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While it’s simply “being human” to occasionally pick at your skin, at calluses, or at the cuticles on your fingers, when a person obsessively self-grooms, it could be a sign of dermatillomania or excoriation disorder. In layman’s terms, this is a skin picking disorder. The condition is a form of obsessive-compulsive disorder and is one of a group of body-focused repetitive behaviors (BFRB). Dermatillomania damages skin and is characterized by compulsively picking, touching, pulling, rubbing, digging into, scratching, or even biting at one’s own skin as a way to get rid of perceived skin irregularities.

Signs of Dermatillomania

Research shows that anywhere between 2% and 5% of people compulsively pick at their skin. Females make up about 75% of those who are diagnosed with excoriation disorder. Skin picking can begin at any age, but commonly shows up in adolescence or at the onset of puberty. The condition made come and go over time, and the location the person picks at may change, but the disorder is generally chronic.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) signs and symptoms of dermatillomania include:

Skin picking that results in visible lesions, skin damage, scars and possibly disfigurement
The person has made repeated, unsuccessful attempts to stop picking at their skin
The symptoms cause clinically significant distress or impairment
The symptoms are not caused by a medical or dermatologic condition or by a substance (example: opiate withdrawal)
The signs and symptoms are not better explained by another psychiatric disorder

Picking at the skin can cause anxiety, depression and embarrassment in those who have dermatillomania. They may attempt to cover their skin lesions with makeup or clothing and may avoid situations in which their condition may be discovered. This can lead to isolation and emotional distress, which can increase the risk of having a mood or anxiety disorder in addition to their dermatillomania. Another complication can be the need for medical care because it isn’t uncommon for the person to get a skin infection, open wound, or scars from picking too much.

Treatment for Skin Picking Disorder

It is thought that fewer than one in five people will seek treatment for excoriation disorder, however Cognitive Behavioral Therapy (CBT) is very helpful for those who do. CBT helps patients identify the negative or inaccurate thoughts, feelings and behaviors that have become problematic and teaches them how to challenge and change their reaction to them.

While the main therapy for dermatillomania is behavioral therapy, medication is sometimes used to reduce the feelings that lead to compulsive skin picking. Although psychiatric medications have limited success, there are some people who benefit from temporary use of them, particularly if they have a concurrent condition, such as anxiety or depression. Additionally, some skin medications can help the underlying condition (such as acne) that causes the individual to pick at their skin.

As a family member, it can be difficult to be supportive of a person with dermatillomania or other BFRBs. The behavior can strain relationships with friends and family. Remember to communicate with patience and empathy and remain calm when talking to the person. If you feel overwhelmed, join a support group or explore the resources in self-help groups or in books on the subject.

Get Help for Dermatillomania

For more information about how a child psychologist at the Children’s Center can help your child overcome skin picking, contact the Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.

Self harm or self-injury is the intentional wounding of one’s own body. Most often, people who self harm will cut themselves with a sharp object.

Self harming may also include:

severely scratching areas of their body with a fingernail or sharpened object
carving words or patterns into their skin
burning or branding themselves using lighters, cigarettes, lit matches, or other hot objects
biting themselves
excessively picking at their skin (dermatillomania) or wounds
hair pulling (trichotillomania)
head banging
punching or hitting themselves
excessive skin-piercing or tattooing may also be indicators of self harm

Generally, people who self-harm do so in private. Often, they follow a ritual. For example, they might have a favorite object that they use to cut themselves or they may listen to certain music while they self injure.

Self harmers will target any area of the body, but the legs, arms, or front of the body are the most commonly selected. These areas are not only easy to reach, they are also easy to cover up, allowing the person to hide their wounds away from judgmental eyes.

Additionally, self harm can include actions that don’t seem so obvious to others. Activities like excessive substance abuse or binge drinking, driving recklessly or having unsafe sex can all be signs of self harm.

Causes of Self Harm

There are many reasons that people engage in the unhealthy coping mechanism of self-injury.

Oftentimes, a self-mutilator may have trouble understanding or expressing their emotions. Those who self harm report feelings of worthlessness and rejection, loneliness or isolation, guilt, self-hatred, and anger.

When a self harmer attacks their own body, they are really seeking:

distraction from painful emotions
to release intolerable mental anguish
a sense of control over their feelings, their body, or their lives
a physical distraction from emotional pain or emotional “numbness”
to punish themselves for supposed faults

People who self injure often feel an intense yearning to injure themselves. Even though they know it’s destructive, this feeling grows stronger until they complete the act of mutilation. Feeling the resulting pain releases their distress and anxiety. This relief is only temporary, though, until their shame, guilt, and emotional pain triggers them to injure themselves again.

Who is At Risk for Self Harm?

Self injury happens in all walks of life. It is not restricted to a certain race or age group, nor to a particular educational or socioeconomic background.

It does happen more often in:

people with a background of childhood trauma, such as verbal, physical, or sexual abuse
those who have difficulty expressing their emotions
those without a strong social support network or, conversely, in those who have friends who also self harm
people who also have obsessive compulsive disorder (OCD), post traumatic stress disorder (PTSD), eating disorders, borderline personality disorder, or those who engage in substance abuse

Although anyone may self harm, the behavior occurs most frequently in teens and young adults. Females tend to engage in cutting and other forms of self-mutilation at an earlier age than males, but adolescent boys have the highest incidence of non-suicidal self injury.

Self-Harming Symptoms

Physical signs of self harm may include:

unexplained scars, often on wrists, arms, chest, or thighs
covering up arms or legs with long pants or long-sleeved shirts, even in very hot weather
fresh bruises, scratches or cuts
telling others they are clumsy and have frequent “accidents” as a way to explain their injuries
keeping sharp objects (knives, razors, needles) either on their person or nearby
blood stains on tissues, towels, or bed sheets

Emotional signs of self harm may include:

making statements of feeling hopeless, worthless, or helpless
isolation and withdrawal
impulsivity
emotional unpredictability
problems with personal relationships

Help for Self Harm

The first step in getting help for self harm is to tell someone that you are injuring yourself. Make sure the person is someone you trust, like a parent, your significant other, or a close friend. If you feel uncomfortable telling someone close to you, tell a teacher, counselor, religious or spiritual advisor, or a mental health professional.

Professional treatment for self injury depends on the specific case and whether or not there are any related mental health concerns. For example, if the person is self harming but also has depression, treatment with address the underlying mood disorder as well.

Most commonly, self harm is treated with a psychotherapy modality, such as:

Cognitive behavioral therapy (CBT), which helps the person identify negative beliefs and inaccurate thoughts, so they can challenge them and learn to react more positively.
Psychodynamic psychotherapy, which helps identify the issues that trigger their self-harming impulses. This therapy will develop skills to better manage stress and regulate emotions.
Dialectical behavior therapy (DBT), which helps the person learn better ways to tolerate distress. They’ll also learn coping skills so they can control the urge to self harm.
Mindfulness-based therapies, which can teach them skills to effectively cope with the myriad of issues that cause distress on a regular basis.

Treatment for self injury may include group therapy or family therapy in addition to individual therapy.

Self care for self-harming includes:

Asking for help from someone whom you can call immediately if you feel the need to self injure.
Following your treatment plan by keeping your therapy appointments.
Taking any prescribed medicines as directed, for underlying mental health conditions.
Identifying the feelings or situations that trigger your need to self harm. When you feel an urge, document what happened before it started. What were you doing? Who was with you? What was said? How did you feel? After a while, you’ll see a pattern, which will help you avoid the trigger. This also allows you to make a plan for ways to soothe or distract yourself when it comes up.
Being kind to yourself – eat healthy foods, learn relaxation techniques, and become more physically active.
Avoiding websites that idealize self harm.

If your loved one self-injures:

Offer support and don’t criticize or judge. Yelling and arguments may increase the risk that they will self harm.
Praise their efforts as they work toward healthier emotional expression.
Learn more about self-injuring so you can understand the behavior and be compassionate towards your loved one.
Know the plan that the person and their therapist made for preventing relapse, then help them follow these coping strategies if they encounter a trigger.
Find support for yourself by joining a local or online support group for those affected by self-injuring behaviors.
Let the person know they’re not alone and that you care.

Need More Information?

Are you concerned that your child is engaging in self harm? Don’t wait to seek help – speak to a compassionate child psychologist at The Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida. Contact us for more information or call us at (561) 223-6568.