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Treatment For Excoriation (Skin Picking And Hair Pulling)

For those struggling with the disorder, treatment for excoriation can sound impossible to do or hard to find. Below we talk about what this disorder is, how to know if you have it, causes, and treatments.

This condition isn’t a dead end — there are always ways to find help and alleviate the pain, both physical and emotional.

Like many mental health conditions and illnesses, we don’t always see what’s happening on the outside of a person. However, there are some that can really affect a person’s appearance, to the point where they need to cover up the signs.

Excoriation (otherwise known as skin picking or dermatillomania) is one of those conditions that isn’t talked about enough.

This is a body-focused repetitive behavior (BFRB), which means exactly what’s implied — that a person repeatedly does something to their body to the point that it becomes harmful. Before we go into the treatment for excoriation, let’s talk about what this is and what it looks like.

How Do I Know If I Have Excoriation?

This disorder involves repetitive picking of one’s own skin, but not for reasons one might think (i.e., intentionally harming oneself due to depression).

This behavior is actually triggered by an attempt to improve perceived imperfections. It involves touching, rubbing, scratching, picking, or digging into the skin to try to make them better or go away. But all of these harmful methods result in tissue damage, discoloration, or scarring.

These behaviors aren’t limited to just the skin on your arms, face, or legs, either. It could mean pulling at your hair (and getting clumps of hair out) and biting and picking at your fingers and nails. That’s why it’s important to know the treatment for excoriation.

While doing these things occasionally is common for most, picking at your skin an excessive amount–to the point where you’re damaging your body more than helping it–is what distinguishes this disorder from any other ordinary behavior.

Additionally, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

defines this disorder as an “obsessive-compulsive and related disorder.” It includes signs such as:

  • Recurrent skin picking that results in skin lesions
  • Repeated attempts to stop the behavior
  • The symptoms cause clinically significant distress or impairment
  • The symptoms are not caused by a substance or medical, or dermatological condition
  • The symptoms are not better explained by another psychiatric disorder

Someone with this condition will likely have visible signs on their skin or in their hair, and will often cover it up with makeup, hats, or other accessories depending on where the picking occurs.

Why Might Someone Pick So Much At Their Skin?

Someone suffering from this generally has an urge or physical sensation prior to picking that triggers them to perform the action.

Feelings of discomfort or other invasive, uncomfortable thoughts–which lead to uncomfortable feelings–may lead to skin picking. Other triggers include having bumps or sore spots, beliefs about how the skin should look or feel, and having an urge to relieve stress or other tension.

Just as someone might turn to a drink or drug to cope with a feeling of discomfort, a person might turn to their skin to help relieve the pain.

This is not to confuse addiction with an obsessive-compulsive and related disorder, but it’s important to note that anyone–from someone with addiction to someone with excoriation–can be dealing with the tough aspects of the human experience. We all present our struggles in different ways.

When it comes to picking, anything counts — legs, buttcheeks, face, arms, stomach, neck. Anywhere that the hands might find a place to then relieve that stress.

The result can be often irreversible — skin that may be discolored for years, scarring and bumps from damaged skin and wounds, etc. Treatment for excoriation won’t treat all the past scars but can help prevent the new ones.

But, seeing these scars can actually make you feel worse, leading to what might feel like an endless cycle. Luckily, there is hope, and there are ways to treat it.

Is There Treatment for Excoriation?

The first step when it comes to treatment for excoriation and relieving this awful, cyclical habit is to be aware of it.

A person with excoriation develops these habits earlier on in life, perhaps without even noticing. For example, as someone who personally sufferers from this, I wasn’t even aware that I was doing it — and to the extent that I was — until later in life.

This kind of behavior wasn’t talked about much, and because I didn’t even realize I was doing it, I thought it was just a bad habit. 

It wasn’t until my 20s that I heard that this was a legitimate condition that stems from other psychological factors, including depression and anxiety. I didn’t realize that I was using this as a way to try to cope with stressful situations. It eventually led to a harmful, hard-to-break habit.

So, knowing that this is occurring is crucial.

Second, becoming aware of doing it as it is happening is key to prevention. The motion that you do with your hands prior to the actual picking is called “scanning.” 

When you feel that urge to “look” for spots with your hands, that’s when you can notice that you’re about to pick or “scan.” Stopping yourself here can prevent you from digging too deep into your skin.

Thankfully, there are lots of great tools out there that can actually help to remind you that you’re doing this very motion. Tools like the HabitWear wearables that can track your hand movement, predicting when you’re about to take part in the picking. 

In my experience, I’ve used the Keen 2 bracelet and set the sensitivity to low — even on its lowest settings, I still receive constant alerts. The buzzing sensation on my wrist actually becomes annoying, to the point where I don’t want to wear it anymore. This can help motivate you to stop the picking.

Also, the wearables will usually come with an app connected to your phone. You can get daily reminders to wear your device and track how often you’re using it or how often the vibration goes off. This helps to keep you accountable and can help to visualize the disorder. 

These apps may have exercises, tools, and educational clips to help you learn about skin-picking. This creates a judgment-free zone to explore your personal journey and helps to create a new pattern for yourself.

Treatment for Excoriation — Psychotherapies And Medications

It’s important to learn about why you’re doing the picking — attending therapy and doing cognitive behavioral therapy (CBT) can help restructure your thoughts to help restructure your responses. 

Additionally, Acceptance and Commitment Therapy (ACT) — which entails acceptance and mindfulness strategies, as well as commitment and behavior change strategies — is a type of CBT that promotes the acceptance of negative thoughts and feelings as part of the human experience.

It can help encourage thinking of ways to respond to these negative thoughts and emotions in a way that is congruent with personal values and goals (“commitment”) and not to engage in destructive behaviors such as skin-picking. 

Talking to your doctor is also key. If you’re experiencing comorbidities such as anxiety and depression, you may find relief from an antidepressant or anti-anxiety medication. These medications won’t keep you from picking right away or treat the skin.

However, they can help with restructuring the chemicals in your brain so that you’re not suffering from as much emotional pain, which often is a trigger to pick your skin or hair.

A combination of both psychotherapy and medication is a powerful pairing, and together they can help create a new balance between your emotional and physical states. Some may eventually feel confident enough not to wear their hat or to use less makeup.

Ultimately, the goal is to prevent further damage and to come to terms and acceptance with yourself and your beautiful, unique body.

At the end of the day, it’s all about having self-compassion. We’re so quick to judge ourselves, especially when we know what we’re doing is “bad.” Seeing the scarring or marks on their skin or the baldness in your hair can trigger you to do it even more

The goal here isn’t to be perfect but to commit to a change. It’s not easy, but it is achievable. Over time, incorporating helpful tools and exercises can help replace an unhelpful habit with a more helpful one.

Remember, too, that you are not alone, and that there is treatment for excoriation available. This is a quiet, “hidden” disorder that people are afraid to talk about. We’re starting to see more people bringing their struggles to light and tips and tricks for how to combat them. The more unified we can all be with our goals to achieve a happier, healthier lifestyle, the more confident we can be to achieve them.

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Samantha Mineroff

Samantha Mineroff is a writer, mental health advocate, and aspiring author. In 2018, her paper, “The Rhetoric of Major Depressive Disorder: Performativity and Intra-activity of Emotions in Major Depression” won best seminar paper award at West Chester University of Pennsylvania. At the Poetics And Linguistics Association (PALA) Conference in 2019, she went to The University of Liverpool to present her paper “An Application of Scripts, Schemas, and Negative Accommodation Theory in Leslie Jamison’s The Empathy Exams.” She currently works as a marketing writer for clinical research. She enjoys live jazz, good conversation, and writing letters. You can reach her at sammineroff@gmail.com