Specializing in the Treatment of OCD, Compulsive Skin Picking, and Related Conditions

The primary characteristic of Compulsive Skin Picking (CSP) is the repetitive picking at one's own skin to the extent of causing damage. Usually, but not always, the face is the primary location for skin picking. However CSP, also known as Dermatillomania, Neurotic Excoriation, or Chronic Skin Picking, may involve any part of the body. Individuals with Compulsive Skin Picking may pick at normal skin variations such as freckles and moles, at actual pre-existing scabs, sores or acne blemishes, or at imagined skin defects that nobody else can observe. Individuals with Dermatillomania may also use their fingernails or teeth, as well as tweezers, pins or other mechanical devices. As a result, CSP may cause bleeding, bruises, infections, and/or permanent disfigurement of the skin.

Sometimes skin-picking is preceded by a high level of tension and a strong "itch" or "urge". Likewise, skin-picking may be followed by a feeling of relief or pleasure. A CSP episode may be a conscious response to anxiety or depression, but is frequently done as an unconscious habit. Individuals with Compulsive Skin Picking often attempt to camouflage the damage caused to their skin by using make-up or wearing clothes to cover the subsequent marks and scars. In extreme cases, individuals with Dermatillomania may avoid social situations in an effort to prevent others from seeing the scars, scabs, and bruises that result from skin picking.

As demonstrated above, Compulsive Skin Picking / Dermatillomania has obsessive-compulsive features that are quite similar to OCD, BDD and Trichotillomania. It is sometimes found in individuals with these disorders, as well as in patents with certain medical conditions. In fact, a recent study found that 23% of those with OCD, and 27% of those with BDD, also had CSP. Though not currently listed in the Diagnostic and Statistical Manual (DSM-IV) published by the American Psychiatric Association, some researchers believe Compulsive Skin Picking / Dermatillomania merits distinction as a separate diagnostic entity.

Treatment of Compulsive Skin Picking / Dermatillomania

The primary treatment modality for Compulsive Skin Picking / Dermatillomania is a combination of various types of Cognitive-Behavioral Therapy (CBT). Perhaps the most important of these is called Habit Reversal Training (HRT). HRT is based on the principle that skin picking is a conditioned response to specific situations and events, and that the individual with Dermatillomania is frequently unaware of these triggers. HRT challenges Compulsive Skin Picking in a two-fold process. First, the individual learns how to become more consciously aware of situations and events that trigger skin picking episodes. Second, the individual learns to utilize alternative behaviors in response to these situations and events.

Other Cognitive-Behavioral Therapy techniques can be used as adjuncts to HRT in the treatment of Compulsive Skin Picking. Among these are Stimulus Control techniques and Cognitive Restructuring. Stimulus Control techniques involve utilizing specific physical items as "habit blockers" to restrict the ability to pick skin, while Cognitive Restructuring helps an individual with Dermatillomania learn to think differently in response to the urge to pick their skin.

One of the most effective CBT developments for the treatment of Compulsive Skin Picking / Dermatillomania is Mindfulness-Based Cognitive-Behavioral Therapy. The primary goal of Mindfulness-Based CBT is to learn to non-judgmentally accept uncomfortable psychological experiences. From a mindfulness perspective, much of our psychological distress is the result of trying to control and eliminate the discomfort of unwanted thoughts, feelings, sensations, and urges. In other words, our discomfort is not the problem – our attempt to control and eliminate our discomfort is the problem. For those with Compulsive Skin Picking / Dermatillomania, the ultimate goal of mindfulness is to develop the ability to more willingly experience their uncomfortable thoughts, feelings, sensations, and urges, without picking their skin.

Group Therapy for Compulsive Skin Picking / Dermatillomania

In addition to individual therapy, the OCD Center of Los Angeles also offers six weekly, low-fee, therapy/support groups for adults with OCD and related conditions, including a group exclusively for adults with Trichotillomania and Dermatillomania. This group is led by one of our staff therapists, and uses the same treatment protocol as our individual Cognitive-Behavioral Therapy program. For more information on this group, click here.

We also offer four, age-specific, therapy/support groups for children and adolescents with OCD and related conditions, including a group specifically for children aged 9-14 with Trichotillomania and/or Dermatillomania. These groups are held monthly, and are limited to six participants. To learn more about our therapy/support groups for children and adolescents with OCD, Dermatillomania, and related conditions, click here.

If you are experiencing any of the above symptoms of Compulsive Skin Picking / Dermatillomania, and would like to discuss individual or group therapy at the OCD Center of Los Angeles, you can call us at (310) 335-5443, or click here to email us. If you live outside Southern California, we recommend that you contact a licensed Cognitive-Behavioral therapist in your local area.