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Pathological Skin Picking: A disorder that will hurt your skin

female-looking-at-the-mirror-touching-her-face

Pathological skin picking is an impulse control disorder indicated by a compulsive need to pick skin despite the problems it causes. A person with this condition is unable to stop, even when they attempt to do so. This behavior is difficult to regulate. 

The main symptoms of this condition include uncontrollable skin picking, social withdrawal, hiding scars and wounds from other people, spending a lot of time on skin picking, and using “tools” such as tweezers to do so. In other words, a person is addicted to picking skin.

While causes of pathological skin picking are unclear, they do have a biological, environmental, and social background. Having other mental health problems, OCD, substance use disorders, and even past trauma can increase the risk of developing this condition.

Although everyone can develop pathological skin picking, women are at a higher risk than men. The condition tends to develop in adolescence or up to the late 30s.

Effects of pathological skin picking are numerous, ranging from scars, wounds, ulcerations, and infections to low self-esteem, negative body image, and social isolation. 

Treatment of pathological skin picking is usually a combination of psychotherapy and medications. But, a patient with this disorder also needs a strong support system.

What is Pathological skin picking?

Pathological skin picking is a repetitive manipulation of the skin that causes scars, wounds, social impairment, and emotional distress. In other words, pathological skin picking is the compulsive need for picking skin which results in tissue damage and has a negative impact on a person’s quality of life.

As an uncontrollable body-focused repetitive behavior, pathological skin picking is a type of impulse control disorder, and it is classified among obsessive-compulsive and related disorders. It was first recognized as a distinct disorder in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), originally published in 2013 by the American Psychiatric Association

About 1.4% of the population develops excoriation, or skin picking, disorder at some point in their lifetime. Some reports confirm that up to 5.4% of the population develops this disorder.

Like with other impulse control disorders, persons with pathological skin picking are unable to stop this behavior despite the skin damage it causes and the distress they suffer.

What are the causes of Pathological skin picking?

The possible causes of pathological skin picking are still largely unclear, but they could be genetic, environmental, and biological. Even though pathological skin picking has been documented since the 19th century in medical literature, it’s still understudied. Sometimes the exact reason why people pick their skin is unknown.

The biggest culprit for the lack of extensive information is that pathological skin picking has only recently been described as a distinct disorder. 

The condition can start at any age but usually occurs in adolescence. 

Additionally, a person can develop pathological skin picking as a response to an infection, rash, or injury that creates a scab. As it heals, the scab may itch and prompt a person to pick on it until it bleeds. This leads to the formation of the new wound, and the cycle continues until a person forms a habit to pick their skin.

Stress and other mental health conditions could also contribute to the formation of this disorder. Some people may scratch or pick their skin in response to stressful situations with which they can’t cope in other ways. Moreover, some persons are compelled to pick skin as a form of self-grooming i.e.; they’re forcing themselves to remove all imperfections.

When do you need to go to the doctor if you suspect you have Pathological skin picking?

The best time to see a doctor is when you start experiencing a strong urge to pick your skin, even though it makes your skin bleed or develop wounds. Persons who realize skin picking takes up a lot of time during the day should schedule an appointment to see their healthcare provider, too.

Other reasons that may encourage a person to see a doctor include developing noticeable scars due to skin picking, feeling upset about how much you pick on the skin, and continuing with this behavior even when it makes you feel ashamed and embarrassed.

Pathological skin picking negatively affects a person’s quality of life. For example, an individual may notice they avoid exposing their skin or hanging out with other people because they’re ashamed of wounds and scars. 

Ignoring this behavior is not the wisest choice. Instead, an affected person should schedule an appointment and see their doctor in order to prevent complications and overcome the urge to pick the skin.

In what circumstances do you need to see a doctor right away?

You should immediately go to your doctor if skin picking leads to too much bleeding and serious wounds. Additionally, a person should see a doctor right away when they start picking on moles, freckles, scars, and spots on the skin in an attempt to remove them. In these cases, a person sees freckles and other spots as imperfections and feels the urge to remove them in order to have perfect skin. 

Make sure to see a healthcare professional right away if a pathological urge to pick skin occurs at the same time as symptoms of other impulse control disorders and mental health conditions.

What are the factors that may increase your chances of developing Pathological skin picking?

The following factors may increase the chances of developing pathological skin picking: stress or anxiety, boredom, skin conditions such as eczema or acne, and negative emotions such as shame and guilt. The presence of other mental health conditions such as depression also increases the risk of pathological skin picking. 

A person is more likely to develop this condition if they also have trauma-related disorders, substance use disorders, and some form of obsessive-compulsive disorder (OCD) such as trichotillomania, according to a study from the Frontiers in Psychiatry

While this disorder can affect any age group, adolescents and adults up to their late 30s are at the highest risk of developing pathological skin picking. 

The Medical News Today reports that patients with autism and ADHD are also at risk of developing skin picking disorder. Body dysmorphic disorder, problems with emotional regulation, and childhood trauma could also increase the risk of this condition. However, a lot more research is necessary to uncover all the mechanisms of action and risk factors behind ADHD and skin picking, or the role of other factors.

Are women at the highest risk of getting Pathological skin picking?

Gender may affect the likelihood of getting pathological skin picking. While anyone can develop this disorder, women are at the highest risk, according to a study from the Psychiatry journal. A typical patient is a female, in her teens to late 30s, who primarily picks pimples and scabs on her face, but may choose other parts of the body too.

The Journal of Psychiatric Research published a study that found 55.4% of the participants with current face picking disorder were female. Additionally, 54.1% of subjects who reported lifetime skin picking disorder were women as well.

A different study, from the General Hospital Psychiatry, discovered that 1916 of 6000 surveyed university students had pathological skin picking disorder. The condition was more prevalent among female students. The study also found that women with skin picking also experienced more depressive symptoms while males with this disorder had higher BMI and perceived themselves as less attractive. 

In a nutshell, while the condition can affect both genders, women are indeed at a higher risk.

What are the possible complications you can suffer when you have Pathological skin picking?

Possible complications you may experience due to pathological skin picking include scars, open wounds, tissue damage, ulcerations, infections, and significant emotional distress. Picking at your skin may also lead to other complications such as social withdrawal, avoiding interacting with family and/or friends, and intense feelings of guilt and shame due to behavior that harms your appearance. 

In the most severe cases, persons with pathological skin picking may create wounds so large to require hospitalization. For that reason, compulsive skin picking disorder causes permanent disfigurement.

What are the preventative measures you should take to avoid developing Pathological skin picking?

The preventative measures you should take to avoid developing pathological skin picking include identifying triggers that lead to this behavior. Once the trigger is identified, it’s easier to avoid it or reduce exposure to it. Additionally, people prone to skin picking should keep their hands busy, put on gloves, or use a squeeze ball to beat boredom or manage stress. It is important to try and resist the urge to pick skin for longer and longer in order to break or prevent the habit of constant picking at skin.

When the urge to pick skin comes along, it also helps to practice self-care in the form of applying a moisturizer, for example. Keeping skin clean is crucial in order to avoid infections. 

Persons who are prone to pathological skin picking should keep their nails trimmed and avoid letting them grow long. Tweezers and other similar objects that aid in skin picking should be kept out of reach.

Another important preventative method is to be proactive about managing underlying problems that contribute to skin picking behavior. For example, patients with depression, anxiety, substance use disorder, OCD, and other conditions may prevent skin picking by managing symptoms of those problems they’re experiencing.

Woman-picking-her-face

What are the possible treatments after being diagnosed with Pathological skin picking?

Possible treatments you may encounter in order to relieve pathological skin picking include a combination of medications and psychotherapy. Treatment of underlying conditions such as depression or OCD may also help a patient recover from excessive picking at skin. 

Besides conservative treatments, alternative methods may also help patients with this condition. Individuals with compulsive skin picking could benefit from aerobic exercise, yoga, hypnosis, or acupuncture.

Unfortunately, many people fail to seek skin excoriation treatment. The main reason they’re reluctant to seek help is the embarrassment associated with this condition. However, ignoring skin picking is dangerous and potentially life-threatening because this behavior can lead to serious infections.

Treating scars, wounds, and lesions created by skin picking is also an important aspect of managing this condition. A dermatologist or a primary care doctor recommends the most suitable approach, usually topical products.

What are some of the different types of psychotherapy to help you deal with Pathological skin picking?

Psychotherapy is the cornerstone of the treatment of pathological skin picking. Different types of therapy suitable for patients with this condition include cognitive-behavioral therapy (CBT) and habit reversal training, as well as acceptance and commitment therapy. In some cases, exposure and response prevention are useful for patients with this condition.

Cognitive-behavioral therapy typically includes patient education, and cognitive restructuring, and focuses on relapse prevention by improving self-efficacy. Habit reversal training is a form of cognitive-behavioral therapy and its main focus is on awareness training and response training. In other words, a patient acknowledges the existence of a problem and becomes aware of the pathological urge to pick skin, but learns to overcome this habit and cope with feelings and emotions in a healthier manner. Patients learn why do people pick at their skin and work with a therapist to overcome this urge.

For instance, CBT and habit reversal training can help a patient substitute pathological skin picking with an incompatible action such as fist clenching. The main point is to help persons with this disorder identify negative thoughts and behaviors in order to replace them with more positive alternatives.  

Acceptance and commitment therapy is also a type of CBT that can be useful for patients with pathological skin picking or pimple picking disorder. With this approach, a patient accepts negative thoughts and feelings but also commits to resolving them in a healthier manner without destructive behaviors.

Exposure and response prevention is used for patients with OCD primarily. Since pathological skin picking belongs to a group of impulse control disorders, this type of psychotherapy could work in this case as well. Exposure and response prevention is suitable in cases where a patient is aware of the situations that make them pick skin.

What medications might you need to help you deal with Pathological skin picking?

Medications a doctor may prescribe to patients with pathological skin picking are antidepressants such as selective serotonin reuptake inhibitors (SSRIs), antipsychotics such as risperidone (Risperdal), and anticonvulsants such as lamotrigine (Lamictal). 

It’s useful to bear in mind that there is no specific medication formulated for the treatment of pathological skin picking. A doctor prescribes medications to treat underlying mental health conditions.

Do people with Pathological skin picking require social coping and emotional support?

Yes, people with pathological skin picking require social coping and emotional support. According to a study from the Comprehensive Psychiatry body-focused repetitive behaviors, like skin picking, could be sensory processing conditions that affect how people process, perceive and control sensory information. As an impulse control disorder, pathological skin picking is complicated to overcome without help. 

A patient with this condition needs help in form of cognitive-behavioral therapy, medications, and also strong support system. Friends and family play an important role in the treatment of this disorder because skin picking stems from deeper roots. It’s a manifestation of a specific problem. A person with skin picking shouldn’t feel like they’re being judged. 

Instead, they need encouragement to get help and support through the whole process. This is particularly important if we bear in mind that persons with pathological skin picking tend to have low self-esteem.

It also helps to join support groups where people share their experiences and help other people with this condition.

Is there an Aftercare program?

We will help you with the aftercare at home. We will set you up with an addiction counselor/psychologist and (with your consent) brief them about your treatment so you can continue working at yourself at home.

What about a special diet?

Our cooks are trained to serve everyone’s needs. If you have any allergies the cooks will prepare special meals made for you.

What is your success rate?

Success rate is difficult to measure. It depends on the motivation of the client. Staying clean and sober in rehab is not difficult, the hard work will start once the client is leaving treatment and has to face the outside world with all its triggers. One thing we can promise is that we will give our clients all the tools to be successful once going home and provide them with the right aftercare.

How long will it take?

This depends on the situation. E.g. does the client need a detox? Is addiction the main problem or are the underlying issues more concerning? It is important that the client finish what he/she signed up for. Overall, we advise that 6 -8 weeks in treatment is average and gives the client a good foundation to start a new life at home with the proper aftercare.

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