While it seems like the act of picking at your own skin would be done with full awareness, the compulsive skin picker is often not aware of his or her behavior, doing it unconsciously. That makes it particularly difficult to stop, because the picker is unaware of his or her actions. The act of skin picking is called dermatillomania and is classified as an impulse control disorder.
Both biological and environmental issues come into play in causing compulsive skin picking. The behavior is observed in many animals, leading researchers to believe it may be a grooming mechanism that’s spun out of control in the brain. Researchers have developed mice who are missing a vital gene that controls grooming behavior, which leads them to obsessively groom, to the point where bald patches of missing fur develop.
CAUSES OF COMPULSIVE PICKING
Because compulsive skin picking is an obsessive-compulsive disorder, it is observed in about 25 percent of those with OCD. Of that group, about a quarter have body dysmorphic disorder. Obsessive-compulsive disorders tend to run in families, and may include other habits such as hair-pulling.
Why do people engage in behaviors like skin picking? Researchers believe it is a form of self-soothing stress relief. The unconscious picking is a way to blow off steam, and has a calming effect on the nervous system.
Conversely, it may also be a form of stimulation. When people are bored, skin picking gives them something to do, whether consciously or unconsciously. It helps stop the bored or distracted feelings that overcome sufferers.
Skin picking may also be indicative of a form of perfectionism. People who pick are often fascinated with their body’s condition, and may stand in front of mirrors giving a cursory review of the body for flaws that can be fixed. Strangely, they wind up looking worse, as the skin-picking damages the very thing they were hoping to perfect. This can lead to a vicious cycle of looking for flaws, trying to fix them, and making matters worse.
OBSESSIONS CAN SPIRAL OUT OF CONTROL
Obsessive-compulsive disorders are often ritualistic in nature, a persistent, repeated or unwanted urge to keep doing something, even if that behavior causes anxiety or extreme distress. Usually, these emotions arise when stress is present.
Some common obsessions include an extreme aversion to dirt or fear that the surrounding environment is contaminated; the need to have things orderly and symmetrical; a stream of horrific thoughts on harming others or oneself; and unwanted thoughts that may involve sexual compulsions or religious objects.
These behaviors may be manifested in things like skin picking, but can also include an aversion to shaking hands or using things that others have touched (hello, Jerry Seinfeld!); a need to keep checking to make sure the door is locked or the stove is turned off; extreme anxiety when things aren’t in a certain order; thoughts of hurting oneself or others; shouting obscenities or otherwise acting out; and anxiety that causes an individual to avoid common courtesies, such as shaking hands with someone new.
The obsessions and compulsions bring only temporary relief to those who must perform them. There are rules to the game, and not performing things to the exact specifications of the rules will drive the obsessed to manic behaviors that may be unconnected to whatever event is driving the behavior. The compulsions can include excessive washing and cleaning; counting objects; checking on things like windows or doors; a constant need for reassurance; adherence to a strict routine; and a need for order.
Beyond skin picking, obsessions can include constant hand-washing, to the point where the skin may be rubbed raw; counting in patterns; silently praying or repeating words or phrases; or making sure records or canned goods are all in a row and facing the same way.
The obsessive-compulsive is often aware that these behaviors are illogical and wrong, but feel powerless to control them.
NOT DANGEROUS, BUT…
Skin picking is not considered a danger to the patient, but it can reach extreme stages that embrace hair-pulling, tear at scabs, and nail biting. Unfortunately, the obsession of performing the act can become the sole focus of the patient, interfering with life, work and relationships. But because the behavior is unconscious, many do not seek treatment for their obsessive-compulsive disorder.
For those who do seek treatment, the compulsive skin picking can be controlled with a combination of anxiety-reducing medication and talk therapy that can pinpoint the reasons for the anxiety and offer solutions that steer the patient away from destructive behaviors.
Medications include the usual regimens recommended for obsessive-compulsive disorders, including antidepressants. The medications take several weeks to achieve results, which is why they are accompanied by talk therapy with hopes of finding new outlets for the patient.
Talk therapy can include habit reversal training, which teaches the skin picker to relax and get centered through breathing exercises and muscle response exercises. It will also cover self-monitoring, which trains the compulsive skin picker to keep track of his or her picking behaviors and its triggers. By writing down the compulsion, the picker can recognize and begin to stop the behaviors as they happen.
Therapy also includes stimulus control, which aims to help compulsive skin pickers identify and avoid the triggers that drive the behavior. This can include environmental situations, various moods, or life circumstances that will cause the picker to engage in the behavior. The therapy will also include what’s termed competing response, which is a technique that will provide an alternative to the destructive picking behavior. Some competing responses that are used include knitting, beading, fidget toys and other means to keep hands busy and away from the skin.
Ultimately, the therapy aims to change the behaviors that are leading to skin picking. Over time, with the proper diversions, the urge to pick will fade, and the need to use diversions will hopefully fade away.