Last week I had written an article about how a person having an ADHD diagnosis can also have other co-existing conditions including depression, Bipolar Disorder, and learning disabilities among many others.  I did leave out one co-morbid condition which one parent pointed out to me. Some people with ADHD also have what is known as Obsessive Compulsive Disorder (OCD).  OCD behaviors can include things like washing your hands repeatedly until they are raw and chafed, checking things repeatedly, or having to maintain certain order in the arrangement of objects or actions.  There is another subset diagnosis to OCD which is called Impulse Control Disorder.  Under this diagnostic category you can find behaviors such as picking at the body including the skin, fingernails and scalp. Pulling out hair may also be included as an Obsessive Compulsive behavior.

Since two of our members had mentioned that their children who have a diagnosis of ADHD were also exhibiting compulsive picking at fingernails and scalp I decided to do a little research on this topic and I will now share what I found.  In looking at ADHD forums and news boards these behaviors may not be as uncommon as you might think. ADDITUDE magazine, for example has an on-line forum where this topic has been discussed. Likewise, on this ADD forum thread you can find people talking about picking their skin and scalp.

Of course there are fancy names for these behaviors.  Compulsively picking at one's skin is called "Dermatillomania" and people who have "Trichotillomania" will compulsively pull out their own hair from their scalp, eyelashes, eyebrows, and even pubic area.  The problem is that this excessive picking can cause permanent scarring and infection.  And hair pulling can cause the person to have bald patches on their scalp. 

The DSM-IVR includes 5 criterion that must be present for a diagnosis of Trichotillomania (pulling out one's own hair) to be made and they include:

• Recurrent plucking of one's hair resulting in noticeable hair loss
• Increasing build-up of tension immediately before the plucking which is is follow by:
• Sense of relief or reduction in tension when the hair is pulled
• The problem is not better explained by an alternative mental or medical disorder
• The problem results in significant distress or impairment to the individual in social, vocational or other areas of life

There are no formal diagnostic criteria for Dermatillomania (compulsive picking at one's skin) but behaviors can include: 

• Repeated skin picking of the face, lips, scalp, hands, fingernails, or arms
• Tension increase immediately before picking
• Tension decrease or relief when skin picking
• The picking causes significant difficulties in life or stress sensations like itching, tingling, or burning or an uncontrollable urge to pick their skin.

Why do some people compulsively pick at their skin or pull out their hair?