When Picking Your Skin Goes Too Far: A HealthCentral Explainer

Patient Expert

Nearly everyone picks his or her skin from time to time to free an ingrown hair, trim a hangnail or cuticle, or to “take care” of a pimple or other skin blemish. It’s pretty normal, right?

Well, if you’re over the age of, say, 35, you may recall that conventional – and medical – wisdom on this topic has changed over the years, sometimes radically. For years doctors, mothers, and magazine articles advised you to never pick at acne, since doing so was sure to scar your skin and lead to infection.  Currently, it seems doctors have eased up on this advice, and you rarely hear of this type of mandate being given to people with skin issues.

But it is possible to pick your skin too much, of course.

In fact, there are people who suffer from a disorder known as dermatillomania, a condition that falls under the category of what are known as body-focused repetitive behavior disorders (RBDs).  According to the DSM-IV-TR, people who suffer from these impulse control disorders are actually unable to resist the urge to perform a certain type of behavior. Other body-focused repetitive behaviors include such things as nail biting, hair pulling, and skin biting. In short, what starts as a bad habit can morph into something very damaging to your health and appearance.

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Researchers are not certain what causes people to develop dermatillomania and RBDs, though they have put forth several theories about their origins.

Some believe it is a biochemical imbalance involving the neurotransmitter dopamine, while others say it is a neurological disorder, caused by underdeveloped motor-inhibitory control, the same problem people who have problems suppressing inappropriate behaviors (such as drug abuse).  Others believe it is psychological in origin, that picking is done in response to repressed rage at a parent who was particularly overbearing or abusive.

What we do know is that people who engage in this behavior all do it because it soothes them in some way. People who have RBDs do them to decrease their stress or anxiety, to relieve boredom, or to try to make their appearance adhere to some sort of image of perfection they don’t feel they’re meeting.

And because they will often single out a particular area of the skin they report “feels different,” RBD sufferers can develop the scabs, scars, and infections all of those experts warned about.  Some people with this disorder develop septicemia, while others do so much damage to their skin that they require skin grafts or even surgery. Having open areas of skin also leaves them susceptible to opportunistic infections such as MRSA, as well.

The disorder has psychological and social consequences, as well. People with dermatillomania – some of whom have the condition in an attempt to improve their appearance – are forced to wear clothing, bandages, or makeup to cover up the visible signs of their disorder. Many even isolate themselves in an attempt to hide both the condition and their shame about it.  There is also a higher incidence of suicidal ideation, suicide attempts, and psychiatric hospitalization in people with dermatillomania.

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Thankfully, dermatillomania is treatable through the use of cognitive behavioral therapy that emphasizes habit-reversal training and exposure and ritual prevention. Often people with this condition will also be prescribed certain psychotropic drugs to help them as they learn to reduce their fixation with their skin or appearance. Others learn to “replace” the ritual of picking with things such as bubble wrap, writing, or similar methodical hand movements that simulates the sensation of picking something.

Treatment is not without difficulties, however. First, many people who have this condition are too ashamed to admit it to their healthcare providers.  Second, unlike an alcoholic whose addictive behavior is triggered in the presence of a drink, dermatillomania sufferers cannot avoid the object of their destructive behavior because they live in their skin.

Warning Signs

If you believe you or someone you care about is living with dermatillomania, look for these signs and symptoms of the conditions:

-       Having persistent open sores, scabs, or swollen areas on face, arms, legs, or other body area

-       Spending excessive periods of time picking at the skin (more than five to 10 minutes per session, or more than 1-2 sessions per day)

-       Using skin picking to relieve stress or boredom

-       Using skin picking to intentionally harm yourself or to gain attention from others

-       Experiencing extreme anxiety if unable to do check the skin or pick at it

-       Having areas of scarred or heavily calloused skin

-       Inflicting damage to the skin that requires medical intervention such as stiches or grafts

-       Expressing a belief that the skin is holding contaminants or “toxins” that must be removed through picking

If you notice that you or someone you know has these signs and symptoms, you should contact a physician or mental health provider to get treatment for this medical condition.

Sources:  Neuro-Behaviorial Institute; American Association for Marriage and Family Therapy; Brain Physics; Wikipedia; MSNBC.com; Daily