The ABC’s of Dermatillomania / Compulsive Skin Picking

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Everybody picks their skin sometimes, right?  If you tell your friends or family that you pick your skin, many of them might say “Oh, I do that, too”.  So, how do you know if your skin picking is severe enough to warrant a diagnosis of Dermatillomania, also known as Compulsive Skin Picking or Chronic Skin Picking (CSP)?

There are a variety of ways in which assessment of skin picking occurs. Self-assessment might occur by the person doing the skin picking when an individual realizes that he or she is causing scabs, scars, and/or infections. A person with Dermatillomania may also be aware that he or she is avoiding social situations, including work, school, and/or social functions such as weddings and parties.  After all, those who have picked to the point of bleeding and scabbing may be too embarrassed to be seen by others who might judge them or ask questions about their skin.

An assessment of Dermatillomania might also come from a dermatologist, aesthetician or family member who sees the physical and emotional consequences of the person’s skin picking. This person may recommend that the skin picker seek professional assistance for the picking.

Generally, most people do pick their skin, pimples, nails, or cuticles at some point. So, what makes the difference between someone who has CSP and someone who does not?

I heard a great classification of skin picking in a workshop by Dr. Charles Mansueto at the Trichotillomania Learning Center’s (TLC) 2006 Conference. I was inspired to create my own version of his classification system. I use it with all of my skin picking clients, and I call it the ABC’s of Skin Picking.

An “A” is something that almost “anyone” would pick. This could be a piece of dry skin hanging off your arm, a pus-filled whitehead on your chin that pops at your mere touch, or a scab that’s barely hanging on which you easily detach.

A “B” is a “bump”, pimple, scab, etc. that only a skin picker would pick. This is something that would either become an “A” over time or go away on its own if left alone. But, a skin picker will frequently start picking at it and make it significantly worse. It may then bleed, ooze, scab, and possibly become infected.  This in turn will cause two additional problems – it will cause the picker significant distress, and it will give him or her something new to pick at later. In my experience, I have found that clients with CSP classify at least 50% of their picking as “B’s”.

“C” stands for “Create”, meaning the individual with CSP is not picking at anything objectively “real”, but in the process of picking at her skin, he or she “creates” something such as a blemish, scratch or scab.  A “C” is something that only someone with Dermatillomania would pick. There is often nothing apparent on the skin, but the picker starts picking or scratching, and in the process creates a wound.

Treatment for Dermatillomania / CSP

The recommended treatment for CSP is with a trained psychotherapist who specializes in treating this misunderstood and often misdiagnosed condition.  Effective treatment focuses on Cognitive-Behavioral Therapy (CBT), with an emphasis on Habit-Reversal Training (HRT) and Mindfulness Based CBT.

In Cognitive Behavioral Therapy for Dermatillomania, the first behavioral goal is to stop picking any “C’s” – in other words, to stop creating new skin problems where none previously existed. Usually, a skin picker can learn to do this relatively easily by becoming more aware of their picking patterns.  Building awareness is generally done by keeping a skin picking log, and with the assistance of a habit-blocker such as wearing gloves.

Gloves provide a barrier to unconscious picking, and help in two ways.  First, the skin picker cannot easily pick at existing scabs, blemishes, etc.  Second, the gloves prevent identification of new places to pick that would otherwise be felt by random, unconscious, mindless “investigation” (touching) of the skin. If you are a skin picker, the previous sentence may resonate with you, and you may say, “I do that!” That would make sense as the two main triggers for skin pickers are touching and looking at their skin.

Removing the opportunity to touch your skin by wearing gloves is a good first start to becoming more aware of your unconscious “scanning”, and reducing the impulse to pick. After you get used to using a “habit blocker” like gloves, the focus of treatment turns to reducing your picking of “B’s.” What are the two most important factors to address in successfully reducing picking of “B’s”? You can read about that in Part 2 of The ABC’s of Skin Picking, coming soon.

•Karen Pickett, MFT is a psychotherapist at the the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions, including Dermatillomania.  Karen can be contacted at karen@ocdla.com.

Tags: Cognitive-Behavioral Therapy (CBT), Compulsive Skin Picking, Dermatillomania, Health, Mental Health, Mindfulness, Skin Picking

2 Comments to The ABC’s of Dermatillomania / Compulsive Skin Picking

1. 

   Hello Karen,

   I was wondering if maybe you could tell me if I have dermatillomania I understand you cannot give me a formal diagnosis but maybe some strategies to help reduce my picking. As of right now the area where I pick the most is the back of my scalp it started as a small patch of dandruff however over this past year my picking has gotten worse and that one patch has spread to most of my lower scalp. I pick every single day and for most of the time during the day it usually starts off as an itch, sometimes I try to avoid to scratch but it becomes overwhelmingly itchy and I cant resist. I also have the idea that the more I pick the dry skin the better it will be , but then my scalp becomes raw and it stings when I wash my hair . I have had some other episodes with picking, when I was younger I used to take toe nail clippers and clip the dead skin off the bottom of my feet, thinking that it would make my feet softer but I would often do it to excess where the bottom of my feet would be pink raw skin, sometimes with blood and it would hurt when I walked . I’ve also had problems with picking my face, popping pimples/blackheads thinking it would improve my skin but I would go overboard with that as well I once burned a part of my face by laying close to a space heater because I read that heat would make pimples go away. I have also been diagnosed with OCD by 6 different doctors and I know this disorder is part of the OCD spectrum I just want some advice if it is worth it to treat it . I am not distressed or anxious because of my scalp picking but I am a little embarrassed because I do it in public especially in class and I feel like people are watching me pulling dead skin off of my scalp. any feedback would be helpful

   Thanks!
Gaby on October 14th, 2011
2. 

   Hi Gaby:
   Thank you so much for your comments and questions. While I can’t provide a diagnosis or treatment via this blog, the symptoms you describe sound consistent with those of Dermatillomania. I suggest you seek consultation with a CBT therapist in your area. You can find a list of therapists specializing in Dermatillomania at http://www.trich.org.

   I also recommend continuing to read our blogs for suggestions and tips. If you haven’t already done so, you might also consider consulting a dermatologist as the itching on your scalp may be a symptom of a skin condition.

   All the best,
   Karen Pickett MFT
Karen Pickett on October 17th, 2011

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