Skin Picking Disorder: What is it and how to stop it?
So, you pick your skin. We’ve all done it — picked at an unsightly
scab or tugged at an annoying hangnail, only to regret it later. But if you find yourself picking at your skin
frequently and find it difficult to resist the urge to pick at it even when it’s
painful, it will leave your skin damaged, cut or swollen; then you may have
Skin Picking Disorder (SPD) or Excoriation Disorder.
According to Eliza Burroughs, a registered psychotherapist
at CBT (Cognitive Behavioral Therapy) Associates in Toronto, SPD is
pathological skin picking characterized by the recurrent picking of the skin
that results in damage to the skin and leads to lesions. It affects one to five per cent of the general
population.
Those diagnosed with SPD will have made repeated unsuccessful
attempts to stop or decrease the picking as well as experience significant
distress or impairment in functioning as a result of the picking, and typically
spend more than one hour per day picking, thinking about picking, and resisting
urges to pick.
“Commonly picked sites include face, arms and hands,
although it can be anywhere on the body,” Burroughs says. This can include
healthy skin, minor irregularities, lesions, or scabs. Picking can occur with just fingers or tools
such as tweezers or pins, and can get so bad that the person might be
embarrassed to show their skin in public.
Among those diagnosed with SPD, the gender balance is
dramatically skewed towards females. Approximately 75 per cent of people with
SPD are women, according to Burroughs.
“It is unclear as to why this may be, however it may
reflect treatment seeking behaviours based on gender or cultural attitudes as
opposed to underlying biological differences between the genders,” she says. “For instance, it is possible that men feel more embarrassment or shame in
seeking treatment for a mental health condition or an appearance-related
concern.”
Why do people pick at their skin?
Like most mental health conditions, the causes of SPD are
not entirely clear and probably multifactorial. Genetics, mental functioning,
emotional regulation and environmental factors all come into play.
”[SPD] may be related to certain emotional states. For
example, stress, boredom, anxiety, fatigue, anger,“ she says. "Similarly,
picking can occur when people are under or over stimulated.”
Burroughs says for some individuals the picking may be
what she terms "automatic,” essentially done without full awareness. Alternatively, the reverse — "focused" picking — may occur.
“There may be a particular skin irregularity that is
targeted and the person may experience a sense of tension if they try to resist
or delay the picking and then experience relief once they can fulfill the
urge,” she says.
What do you do if you have SPD?
First, it’s important to understand that there are
options. There are many physicians, psychiatrists, psychologists, and
dermatologists who specialize in SPD treatment, like Burroughs herself. She
provides Cognitive Behavioral Therapy (CBT) to her patients dealing with the
disorder.
“This includes habit reversal training, and
psychoeducation and strategies that target the thoughts and behaviours
associated with SPD,” she says.
There are currently no medications approved specifically
for use in the treatment of SPD, however, some SPD pharmacological studies have
looked at the same kind of medications used for OCD or other body-focused
repetitive behaviours like Trichotillomania (compulsive hair pulling), says
Burroughs. However, she recommends talking to a physician or psychiatrist before
making any decisions.
If therapy or medication is, in fact, not the right course
of action for you, Burroughs has provided some helpful ways to lessen the urge
to pick:
1.) Target
the sensation another way. For example, if your skin is itchy, use a brush to
rub lightly against the skin
2.) Make it
difficult for the fingers to automatically start picking. For example, tape
fingers or wear gloves in high risk situations (e.g. while watching T.V.)
3.) Do a
competing response (a behaviour that makes it virtually impossible to do the
picking behaviour). For example, clench fists, take-up knitting, doodle.
4.) Mindfulness
and meditation can help overcome urges by increasing awareness of the urge,
physical sensations, and related thoughts.
5.) Relaxation
training, deep breathing, progressive muscle relaxation
6.) Regular
exercise
7.) Maintaining
a balanced lifestyle with healthy sleep habits and diet
8.) Ask a
friend or loved one to help but make sure you set the rules. For example, they
are allowed to gently tap you if they notice you picking but they’re not
allowed to grab your hand. Everyone is comfortable with different styles. One
person may want a gentle approach; another may prefer having their hand pulled
away.
"OR Natural" Skin Care Solutions. Laguna, NSW Australia 2325.
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