Am I a skin picker?
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Skin picking

Ten things to know about skin picking:

  • Some skin picking is normal. Almost every mammal on earth picks at its skin to some degree. However, 2% - 4% of human beings take skin picking too far and end up injuring the skin. This equates to 6 to 12 million people, which makes severe skin picking a far from rare occurrence.
  • Picking happens more often when people are sedentary, such as when they are watching TV, driving, reading, or talking on the telephone. Evidence suggests that picking happens far more often when people are alone than when around others.
  • Self-injurious skin picking tends to begin in adolescence or early adulthood. Its severity may slightly increase or decrease over time, but remains intact for many years or even a lifetime.
  • Pickers tend to describe their experience as “trance-like” or “checked out” and each instance of picking can last for seconds or hours at a time.
  • Oftentimes a person will only stop picking once the skin is bleeding or has become injured.
  • Picking can result in injury to the skin such as bleeding, sores, localized infections, or even deep craters, and can cause scarring.
  • Skin picking and the damage it causes can provoke intense distress, deep shame, and may cause avoidance of social situations. Often skin pickers live in fear of being “found out.”
  • Picking can occur anywhere on the body. People pick pimples, scabs, or even healthy skin.
  • Fingers are often used to pick, but needles, tweezers, and other small instruments are also sometimes used.
  • People who pick at their skin tend to have a higher incidence of Obsessive Compulsive Disorder (OCD), Obsessive Compulsive Personality Disorder (OCPD), and Body Dysmorphic Disorder (BDD). Skin pickers tend to have higher levels of depression and mood disorders and tend to abuse drugs and alcohol more frequently.

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Why do we pick?:

Perfectionism: People will often start to pick in an attempt to “fix” something that is perceived to be wrong with the skin. In an attempt to improve the appearance of the skin, the opposite often happens, and the skin is left in worse shape than before picking began. This in turn can lead to further skin picking.

Unconscious reasons: Oftentimes, picking is an unconscious strategy to alleviate stress. Entering into a trance-like state, a person can zone out from stressful matters and instead concentrate on picking at the skin.

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Treatment options:

pill

SSRIs: Initial studies show selective serotonin reuptake inhibitor medications like Prozac, Luvox, Paxil, and Zoloft providing some short-term and longer term relief. Initial results from small studies are pointing toward about a 50% success rate. When success is achieved, it is often described as significant. These prescriptions come with a bevy of side effects, some of which can be quite disturbing to the patient taking the drug. Be certain to research SSRIs fully and have a heart-to-heart with your doctor before embarking on SSRI therapy.

cbt

Behavioral Therapy: We have limited research into behavioral therapy when it comes to skin picking. However, a few case reports are hinting at success using Cognitive Behavioral Therapy (CBT) and other techniques, as outlined below:

Name of CBT or other technique One example of each
Awareness training Notice when your hand first starts to move toward your face.
Competing response Instead of picking, extend your arm out in front of you and make a thumbs-up.
Self-monitoring Start a journal and enter into it the time of day that you pick and for how long you pick.
Time-out When the urge to pick becomes overwhelming, leave the premises for a while.
Stimulus control and response prevention Make a rule that you will only spend 10 minutes in front of any mirror at any one time.
Relaxation Practice deep breathing instead of picking.
Social support network Tell your friends and family about your goal and ask them to get involved.
Education Learn about BDD, OCD, OCBD, and/or BPD.
Incentivization List painful outcomes of continuing the behavior and pleasurable outcomes of stopping the behavior.

Note: The symptoms of skin picking are startlingly similar to nail biting.

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chill out

Join us! Start the chill out program now. There's no need to sign up. Also, it's free. I’ll be doing this right along with you guys. While I am not a skin picker, I have been a lifelong obsessive nail biter. At times in my past, I have bitten and picked my nails to the point where I injured my nail bed. The chill out program outlines step-by-step a cognitive behavioral pathway designed to help us stop picking. I think it's going to be fun.

References

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