The primary characteristic of Compulsive Skin Picking (CSP) is the repetitive picking at one's own skin to the extent of causing damage. Usually, but not always, the face is the primary location for skin picking. However CSP, also known as dermatillomania or neurotic excoriation, may involve any part of the body. Individuals with CSP may pick at normal skin variations such as freckles and moles, at actual pre-existing scabs, sores or acne blemishes, or at imagined skin defects that nobody else can observe. Individuals with CSP may use their fingernails, as well as their teeth, tweezers, pins or other mechanical devices. As a result, CSP may cause bleeding, bruises, infections, and/or permanent disfigurement of the skin.
Sometimes skin-picking is preceded by a high level of tension and a strong "itch" or "urge". Likewise, skin-picking may be followed by a feeling of relief or pleasure. A CSP episode may be a conscious response to anxiety or depression, but is frequently done as an unconscious habit. Individuals with CSP often attempt to camouflage the damage caused to their skin by using make-up or wearing clothes to cover the subsequent marks and scars. In extreme cases, individuals with CSP may avoid social situations in an effort to prevent others from seeing the scars, scabs, and bruises that result from skin picking.
As demonstrated above, CSP has obsessive-compulsive features that are quite similar to OCD, BDD and Trichotillomania. It is sometimes found in individuals with these disorders, as well as in patents with certain medical conditions. In fact, a recent study found that 23% of those with OCD, and 27% of those with BDD, also had CSP. Though not currently listed in the Diagnostic and Statistical Manual (DSM-IV) published by the American Psychiatric Association, some researchers believe it merits distinction as a separate diagnostic entity.
The primary treatment modality for CSP depends on the level of awareness the individual has regarding the problem. If the CSP is generally an unconscious habit, the primary treatment is a form of Cognitive-Behavioral Therapy called Habit Reversal Training (HRT). HRT is based on the principle that skin-picking is a conditioned response to specific situations and events, and that the individual with CSP is frequently unaware of these triggers. HRT challenges the problem in a two-fold process. First, the individual with CSP learns how to become more consciously aware of situations and events that trigger skin-picking episodes. Second, the individual learns to utilize alternative behaviors in response to these situations and events.
There are a number of other therapeutic techniques that can be used as adjuncts to HRT. Among these are Stimulus Control techniques and Exposure and Response Prevention (ERP). Stimulus Control techniques involve utilizing specific physical items as "habit blockers" to restrict an individual's ability to pick at his or her skin. ERP, which is the primary treatment for OCD and many OC Spectrum disorders, is most valuable if the individual with CSP is already aware of the specific situations and events that trigger skin picking episodes, and has already made significant recovery using HRT. To learn more about ERP, click here. Also, medications that are frequently used to treat OCD may be valuable adjuncts to CBT in the treatment of Compulsive Skin Picking.
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