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Excoriation Disorder: A Walk in Our Skin

Excoriation Disorder is not only physically painful but also causes mentally/emotional anguish.

A fidget toy I have in my possession.

A fidget toy I have in my possession.

What Is Excoriation Disorder?

I've lived with the disorder, dermatillomania, for more than half my life; the damage is mostly on my hands and fingers. After many years of skin-picking, my fingertips are always sore, the smallest trauma (hitting my hands on something hard) is quite painful. I hide my hands in gloves during bad episodes, even when uncomfortable in the middle of the hot and humid summers.

This article will highlight what dermatillomania is and examples of treatments to minimize this debilitating disorder.

Excoriation Disorder, or dermatillomania, is a psychological disorder categorized by the compulsive urge to pick at one's skin. People struggle with the compulsion to scratch, pick, dig and repetitively rub their skin in vain to improve perceived flaws. Over time, this impulse-control disorder can have significant detrimental effects with tissue damage, pigment discoloration, and scarring.

Symptoms

  • Recurrent picking causing painful lesions
  • Consistent efforts to stop the behavior
  • There is significant distress/impairment in their daily routine.
  • The behavior is not the result of substance or medical conditions (includes dermatological).
  • The symptoms are not the results of another psychiatric condition.

Experiences that follows the indulgence of the obsessive behavior

  • A sense of reward (relief or pleasure)
  • Altered mentation (embarrassment, social anxiety, and avoidance)
  • The patient suffers from skin infections, scars, painful lesions, and permanent disfigurement.

Note: This information can be found in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Treatments

Cognitive Behavior Therapy (CBT) is an approach used by therapists to help patients recognize feelings, thoughts, and behaviors that may be harmful to their mental health. This form of psychotherapy helps the patient learn coping strategies they can later apply to their lives.

Habit reversal training involves awareness (identifying the triggers, competitive responses); learning how to substitute the wrong behavior for a healthier alternative; emotional support (having the support of loved ones/family).

It should be noted: Habit reversal training is not always effective long-term; other types of treatments should be used in conjunction for the best chance of long-term success.

One technique I've tried as an example of habit reversal training is the use of a fidget toy. These are hand-held "toys" coming in many shapes and textures; used as stress-releasers, distracters for people suffering from compulsive disorders, and even aid for ADHD. While this toy has been a very helpful distractor for me, it is not a 100% fix-all.

Comprehensive behavioral treatment comes from the theory the patient engages in repetitive behavior because it meets one or more of their reward system criteria (relief/pleasure).

With their therapists' help, patients can self-assess to understand the rewards and consequences of their behavior and the internal/external triggers that cause them. Internal triggering could be tactile sensation or intrusive thoughts and feelings. External triggering could be places and activities.

Medications

Psychotropic drugs for anxiety and depression can be prescribed, though often with mixed results. It's important to speak with a doctor or psychiatrist if you want to explore medication.

Other types of medications prescribed are for pain, mood stabilizers, and dopamine blockers. From experience, prescriptions are not always the answer.

Finding a Balance Is Key

A balanced treatment plan is vital. Using only drugs will not cure everything; using only talk therapy will not fix everything. Every person is different in their needs and what is best for them and their road to healing.

Remember, treatment is a process. There will always be two steps forward, one step back. Even if the treatment is successful, there most likely will be fumbles along the way, and there is no reason to feel bad about it, which leads to my last point.

  • Effective self-preservation means accepting your relapse and the willingness to continue using coping strategies learned and to know when to reinstate them when you feel lost.
  • And maintain a nonjudgmental attitude toward yourself and have the inner strength to contact a licensed professional if/when needed.

Determination will set you free.

Sources

  • American Psychiatric Publishing. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. San Francisco: American Psychiatric Publishing.
  • The TLC Foundation for Body-Focused Repetitive Behaviors. (2016). Body-Focused Repetitive Behaviors Hair-pulling, Skin-picking, and Related Disorders. Scientific Advisory Board of The TLC Foundation for Body-Focused Repetitive Behaviors.

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

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