MOST OF US know that inflammation or sores on SKIN is better not to touch it, but I guess every once provided in a situation where the stop was impossible, and barely noticeable pimple because of attempts by him to get rid of in a matter of minutes turned into a bright spot. Sometimes the situation is completely out of control, and a person has been trying for years to get rid of the habit of picking at the skin on the face or body. Together with the experts, we figure out why this is happening and when to seek help.
What it is
In English sources, the problem is usually described as skin picking – in Russian, the closest is perhaps the inelegant phrase “picking skin”. The CompulsiveSkinPicking community on Reddit has more than thirty thousand people who share successes , complain about relapses and joke : “It should be written in my bathroom that objects on the skin are actually smaller than they appear in the mirror.” A community commentary states that CSP is an obsessive-compulsive spectrum disorder, which is the desire to pick on real or perceived pimples, peeling, calluses, uneven skin texture, and resisting this desire is as difficult as refraining from scratching an itchy place or cough. These actions can lead to unpleasant consequences: pain, wound infection, scarring. In addition, people may experience shame, guilt and suffer from social stigma.
The disorder was described as early as 1875 under the name “Neurotic excoriation” . The 11th version of the International Classification of Diseases provides for the diagnosis of Excoriation Disorder in the category of obsessive-compulsive disorder. In the current ICD-10, you can find the sub-item “Self-induced dermatitis”. Sometimes the condition is called dermatillomania, but this is not entirely correct: with mania, a person is most often not aware of his actions. In the Diagnostic and Statistical Manual of Mental Disorders (DSM), in the current fifth version, there is a diagnosis of ” Excoriation (skin-picking) disorder “, referred to as obsessive-compulsive disorder.
It is believed that about 1.4% of people develop this condition over the course of their lives , three quarters of whom are women (although this ratio may be due in part to the fact that women are more likely to seek help). True, the prevalence may be higher – studies have reported that 3.4% and even 5.4% of people have the disorder . In 2018, a publication was published about body-oriented movement iterations, that is, repetitive movements associated with the body – these include the habits of picking skin, biting nails, pulling one’s hair, and so on. It turned out that 60% of the 4335 participants had evidence of subclinical disorders, and in 12% it was obvious.
Diana says that since childhood she compulsively squeezes out pimples, blackheads , picks calluses and bites her lips: “I have anxiety disorder and a mild form of OCD. In part, these actions help to cope with anxiety – problems begin when I cease to control the process. Sometimes you seem to turn off for a couple of minutes, it seems to you that you can not stop doing it, once you started. I do this all the time when the difficult period: it comes to the point that I hide the magnifying mirror from myself, just in case. It is very difficult not to think about picking if you have already noticed something that can be attacked. Everything ends the same – bloody smudges, age spots, scars, inflammation. The main thing is that how much would you not picking and not crushed, acne will never come to an end, so my goal now – to find solace with the help of more productive ways. In part, I work on this with a psychotherapist who, at the very least, taught me not to scold myself for this behavior. As a child, my mother could forcibly squeeze a pimple out of me – and it seems that the very idea that it is “normal” to look for “shortcomings” in oneself and to cope with them by force originates from there.
How is the diagnosis made
With excoriation disorder, usually there is not only the very picking of the skin, leading to wounds and inflammation on it, but also repeated attempts to stop doing it. Most often the skin of the face, head, arms, front surface of the legs suffers, but it happens that the only surviving area is the upper back – it simply cannot be reached there. Another diagnostic criterion is the patient’s serious anxiety about this condition, a feeling of loss of control, a sense of shame, problems with communication or at work, avoidance of activities. Difficulties with work or study can arise from the fact that a person actually spends several hours a day picking or thinking about skin .
At Anastasia Simbirsk disorder excoriation for twenty years, and it greatly affects the quality of life: “I am now twenty-six, and the first damage I caused myself in six years – tore the skin on the knuckles hands. At eight I had chickenpox, I burst bubbles, picked sores in their place. At fourteen, I picked up the pimple between my eyebrows so that an infection developed there, there was severe swelling, I was admitted to the hospital. At sixteen, my legs were injured, there were huge purulent wounds that I did not treat, and now there are round scars, as if burns from cigarettes. In between these moments, I just always picked my face and legs, at some point I moved to my chest – it is also covered with scars. At twelve I started using foundation to hide sores on my face, I couldn’t even go out for bread without putting on makeup. The hardest thing is in summer – it is difficult to wear open clothes, I hardly go out, I don’t go swimming. For overseas people tactfully, but here I have heard many times: “And that you with your feet? And with the face? Why such a foundation layer? “”
It is important to rule out other conditions – to make sure that skin picking is not caused by another psychiatric problem, such as accompanied by tactile hallucinations. Obsessive touching of the skin also occurs with the use of certain substances, in particular cocaine. Finally, it is important to rule out diseases like scabies.
Why is it hard to deal with it
Among those who are aware of the problem, many do not seek help. It is clear that this also happens with other conditions or diseases, for various reasons, often a person does not want to spend money and time on going to the doctor . But with obsessive picking of pimples and skin irregularities, there is another problem – shame due to the inability to cope on their own and lack of “willpower”. It seems that this is not a disease with which it is worth going to the doctor, but just a “bad habit”. Nevertheless , everything is serious: in particular, excoriation disorder correlates with dependence on nicotine and alcohol and can be accompanied by depression or bipolar disorder, which cannot be dealt with on our own .
It happens that people come to the doctor, but not quite the right place – they usually go to the dermatologist first . Perhaps someone is embarrassed to go to psychotherapists – but, as one of the studies has shown , most do not even know that to work with a situation it is necessary to turn to them. Other authors found that only a small proportion of both dermatologists and psychiatrists were confident in their own understanding of psychodermatological difficulties .
Vera Voronina, a dermatologist at the Rassvet clinic, says that there are also more serious conditions in which people do not even notice that they are constantly touching their skin. Patients sometimes seek help because of skin problems or loss of hair, eyelashes, eyebrows (with trichotillomania ), without realizing that this is a man-made problem. The dermatologist sees that this is a consequence of external influences, but patients refuse to believe it, and when they manage to talk, they can, for example, report that someone is crawling on the skin; this is called zoopathic delirium and is associated with mental disorders such as schizophrenia.
How is it treated
Since this condition is classified as an obsessive-compulsive disorder, it is treated by a psychiatrist or psychotherapist. While there is no method registered with medical regulatory authorities (such as the US FDA) specifically for treating excoriation disorder, psychotherapy and drug interventions are being researched and some are considered effective. Learn and alternative methods – from yoga to acupuncture; in particular, yoga and aerobic exercise have shown promising results, but only as an adjunct to psychotherapy and pharmacotherapy.
Psychiatrist and psychotherapist, candidate of medical sciences Vitalina Burova says that in her practice there are almost always patients who have turned to the referral of a dermatologist to pick out their skin or pull out their hair. The doctor’s task is to begin by determining whether the patient has symptoms of depression or anxiety of such a level that medical correction is required. If there are indications, then drugs are prescribed and cognitive-behavioral psychotherapy is mandatory, and if there are no indications for psychopharmacotherapy, then excoriation is treated only with psychotherapy, without drugs. The course of treatment requires at least ten weekly sessions, but as a rule, the process takes from six months to a year.
Among the types of cognitive-behavioral therapy, they use, in particular, the habit reversal therapy method aimed at “unlearning” skin picking. First, the patient learns to be aware of the peculiarities of his habit – for example, he keeps a diary, where he notes when and how it happens, in what environment, what sensations precede it. Then, when it is already easy to recognize the impulse to start touching the skin, substitute actions come to the rescue – something easily doable, incompatible with picking and at the same time no more noticeable outwardly than a habit that needs to be eliminated. The simplest examples are squeezing a rubber ball, sitting on your hands, or clenching your fists. Relaxation techniques, breathing exercises, and the help of others are connected to this method – for example, parents can use reminder words for a child. There is evidence that the method is effective even when used independently (as part of an online course).
The psychotherapist can offer other methods of treatment: for example, psychodynamic psychotherapy with the elaboration of events from childhood, fantasies and unconscious processes; mindfulness therapy, during which a person learns to perceive his feelings, thoughts, memories without judgment. The benefits of psychotherapy in excoriation disorder have been demonstrated more than once – but with drug therapy so far, everything is not very good. It is believed that a short-term effect is observed in all studies of this condition, even if the drug is actually ineffective – the placebo effect is triggered and the awareness of patients who simply put in more effort not to pick the skin.
Medicines are still used, mainly antidepressants and antipsychotics. For antidepressants in the serotonin reuptake inhibitor group, the results are good, but few people participated in the studies, and the methodology was not always convincing. For some drugs, only information on individual cases is available at all . On today scientists are of the opinion: and disorder excoriation itself and its treatment remains to be deeply explored.
How to help yourself
According to Anastasia, over the past two years her disorder has progressed, and she asked for psychological support. “During four sessions with a psychologist, I was able to speak out, it became easier. Now I ‘m trying to cope on my own, reading books on self-development, doing meditation. If earlier dermatillomania was a manifestation of suppressed emotions – fear, anger, aggression, resentment – now I am psychologically and emotionally calm. But the body is already accustomed to these actions, and the hands are constantly looking for something that can be picked up and squeezed out. Now I ‘m a blog in instagrame where openly started talking about his frustration. It became much easier, because I met girls with the same problem – and before that I thought I was crazy and so alone. “
Information on the Russian language and about the disorder excoriations, and an obsessive-compulsive disorders in general, very little. In English, you can study the website of the International ROC Foundation – they also translated their own information booklet on the topic into Russian . Those who suspect they have an excoriation disorder and want to communicate with other people with this condition, you can contact one of the small closed groups on the VKontakte network or (in English) on the same Reddit. There is a Russian-speaking group on Facebook about body-oriented movement iterations: hair pulling, skin picking, nail biting and other similar habits.
The website of the British organization that helps people with obsessive-compulsive disorders provides several recommendations for those who are still deciding to go to the doctor or are waiting for an appointment. The main ones are to keep your hands busy, ask loved ones to stop you, cleanse and moisturize your skin well, and not grow your nails yet and remove tools like tweezers away from you.