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.
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,
Onychophagia, Compulsive Skin Picking, Compulsive Nail Biting, and
of skin picking include:
Recurrent skin picking - face, lips, scalp, hands or arms.
increase immediately before picking.
gratification, tension decrease or relief when skin picking.
picking causes significant difficulties in life, or stress.
Sensations such as itching, tingling, burning, or an uncontrollable
urge to pick their skin.
Behaviors - body rocking, thumb sucking, knuckle cracking, cheek
chewing, and head banging.
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.
Body Dysmorphic Disorder
Dermatillogical Skin Disorder.
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
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.
and Psychotherapy [ See
Therapy Section ]:
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
[ See Psychopharmacology
Section ] :