Skin Picking...Bad Habit or Psychiatric Neurosis?

Have you ever picked a scab or popped a pimple?
Doing so occasionally is merely just a bad habit, but picking, squeezing, and scratching to the point where you permanently destroy skin tissue may be an indication of underlying emotional issues.

I began picking my skin compulsively in middle school when life began to get stressful and I developed low self-esteem. I wasn't comfortable with the changes that my body was undergoing from puberty, I always felt the need to be perfect and go above and beyond what was necessary for school assignments, and naturally, I was bullied for being the class nerd.

Like a lot of adolescents, I was overly concerned about my appearance and freaked out whenever I got an acne blemish. No teenager wants to walk around with a face full of pimples so it's perfectly natural to pop them. Unfortunately for me, my acne vulgaris turned into acne excoriee. I couldn't stop picking! I learned that the best way to get rid of pimples is to not pick. However, I felt like I HAD to pick, like I had to get the pus out of me or something bad would happen!!! I couldn't deal with the idea that my face was oily. And I accidentally discovered that the oil in your skin appears florescent yellow and orange under a blacklight. That's when I began to pick imaginary flaws, ultimately creating real skin problems. I irrationally thought that if I squeezed all of the oil out of my skin and picked all of my blemishes, I would make my skin smooth, clean, and perfect.

This of course, was (obviously) not true. Picking acne is highly unsanitary and almost always leads to the development of more blemishes because the pus infects other pores in the skin, thus, breeding more acne which I also picked at. As you can imagine, this created a vicious cycle.

I primarily used my fingernails to pick my skin, but I also used sharp instruments such as manicuring scissors. It may sound incredibly painful, but it's strangely satisfying. Picking has the ability to release a lot of tension and anxiety. If you're a picker, you know exactly what I mean.

I also struggled with excessively scratching my eczema to the point where it would bleed, scab up, and become the next target of my picking. I picked just about anything I could get my hands on, my scalp, ears, arm, back, legs, feet, basically anything that I thought needed "fixed."

When I was sixteen years old, I learned that there was a medical term for my compulsive skin picking...dermatillomania. And that's when I began treatment.

I was initially medicated with selective serotonin reuptake inhibitors (SSRIs), the same medications that are used to treat Obsessive Compulsive Disorder (OCD). Dermatillomania and its counterpart, Trichotillomania (compulsive hair-pulling) are both believed to be on the spectrum of OCD, hence why they are treated with similar medications. In my case, SSRIs were effective in treating my OCD symptoms, but because I'm bipolar and SSRIs have the ability to induce mania, the side effects greatly outweighed the benefits and I had to stop the medication. Luckily, there are other medications available. The gold standard for OCD treatment is the tricyclic antidepressant, Anafranil. However, psychiatrists seem more eager to prescribe the newer SSRIs first. Benzodiazepines such as Xanax and Ativan can be used to treat the anxiety that often leads to picking compulsions. Of course, the best treatment option combines medication with therapy. The most commonly used treatment modality for OCD is cognitive-behavioral therapy, particularly exposure and response prevention. Traditional talk therapy can also be useful in helping the patient work on the underlying problems that may be leading to the picking. Alternative methods such as neurobiofeedback and hypnosis have demonstrated effectiveness in OCD patients as well.

I still struggle with dermatillomania and am often too ashamed to openly talk about it. I'm always afraid that someone will think it's trivial and all I have to do is stop picking. If I could simply stop picking, I wouldn't have this problem. All forms of OCD are very neurological in nature, affecting the basil ganglia, frontal lobes, and serotonin levels in the brain. Having urges to pick is similarly as uncontrollable as having tics.

Dermatillomania is a very serious psychiatric condition that can lead to an array of physical problems. I recently picked myself into a staphylococcus infection that landed me in the hospital for a week.

It can also worsen your overall psychological wellbeing. There's a lot of shame that comes along with dermatillomania. Those afflicted with this condition including myself frequently go to extreme measures to hide their wounds, often isolating themselves from people until their skin has healed. Having this additional distress can viciously lead to more picking. This disorder is also very time consuming. Many dermatillomaniacs lose several hours of their day engaging in skin picking rituals.

Probably one of the most embarrassing and taboo symptom about this disorder is that many dermatillomaniacs eat their own scabs, blood, and pus from skin lesions. They may also consume other body waste such as mucus, earwax, and salty sweat. This is where you start getting into the psychiatric territory of Pica, an eating disorder characterized by consuming items or materials that are not considered to be food, things like chalk, erasers, dirt, shampoo, toothpaste, etc. Pica is believed to be on the spectrum of OCD which makes perfect neurological sense as it is consistent with the obsessive compulsive characteristics of dermatillomania and trichotillomania.

Some mental health professionals still consider compulsive skin picking and hair pulling to be a form of self-injury. These behaviors are definitely self-injurious in nature, but they are not consciously meant to deliberately inflict self-harm.

In the past, dermatillomania and trichotillomania have incorrectly been thrown into a diagnostic category of impulse control disorders. In the DSM-IV, impulse control disorders include pyromania, shoplifting, and gambling. This never made any sense to me. Skin picking and hair-pulling aren't similar to impulsive behaviors. They are compulsions. It seems that the folks at the American Psychiatric Association are finally getting this. They have proposed to reclassify trichotillomania as an obsessive compulsive spectrum disorder rather than an impulse control disorder in the DSM V (which is scheduled to come out in May 2013). Skin picking disorder is said to fall under the same umbrella.

For more information about dermatillomania, check out: SkinPick.com.