Compulsive Skin
Picking (CSP), also called pathological skin picking, neurotic excoriation,
or dermatillomania, is defined as the habitual picking of skin lesions
or the excessive scratching, picking, or squeezing of otherwise healthy
skin is a poorly understood disorder.
Some researchers
now believe that compulsive
hair pulling, skin picking, and nail biting form a subgroup of
what is becoming known as the Obsessive-
Compulsive Disorder Spectrum. OCD has been previously been regarded
as only a single disorder but may in fact represent a range of related
disorders, including classic OCD, Body
Dysmorphic Disorder, Anorexia Nervosa,
Bulimia, Trichotillomania,
Onychophagia, Compulsive Skin Picking, Compulsive Nail Biting, and
Tourette's Syndrome.
The characteristics
of skin picking include:
Recurrent skin picking - face, lips, scalp, hands or arms.
Tension
increase immediately before picking.
Pleasure,
gratification, tension decrease or relief when skin picking.
The
picking causes significant difficulties in life, or stress.
Sensations such as itching, tingling, burning, or an uncontrollable
urge to pick their skin.
Associated
Features:
Stereotypic
Behaviors - body rocking, thumb sucking, knuckle cracking, cheek
chewing, and head banging.
Anxiety.
Depression.
Differential
Diagnosis
Some disorders have similar symptoms. The clinician, therefore, in
his diagnostic attempt has to differentiate against the following
disorders which need to be ruled out to establish a precise diagnosis.
Depression
Anxiety
Substance
Abuse
Body Dysmorphic Disorder
Obsessive Compulsive
Disorder
Trichotillomania
Dermatillogical Skin Disorder.
Cause:
Most people develop
this problem in their teens or 20's. An episode may be a conscious
response to anxiety or depression, but is frequently done as an unconscious
habit.
Treatment:
The primary treatment
modality for CSP depends on the level of awareness the individual
has regarding the problem. If the CSP is generally an unconscious
habit, the primary treatment is a form of Cognitive-Behavioral Therapy
and drug therapy.
Counseling
and Psychotherapy [ See
Therapy Section ]:
Cognitive Behavioral
Therapy and Habit Reversal Training (HRT) may be used, as it appears
that skin-picking is a conditioned response to specific situations
and events, and that the individual with CSP is frequently unaware
of these triggers. HRT challenges the problem in a two ways. Firstly,
the individual learns how to become more consciously aware of situations
and events that trigger skin-picking episodes and secondly, the individual
learns to utilize alternative behaviors in response to these situations
and events.
Pharmacotherapy
[ See Psychopharmacology
Section ] :
Antidepressants:
Anafranil.
Prozac, Zoloft.
Paxil.
Luvox.
Celexa.
Lexapro.
Serzone.
Effexor.
