Dermatillomania and Trichotillomania – Symptoms and Treatment
The primary characteristic of Dermatillomania (also known as Skin Picking Disorder or Excoriation) is the repetitive picking at one’s own skin to the extent of causing damage. The defining characteristic of Trichotillomania is the recurrent, compulsive pulling out of one’s own hair, often resulting in observable hair loss.
The most common hair pulling sites are the scalp, eyebrows, and eyelashes, while the face is the most common location for skin picking. However, Dermatillomania and Trichotillomania may involve any part of the body. Individuals with either condition may pull or pick in their pubic area, their perirectal region, and/or their arms, legs, feet, back or chest. Those with Dermatillomania 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 either condition may use their fingernails, tweezers, pins or other mechanical devices.
Often, but not always, episodes of Dermatillomania and/or Trichotillomania are preceded by a high level of tension and a strong “urge”. Likewise, hair pulling and skin picking are usually, but not always, followed by a sensation of relief, pleasure, or gratification. Hair pulling and skin picking are usually done alone, often while watching TV, reading, driving, talking on the phone, or while grooming in the bathroom.
An episode of Dermatillomania or Trichotillomania may be triggered by a negative mood state or occur in response to stress, but may also 
occur while an individual is calm and relaxed. Sometimes hair pulling and skin picking are done as a conscious behavior, but may also be done as an unconscious habit. Recent reports indicate that approximately 10% of those with Trichotillomania also eat their hair after they pull it (Trichophagia). This can result in hairballs called bezoars, which can lead to severe gastrointestinal blockage. Some people with Dermatillomania also eat their skin and scabs, though there is less research on this issue. Dermatillomania often causes bleeding, and may also result in bruises, infections, and/or permanent disfigurement of the skin. Trichotillomania may result in permanent hair loss.
Individuals with Dermatillomania and Trichotillomania often attempt to camouflage the skin damage and hair loss that accompany these conditions. Common camouflaging techniques include the use of hats, scarves, make-up, long pants, and long-sleeve shirts. Some with Trichotillomania may use false eyelashes, or in some cases have false eyebrows permanently tattooed. In extreme cases, individuals with either condition may avoid social situations in an effort to prevent others from seeing their skin damage or hair loss.
As demonstrated above, Dermatillomania and Trichotillomania have symptoms that are quite similar, and both conditions are sometimes described as “body-focused repetitive behaviors” (BFRBs). Likewise, both conditions have obsessive-compulsive features and are considered Obsessive Compulsive Spectrum Disorders. Both Trichotillomania and Dermatillomania are commonly experienced by those with Obsessive-Compulsive Disorder (OCD) and Body Dysmorphic Disorder (BDD). In fact, one research study found that 23% of individuals with OCD, and 27% of those with BDD, also had Skin Picking Disorder.
