The ABC’s of Dermatillomania / Skin Picking Disorder

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Everybody picks their skin sometimes, right?  If you tell your friends or family that you pick your skin, many of them might say “Oh, I do that, too”.  So, how do you know if your skin picking is severe enough to warrant a diagnosis of Dermatillomania, also known as Skin Picking Disorder or Excoriation?

There are a variety of ways in which assessment of skin picking occurs. Self-assessment might occur by the person doing the skin picking when an individual realizes that he or she is causing scabs, scars, and/or infections. A person with Dermatillomania may also be aware that he or she is avoiding social situations, including work, school, and/or social functions such as weddings and parties.  After all, those who have picked to the point of bleeding and scabbing may be too embarrassed to be seen by others who might judge them or ask questions about their skin.

An assessment of Dermatillomania might also come from a dermatologist, aesthetician or family member who sees the physical and emotional consequences of the person’s skin picking. This person may recommend that the skin picker seek professional assistance for the picking.

Generally, most people do pick their skin, pimples, nails, or cuticles at some point. So, what makes the difference between someone who has Skin Picking Disorder and someone who does not?

I heard a great classification of skin picking in a workshop by Dr. Charles Mansueto at the Trichotillomania Learning Center’s (TLC) 2006 Conference. I was inspired to create my own version of his classification system. I use it with all of my skin picking clients, and I call it the ABC’s of Skin Picking.

An “A” is something that almost “anyone” would pick. This could be a piece of dry skin hanging off your arm, a pus-filled whitehead on your chin that pops at your mere touch, or a scab that’s barely hanging on which you easily detach.

A “B” is a “bump”, pimple, scab, etc. that only a skin picker would pick. This is something that would either become an “A” over time or go away on its own if left alone. But, a skin picker will frequently start picking at it and make it significantly worse. It may then bleed, ooze, scab, and possibly become infected.  This in turn will cause two additional problems – it will cause the picker significant distress, and it will give him or her something new to pick at later. In my experience, I have found that clients with Skin Picking Disorder classify at least 50% of their picking as “B’s”.

“C” stands for “Create”, meaning the individual with Dermatillomania is not picking at anything objectively “real”, but in the process of picking at his / her skin, the person “creates” something such as a blemish, scratch or scab.  A “C” is something that only someone with Dermatillomania would pick. There is often nothing apparent on the individual’s skin, but the picker starts picking or scratching, and in the process creates a wound.

Treatment for Dermatillomania / Skin Picking Disorder

The recommended treatment for Skin Picking Disorder is with a trained psychotherapist who specializes in treating this misunderstood and often misdiagnosed condition.  Effective treatment focuses on Cognitive-Behavioral Therapy (CBT), with an emphasis on Habit-Reversal Training (HRT) and Mindfulness Based CBT.

In Cognitive Behavioral Therapy for the treatment of Dermatillomania, the first behavioral goal is to stop picking any “C’s” – in other words, to stop creating new skin problems where none previously existed. Usually, a skin picker can learn to do this relatively easily by becoming more aware of their picking patterns.  Building awareness is generally done by keeping a skin picking log, and with the assistance of a habit-blocker such as wearing gloves.

Gloves provide a barrier to unconscious picking, and help in two ways.  First, the skin picker cannot easily pick at existing scabs, blemishes, etc.  Second, the gloves prevent identification of new places to pick that would otherwise be felt by random, unconscious, mindless “investigation” (touching) of the skin. If you are a skin picker, the previous sentence may resonate with you, and you may say, “I do that!” That would make sense as the two main triggers for skin pickers are touching and looking at their skin.

Removing the opportunity to touch your skin by wearing gloves is a good first step to becoming more aware of your unconscious “scanning”, and reducing the impulse to pick. After you get used to using a “habit blocker” like gloves, the focus of treatment turns to reducing your picking of “B’s.”

So, what are the two most important factors to address in successfully reducing picking of “B’s”? You can read about that in part 2 of this series on Dermatillomania.

To take our free online test for Skin Picking Disorder / Dermatillomania, click here.

To read part two in our series of articles on Dermatillomania / Skin Picking Disorder, click here.

To read an excerpt of from our free special report “Skin Picking Disorder: Top Twelve Roadblocks to Recovery”, click here.

•The OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions, including Dermatillomania / Skin Picking Disorder.  In addition to individual therapy, the center offers six weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment.  To contact the OCD Center of Los Angeles, click here.