Dermatillomania: The Compulsive Urge to Pick

Dermatillomania, also known as compulsive skin picking (CSP), is an impulse control disorder. People with CSP use fingernails, teeth, tweezers, and pins to pick at their skin in response to a compulsive urge. They pick at scabs, acne, and other blemishes-most often on the face, scalp, or extremities, but sometimes on the torso or other parts of the body, as well. In more severe cases, a person with dermatillomania will pick at freckles or moles, or will create blemishes through cutting, scratching, or digging. Sometimes they will have sores for weeks at a time before they will heal. The result is often bleeding, bruising, infection, and scarring.

It is not known what causes dermatillomania, but it has been linked with other impulse and behavioral disorders such as trichotillomania, body dysmorphic disorder, anorexia nervosa, and social phobic anxiety disorder. Most sufferers first show signs of CSP in their teens and twenties. It is believed that compulsive picking is preceded by tension or anxiety, and the act of picking is stress relieving rather than painful.

Aside from eating disorders and social anxieties, dermatillomania sufferers often have other impulse control and behavioral disorders such as obsessive-compulsive disorder, perfectionism, and borderline personality disorder.

Most pickers are unaware of their triggers. Many people with CSP pick daily, and sometimes several times a day. Some pickers are aware of their actions, but are unable to control the impulse. Others enter a trance-like state, sometimes for hours, only to be confronted with the results. This causes shame and anxiety, which leads to more picking. The feeling of being out of control can spread to other areas of life and cause problems in work and relationships, as well as self-destructive behaviors such as alcoholism or self-injury.

Compulsive skin pickers will go to great lengths to hide their disorder. They cover sores and scars with make-up and clothing. Because picking can cause significant stress, some pickers will avoid all social interactions and refuse to go to the doctor for fear that someone will see the marks. This means that picking goes largely unreported and untreated. Other characteristics of compulsive skin picking include obsession with bathing and make-up routines, and a compulsive tendency to examine skin closely in a mirror.

Some sufferers of CSP are treated with antidepressants such as Zoloft or Paxil. However, because dermatillomania is largely behavioral, medication does not work in the long term. Some doctors believe compulsive skin picking is a result of a faulty brain pattern in response to certain stresses and triggers. As such, pickers should be encouraged to seek cognitive behavioral therapy and habit reversal training with a licensed professional. They may also seek out the help of a dermatologist to reduce the effects of scarring and clear up any blemishes that may lead to the urge to pick.