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.
