientation or make my dysphoria go away. And once I inevitably wished I were born male or felt attracted to a girl again, I worried that since I “broken the promise,” God would punish me.

After high school I attended college at Brigham Young University, where my compulsions spiraled into a crisis point. During my freshman year, I started self-harming to “punish” myself for my transgender identity and my attraction to women.

Later, through a Medieval Studies course I took during my sophomore year, I realized that I was falling into the same mental distortion that very may well have caused Martin Luther to whip, starve, and deprive himself of sleep as a young monk. I thought that it would take away the guilt and maybe make things right with God.

But the guilt (or more accurately, intrusive thoughts) just kept getting worse, as did my compulsions. Several months later, I ended up in the emergency room for suicidal ideation. I knew something had to change because I literally couldn’t keep living with that pain.

Obsessive-compulsive disorder is traditionally treated with cognitive-behavioral therapy, but for scrupulosity, sometimes adjustments need to be made. To treat scrupulosity, a clinician needs to both help a patient recognize intrusive thoughts and compulsions as well as “detoxify” a person’s relationship with religion. Often, this involves helping a patient shift their belief in God from an angry, unforgiving figure to one that is compassionate and understanding.

Once I inevitably wished I were born male or felt attracted to a girl again, I worried that God would punish me.

Viewing the divine as punitive and vengeful in this way is strongly linked to mental illness, according to the study “Beliefs About God and Mental Health Among American Adults” published in 2014 by the Journal of Religion Health. According to its authors, seeing God as a figure who will punish them at the first misstep is “positively associated with general anxiety, social anxiety, depression, paranoia, and obsession-compulsion” among religious populations. As a transgender Mormon, I felt like every step I took was deserving of that punishment and my mental health suffered because of it.

The summer after my hospital visit, I began attending support groups for transgender Mormons. Here, I met people who would become some of my best friends. Among others, I met a non-binary parent who felt torn between their gender identity and their family, a fellow trans BYU student who shared my love of books, and an older trans woman who gave me a handmade leather journal for Christmas, which this day is one of my most prized posessions.

For a long time, I thought that my gender identity meant that I was unworthy of love, especially love from God. But I couldn’t imagine telling any of my transgender friends that they didn’t deserve to find happiness in life. Between them and continued treatment for my OCD, I finally found peace with my gender identity and decided to transition during my sophomore year.

Several years later, I became one of the first openly transgender men to graduate at BYU. My years in college led to some of the most meaningful and challenging moments in my life. Between the strict policies towards LGBT students and my own challenges with OCD, I don’t think I could have done it again. But because of the queer students I met who helped me develop a healthier relationship with faith, I also wouldn’t trade it for anything.


As a queer religious person, I’m sometimes asked how I balance these conflicting identities. Many LGBTQ Mormons feel like they’ll be rejected by God and their community because of who they are. Some Mormon families are more progressive than others but overall, the admonition to “love the sinner, not the sin” translates into plenty of queer children who are shunned by their families once they transition or date someone of the same sex.

I guess in some ways, I’ve felt that rejection from God all my life — just not strictly for being transgender. But I’ve realized those feelings are a combination of internalized shame and a psychological disorder. I think that through shifting my beliefs from a punitive to a loving God, I’ve been able to separate my spirituality from some of the stricter beliefs held within the Latter-Day Saint community.

My prayers started to sound like this: Dear God, please don’t hurt me for my feelings towards Natasha. I promise that if you don’t hurt me, I won’t have crushes on girls anymore.

These days, I take an anti-anxiety medication to keep the neurological aspects of my OCD regulated. When it flares up, I seek therapy. And I’m also lucky to have a family and a partner who are patient enough to listen and support me through my struggles.

But for the most part, I’m at peace with religion, maybe for the first time in my life. I don’t blame God or my faith for the pain that scrupulosity caused me. Its roots lie in a neurological condition that could affect anyone — even atheists can develop scrupulosity. I could blame my brain for its faulty wiring, but that seems as effective as a diabetic blaming their pancreas for failing to make insulin.

There’s a verse in Mormon scripture that, when referring to God, reads, “I know that he loveth his children; nevertheless, I do not know the meaning of all things.”

I don’t know why I was born with obsessive-compulsive disorder. I don’t know why people suffer from mental illness, or why the queer community has to endure so much discrimination, or why suffering exists at all. Life doesn’t always give easy answers. But I believe that God loves us as we are and not as we believe we need to be, even if my OCD tries to persuade me otherwise.

Skin picking (excoriation disorder): Causes and treatment

People may pick their skin occasionally. For example, they might itch a scab or pop a pimple. However, occasional skin picking can develop into a chronic behavior called skin picking disorder, or excoriation disorder.

The exact cause of skin picking disorder remains unknown. That said, it may develop alongside other health conditions, such as obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), or autism.

Skin picking disorder can significantly impact a person’s quality of life and overall health.

In this article, we discuss the potential causes and common treatments of skin picking.

What is skin picking disorder?

People with skin picking disorder may repeatedly pick at pimples, blisters, or scabs.

Skin picking disorder is a body focused repetitive behavior (BFRB) that affects about 1.4% of adults in the United States.

People with skin picking disorder may repeatedly pick, pull, or tear at healthy skin, pimples, blisters, or scabs.

Skin picking disorder occurs more frequently in females than males. Symptoms most often develop during adolescence and adulthood.

Symptoms of skin picking disorder include:

  • engaging in skin picking despite multiple attempts to address the behavior
  • developing recurring skin lesions or open wounds due to picking
  • experiencing significant psychological, physical, or social impairment as a result of skin picking

People may pick their skin for various reasons. Some may feel compelled to remove perceived imperfections, while others pick in response to stress, boredom, or out of habit.

In many ways, skin picking disorder is a repetitive or obsessive grooming behavior similar to other BFRBs, such as hair pulling and nail picking.

Skin picking behaviors can last anywhere from a few minutes to several hours or several months, with periods of remission in between.

If untreated, skin picking can lead to painful lesions, bleeding, scars, and significant psychological distress.


Causes

Skin picking disorder may develop in response to stress or mental health conditions.

People can develop skin picking disorder in response to:

  • An infection, rash, or injury that creates a scab: The scab may itch while it heals, which leads people to scratch or pick it until it bleeds and a new wound forms. They may then pick at the new scab. A picking cycle forms and the behavioral pattern becomes a habit.
  • Stress or mental health conditions: During times of stress, people might pick or scratch their skin, pull their hair, or bite their nails to relieve it. Others might feel compelled to pick their skin as a form of self-grooming or in an attempt to remove real or imagined imperfections in the skin.

Although skin picking has no specific cause, it may result from biological and environmental factors.

Skin picking disorder can develop alongside OCD or another mental health condition. We discuss this in more detail below.

OCD

OCD is a mental health condition characterized by unwanted repetitive thoughts and behaviors. According to the National Alliance on Mental Illness, OCD affects more than 2% of the U.S. population.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists skin picking as a common compulsion that develops in people with OCD.

Trichotillomania

Trichotillomania is a compulsive condition related to OCD. It leads to habitual behaviors such as hair pulling, nail biting, and teeth grinding.

An estimated 38% of people who have skin picking disorder also have trichotillomania.

ADHD

ADHD is a neurodevelopmental condition that interferes with a person’s ability to pay attention and control impulsive behaviors.

The Centers for Disease Control and Prevention (CDC) list ADHD as “one of the most common” neurodevelopmental conditions among children.

People with ADHD may develop skin picking disorder in response to their hyperactivity or low impulse control.

Autism spectrum disorder

Autism spectrum disorder (ASD) is a neurodevelopmental condition that affects behavior and communication.

Doctors consider autism a spectrum disorder because it can cause a vast range of symptoms that appear at different intensities.

Although autism symptoms can differ from person to person, common symptoms include:

  • inconstant eye contact
  • showing little or no enjoyment during activities or interactions involving other people
  • showing more or less sensitivity to sensory information, such as noise, lights, or temperature
  • repeating certain behaviors or phrases, which is known as echolalia

The behavioral symptoms of ASD can manifest as repetitive behavior, such as skin picking, that often includes self-injury.

Treatments

Treatment options for skin picking disorder usually include medication and therapy. Treating any underlying condition can help alleviate the impulse to pick.

Medication

Skin picking disorder related to an underlying mental health or developmental condition might respond to medications such as:

  • selective serotonin reuptake inhibitors (SSRIs) and other antidepressants
  • anticonvulsants such as lamotrigine (Lamictal)
  • antipsychotics such as risperidone (Risperdal)

Therapy

A therapist may suggest an alternative to occupy the hands, such as squeezing a rubber ball or using a Rubik’s cube.

People with skin picking disorder may benefit from cognitive behavioral therapy (CBT), which focuses on addressing negative habits and impulse control issues.

During CBT, a mental health professional or counselor will help a person identify and address emotional, physical, and environmental triggers that contribute to negative behaviors.

They can suggest safer alternative activities for people who pick in response to stress, anxiety, or boredom. Alternatives can include:

  • squeezing a rubber ball
  • using a Rubik’s cube
  • drawing, painting, or knitting

Those who unconsciously pick their skin may benefit from wearing gloves or adhesive bandages to prevent tissue damage and reduce the urge to pick.

People can take action at home by practicing stress management techniques and altering their environment to reduce exposure to potential triggers.

Tips for managing skin picking disorder at home include:

  • applying soothing topical ointments, such as aloe vera gel or high quality coconut oil
  • exercising regularly
  • practicing yoga, meditation, or deep breathing exercises to reduce stress or anxiety
  • removing or covering mirrors to avoid seeing skin blemishes
  • hiding any tools used to pick or pull skin, such as tweezers, nail clippers, and scissors


Summary

Skin picking disorder, or excoriation disorder, is a repetitive behavior characterized by compulsive picking, scratching, or pulling of the skin.

People pick their skin for different reasons. For example, they may also have a mental health condition, such as OCD or ADHD. Repetitive behaviors such as skin picking are also common symptoms of ASD.

Without treatment, skin picking disorder can lead to open wounds, scars, and significant emotional distress. People with skin picking disorder may also experience social withdrawal and avoid interacting with friends and family due to their beliefs about their appearance.

Treatments for skin picking disorder focus on identifying triggers, addressing the behavior, and managing the symptoms of any underlying medical or psychiatric conditions.

CBT and other forms of therapy can help a person identify any psychological, physical, or environmental factors that may be contributing to their skin picking behavior. SSRIs, anticonvulsants, and antipsychotics can also help treat skin picking disorder.

A trained medical professional can help a person decide which treatment option may be best for them.