Skin Picking Disorder: Psychological management

  • Best ResultsDepends on insight
  • Treatment Recovery2-12 months
  • Procedure TimeNA
  • Skin SpecialistPsychiatrist, psychologist
  • Duration of ResultsCan be permanent
  • AnaestheticNA
  • Back to WorkNA
  • Cost$

Skin Picking Disorder: Psychological management

Skin picking disorder, also known as neurotic excoriations or dermatillomania is a common psychological condition that presents as skin picking. It affects 5% of the population. If patients have insight, skin picking is easily treatable. Early & effective management will mitigate permanent scarring. Simple psychological exercises can have a massive impact on skin health. Proper wound care will markedly reduce scarring.

FactsFacts on psychological management of skin picking

  • Excoriations or picking is a very common condition affecting 5% of the population
  • It can be due to acne, a condition known as acne excoriee (separate entity)
  • Dermatillomania, skin picking, neurotic excoriations do not have primary lesions
  • Picking can be localised to skin, hair, or the nails/cuticles
  • Treatment should be directed at the skin as well as subconscious behaviour
  • Skin directed treatments include hydrocolloid dressings, wound care & medical phototherapy
  • Behavioural modifications include CBT & habit reversal therapy
  • If you cannot stop picking, professional help is encouraged

What is skin picking disorder or dermatillomania?

Put bluntly, this is a psychological disorder that is taken out on your skin. By definition, your skin is the one that cops collateral damage. If you have skin picking, secondary to acne, this is called acne excoriate (see the section of acne to understand).

If you have insight, or are open to treatment, both dermatillomania & acne excoriee (picking acne) can be effectively treated. The answer lies in changes of behaviour from a psychological viewpoint.

What do psychologists do?

They give insight & will teach you how to cope with compulsions. They can also teach you how to break your skin picking habit. Psychologists prescribe you thought provoking exercises & not medication. If you are serious about breaking your picking habit, a psychologist is invaluable. See below.

What is cognitive behaviour therapy?

CBT, also known as cognitive behaviour therapy, increases self-awareness. This form of therapy modifies thoughts and behaviours that are related to the skin-picking habits. It explores specific behaviour and identifies thoughts associated with skin picking. CBT replaces these maladaptive thoughts and behaviours with adaptive ones.

You’re not gonna learn CBT in one or two sessions. It takes 5-10 visits to get things right, so don’t give up. If you can’t be arsed to see a psychologist and want to spend the deposit for your house on skin care that won’t solve your problem, at least watch a few CBT videos on YouTube.

What is habit reversal therapy?

HRT stands for habit reversal therapy. It teaches awareness training with regards to identifying specific behaviours in situations and helps the patient to develop and adopt alternative responses in those situations. Multiple sessions are required.

Davin’s Viewpoint on skin picking disorder

This is a common condition that presents as secondary skin related picking. The root cause is psychological, & hence it is best managed with exercises such as cognitive behaviour therapy & habit reversal therapy. The role of a medical dermatologist is to rule out conditions that can mimic skin picking & to prevent scarring via wound care.

How fast you get better & the long-term prognosis is directly proportional to your insight. If you have good insight, & accept the diagnosis, skin picking can be reduced & in many cases cured. Early management will mitigate permanent scars.

The psychological aspect of skin picking is complex. It is an overlap with obsessive compulsive behaviour with an element of higher level – tertiary relief during the picking episode. Psychologically this can mimic gambling (or even binge eating) as it activates the pleasure part of the brain (probably releasing serotonin). If one views this as a complex interplay of actions with resulting neurotransmitter release & receptor activation, then pharmacological intervention seems sensible (drugs over herbs & the smell of essential oils, though oils can modify neurotransmitter release. I accept that).

I do believe that a psychologist & psychiatrist are the go-to professionals as they have infinitely more experience (and importantly time) compared to dermatologists. I view my profession as the mediator to exclude organic causes. The problem with dermatologists is that we are extremely time poor, as most of us concentrate on not missing out on organic pathology. Skin picking disorder can be solved in as little as two months, if patients have insight and are compliant. The flipside is that many go untreated over five to ten years, spending thousands on skin care, & procedures without cure or improvement. Ball is in your court.

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