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 and leaves your skin damaged, cut or swollen, you may have Skin Picking Disorder (SPD) or Excoriation Disorder.
What is Skin Picking 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 between 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 behaviors 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 multi-factorial. 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 Behavioural 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 behaviors 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 behavior that makes it virtually impossible to do the picking behavior). 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.
