What is Dermatillomania?

I know what it is like to be afraid of your own hands and nails.

Dermatillomania is a condition that psychologically manifests itself in the form of skin picking which is seen to be compulsive and repetitive. It is commonly referred to as Excoriation and Skin-Picking Disorder. It was originally classified under Impulse Control Disorder but is now an own separate condition under Obsessive-Compulsive and Related Disorders, as per DSM-V.

Here, the individuals are unable to stop picking at their own skin and it often causes significant dysfunction. They use their fingers or sometimes even tweezers to pick their healthy or unhealthy skin leading to tissue damage. The face, fingers, arms, legs are usually targeted. It is seen that they might have other obsessive-compulsive problems.

Research shows that this frequent skin-picking is usually followed by stress and anxiety. It is commonly seen to be comorbid with conditions like substance abuse, body dysmorphic disorder, and major depressive disorder. It is a condition that more likely to be experienced by women than men. Here, skin-picking often gives a sense of satisfaction and is the main reason why it is chronic. A primary body part is chosen and is focused on by the individual.

The duration of picking differs from one individual to another; some may do it continuously for hours while others may do it multiple times in a day. This behavior leads to tissue damage and can get so severe that skin grafting might be required. Unfortunately, Dermatillomania leads to the development of intense feelings of guilt and helplessness, sometimes resulting in self-harm.

It has been understood that Excoriation is a result of a coping mechanism developed by the individual in response to stressful situations. An interesting theory states that this behavior is sometimes seen due to repressed rage because of authoritarian parents. A genetic component also influences Excoriation. Sometimes, perfectionism is seen to be a primary trait in those who are diagnosed with this disorder. Traumatic events during childhood can also be a causal factor. Skin conditions like eczema is also a cause for the same.

Cognitive-Behavioral Therapy is the most common form of treatment of Dermatillomania. This helps in identifying trigger points for the individual and thus accordingly forming coping strategies for the same. Habit Reversal Training is also used to reduce repetitive behaviors. Here, they introduce a behavior that is less harmful in place of skin-picking.

The pharmacological treatment includes SSRIs and anti-epileptic medications. A more day-to-day solution can be to distract oneself by keeping hands occupied using stress-balls or fidget gadgets. One is taught to develop a skin-care routine by moisturizing their hands. They are also made to recognize the areas that they commonly pick. Keeping nails short is the main solution to this problem. Other sharp tools like tweezers and pins should be kept out of reach from the individual as well.

Slowly, this disorder begins to interfere in an individual’s daily life by making them all the more conscious about their skin. They begin to avoid social situations or put on full-clothing to cover up the damaged skin.

Their anxiety takes control over them and might worsen the situation. It is important to reach out for help the second the symptoms are noticed and treatment should not be delayed. As it can be comorbid with many other psychological conditions, it is necessary to not avoid or overlook any symptoms. It is an extremely difficult disorder to live with and brings shame to the individual. Pushing them towards acceptance is the only way out of Excoriation.