Treatment For Excoriation- Skin Picking
Dermatillomania or Excoriation- skin picking disorder, is an OCD- related disorder in which a person cannot stop picking at their skin. Excoriation is a Body Focused Repetitive Behavior (BFRB) which also includes Trichotillomania (hair pulling) – Hoarding Disorder, and Tic Disorder. While a person picking at a scab or a pimple may not be uncommon, compulsive skin picking may be a sign of something else. When the compulsive skin picking becomes problematic, causing significant distress in the person life, it might be more indicative of a skin picking disorder. Body focused repetitive behaviors (BFRBs) can be co-morbid with other related disorders such as OCD. Comorbidity occurs when a person has two or more conditions at the same time.
Signs of Excoriation:
Recurrent skin picking- despite efforts to stop or decrease the picking behavior.
Excessive time spent skin picking- over an hour a day.
Excessive time spent thinking about skin picking or resisting the urge to pick at their skin.
Skin picking causes significant distress in the persons life.
Physical impacts on the body from the skin picking- skin irritation, tissue damage, scarring, or infection present.
Negative impact on social/occupational functioning.
Picking behaviors can be preceded for example by feelings of boredom or anxiety. There might be a sense of relief after a person engages in their skin picking. Certain rituals may be present with skin picking, which can include the place they do it at or using certain tools to pick. Skin picking can commonly be done in an automatic sense. Where the person does not even realize they are picking, leading it be an automatic behavior. This can be particularly distressing as the picking done automatically may extend for longer periods of time, leading to more damage being done to the picked areas.
Treatment for Excoriation:
Treatment for Excoriation is an evidence based practice, Habit Reversal Training (HRT). HRT is a type of Cognitive Behavioral Therapy (CBT). Awareness training during HRT is aimed at helping the person develop better self control and awareness to their BFRB. In HRT, competing responses will be practiced and reinforced once the person is hitting the right goals with their awareness training. Competing responses are going to be behaviors that are the opposite of the BFRB. Competing responses will be behaviors that limit the use of the BFRB. Further goals aim at developing better coping skills, mindfulness exercises and healthy thoughts/behaviors towards your body. As a licensed mental health therapist trained in HRT, I will assist you through the awareness training, competing response development and building motivation for change. If you feel that skin picking has had a negative impact on your life, you might consider counseling and HRT to learn how to handle it more effectively. Please feel free to reach out for a free consultation, where we can discuss the impacts of excoriation and benefits of counseling/HRT.
