More than just expressing pimples: We spoke to experts about what skin picking disorder is, how it manifests itself physically and mentally and what can be done to treat it.
"Hello again - I'm crusted and reddened here," wrote Tallulah Willis in the caption of a recent unvarnished selfie on Instagram. Further: "I felt like I was out of control, so I focused on something I can control, so I put my fingernails in the face, my esthetician and dermatologist sighed and the healing process could start all over again. "
Not for the first time, Willis, illustrator, fashion designer, and mental health advocate speaks openly about her battle with skin-picking disorder, also known as excoriation disorder or dermatillomania, a mental illness closely related to obsessive-compulsive disorder. It manifests itself through repeated scratching and tugging on your own skin. Willis's willingness to speak publicly about the difficulties of living with skin picking disorder is invaluable in raising awareness and reducing stigma about the disease. According to the International OCD Foundation, an organization that helps people with obsessive-compulsive disorder, the disease affects around 1 in 20 people, more women than men.
Also, given the mental health implications, the pandemic will bring, it is time to get to the bottom of what exactly skin picking disorder is, how it affects physically and mentally, and how to look at the treatment options. Read the assessments of three different experts here.
"We all pick our skin occasionally, but it can be very difficult for people with the skin-picking disorder to stop," said Lisa Zakhary, MD, Ph.D., medical director of the Massachusetts General Hospital (MGH) Center for OCD and Related Disorders (CORD) and co-founder of the MGH Comprehensive Skin Management Clinic. According to Zakhary, skin picking disorder is characterized by recurring picking, repeated attempts to stop picking, and the resulting stress or discomfort. The most common areas of pecking are the face, back, arms, legs, hands, and feet, with most people using their fingernails. The psychologist Dr. Jenny Yip, founder of the Renewed Freedom Center, points out that skin picking disorder is a body-related, repetitive behavior that also includes related disorders such as nail-biting, lip plucking, and trichotillomania. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), this body-focused, repetitive behavior is categorized as part of OCD but is not exactly the same.
From a dermatological point of view, clear signs in the absence of primary skin disease are numerous injuries to the skin, including scratches, worn skin, purulent spots and bumps, and scabs. "Chronic skin picking can lead to an endless cycle of itching and scratching skin damage, infection, and many stigmas, including hyperpigmentation, skin thickening, and itchy skin nodules," explains NYU dermatologists Evan Rieder. In many cases, people with skin picking disorder tend to pick at any changes that are visible and palpable. "When they see something that looks imperfect, such as bumps on the skin, they have an urge to tug at it," explains Yip. “It's similar to when you have a crust about to fall off and you have an intense urge to get rid of it. Increase that urge a hundred times - this is how it feels when you have a skin-picking disorder to have."
By raising awareness of the skin-picking disorder, Zakhary aims to combat the widespread misconception that it is a relatively harmless disease or that, as she puts it, "is no worse than any other bad habit such as being sick B. to look at a screen just before going to bed ". In addition to the severe physical consequences, many who suffer from skin picking disorder avoid social situations for fear that their skin picking will be discovered. "That can affect personal and work life and lead to depression and anxiety," says Zakhary.
Shame and guilt are also part of the psychology of battling skin-picking disorder, Yip points out. "People with skin picking disorder don't enjoy scratching their skin - they've tried to stop many times in the past," she explains. "When it happens again and comes to a point where it starts to bleed, it creates shame and guilt. It becomes a vicious circle because when you feel shame, shame, and guilt, it makes you feel stressed, which in turn triggers that Skin picking is. You are then even more stressed and the first reaction to stress is to pick your skin. "
"The main triggers for picking can be found in boredom and under-challenged, but also in desperation and overburden," explains Yip. "The pandemic has provided the ideal space for those feelings. The stress of the pandemic, all the regulations and the people dying around you, and nothing else to focus on as everyone is in quarantine, without exception. " Rieder also saw how increasing use of the screen and zooming had a negative impact on the patient's self-image. "I am currently watching a lot of people scrutinizing every detail of their skin, which is largely due to excessive use of social media and video conferencing," explains Rieder. "This behavior is partly paired with plucking and working on the skin in an attempt to somehow improve light imperfections in the skin."
Skin picking is typically a chronic condition with occasional flare-ups, and dermatological treatments, therapies, and medications can help, but it varies from patient to patient. "Understanding what triggers the picking can help find the right treatment," explains Zakhary. "For example, people whose picking is triggered by a skin condition such as acne can benefit from dermatological advice. However, if picking is triggered by sadness, anger, fear, or more general obsession, it is advisable to seek psychological advice."
In order to raise awareness of the triggers of picking, it is important to identify the where, when, and how, emphasizes Yip. "Most of the time, people say they are going into a trance state," she explains. "They don't really have an awareness of how much they've been pulling on their skin until they're done." Once the triggers are identified, most experts recommend some form of specialized cognitive-behavioral therapy (CBT). "She teaches strategies to reduce picking, such as controlling external stimuli to reduce the likelihood of picking," explains Zakhary, giving examples such as short fingernails, wearing gloves, or engaging the hands with distraction objects. Another type of behavior therapy is Habit Reversal Training (HRT), in which people are taught to systematically replace the urge to pick with other behaviors that are incompatible with picking. "It's about creating barriers," explains Yip about the Habit Reversal Training that she offers at the Renewed Freedom Center. "You could also have some type of prickly stress ball around that gives you a similar feeling to skin picking. If you have a tendency to pluck while cooking, then you could be trying to hold an object in your hand all the time so your hands are never free. " Although there are no US Food and Drug Administration-approved drugs to treat skin picking, Zakhary notes that there is growing evidence that antidepressants with selective serotonin reuptake inhibitors (SSRIs) and N-acetylcysteine (NAC ), an antioxidant, can be helpful.
Rieder recommends products such as Vaseline and ceramide-based creams to heal the skin barrier. "They're best for repairing the compromised skin barrier without causing allergies or irritation," he explains. "Those affected often want to use products with active ingredients or anti-aging and lightening effects, but these lead to problems in this case." Ultimately, personalized behavior therapy is the key. "People living with the skin-picking disorder need to get involved in treatment, be willing to work at home to help themselves, and see a therapist regularly (sometimes weekly) for improvement," says Rieder. "A heightened awareness in society can help people to find suitable contacts who will help them to improve their chronic and difficult condition."