Overview
Dermatillomania, also known as excoriation disorder or skin-picking disorder, is a mental health condition where individuals compulsively pick or scratch their skin, leading to injuries or scarring. Classified under obsessive-compulsive disorders (OCDs), dermatillomania can significantly impact a person’s mental health, well-being, and quality of life (DermNet NZ, 2024; Mayo Clinic, 2024).
Defining Dermatillomania
Dermatillomania (pronounced derm-ah-till-oh-main-ee-ah) derives from three Greek words:
- Derma: Skin.
- Tillo: Pulling or picking.
- Mania: Excessive behavior or activity.
Individuals with dermatillomania exhibit repetitive skin-picking behaviors, often resulting in open sores, bleeding, and scarring. This condition can target normal skin variations like freckles and moles, pre-existing defects such as scabs, sores, acne, or even imagined imperfections. The compulsive nature of this disorder can involve using fingernails, teeth, or tools like tweezers and pins.
Symptoms and Self-Identification
Many people occasionally pick at their skin, but dermatillomania is characterized by the inability to stop, causing significant damage and emotional distress. Key indicators include:
- Persistent skin picking resulting in cuts, bleeding, or bruising.
- Picking at moles, freckles, or scars in an attempt to “smooth” them.
- Unconscious picking behaviors, especially during periods of stress or anxiety (Cleveland Clinic, 2024).
Coping Strategies and Self-Help
Individuals with dermatillomania can try several strategies to manage their condition:
- Keeping hands busy with objects like stress balls or by wearing gloves.
- Identifying and avoiding triggers that lead to picking.
- Gradually increasing the time they resist the urge to pick.
- Caring for the skin by applying moisturizers and keeping it clean to prevent infections.
Professional Treatment
If self-help strategies are ineffective, professional treatment may be necessary. A general practitioner (GP) can evaluate the condition and refer individuals to specialists for further diagnosis and treatment, which may include talking therapies and medication.
Differences Between Dermatillomania and OCD
While dermatillomania is classified under OCDs, there are key differences:
- Obsessions: OCD involves uncontrollable, unwanted thoughts or urges, which are not present in dermatillomania.
- Feeling of Reward: Individuals with dermatillomania often feel relief or positive emotions after picking, unlike those with OCD.
- Damage: Self-injury is common in dermatillomania but rare in OCD.
Demographics and Prevalence
Previously thought to be more common in women, recent studies indicate that approximately 55% of those affected are women, who are also more likely to seek treatment. Dermatillomania often begins during puberty but can occur at any age and is more prevalent among individuals with conditions like acne or eczema.
Physical and Mental Health Effects
Dermatillomania leads to compulsive skin picking, which can be either automatic (unconscious) or focused (deliberate). This behavior often targets accessible body parts such as the face, scalp, neck, hands, and arms. Severe cases can result in extensive skin damage, potentially requiring surgical interventions like skin grafts. Infections from wounds may spread, leading to life-threatening conditions like sepsis.
Psychological Impact
The visible injuries caused by dermatillomania often lead to feelings of embarrassment and shame, prompting individuals to hide their scars with clothing or makeup. This condition can contribute to anxiety, depression, and social isolation, adversely affecting work and social life.
Causes and Associated Conditions
The exact causes of dermatillomania are unclear, but potential factors include:
- Genetics: A higher likelihood of the condition among those with a family history.
- Brain Structure: Differences in brain areas controlling habits and learning.
- Psychological Factors: Stress, anxiety, and other mental health conditions may trigger skin-picking behaviors.
Diagnosis and Tests
Diagnosing dermatillomania involves meeting several criteria:
- Ongoing or repeated skin picking.
- Multiple attempts to reduce or stop the behavior.
- Significant negative impact on life due to the behavior.
- The behavior is not attributable to another medical or mental health condition.
Treatment Approaches
Effective treatment for dermatillomania typically combines medication and therapy:
- Medications: Antidepressants (SSRIs), anticonvulsants, antipsychotics, and nutraceuticals like N-acetylcysteine.
- Therapies: Habit reversal therapy, cognitive behavioral therapy (CBT), acceptance and commitment therapy, and group support.
Complications and Self-Care
Severe skin damage from dermatillomania may require medical treatment, including surgery and antibiotics. Managing symptoms involves seeking professional diagnosis and treatment, as self-diagnosis and treatment are not recommended.
Conclusion
Dermatillomania is a serious mental health condition requiring comprehensive treatment involving both medication and therapy. Understanding its symptoms, causes, and treatment options is crucial for managing this disorder effectively and improving the quality of life for those affected.
References
DermNet NZ. (2024). Skin Picking Disorder (Dermatillomania). Retrieved from https://www.dermnetnz.org
Mayo Clinic. (2024). Excoriation (Skin-Picking) Disorder. Retrieved from https://www.mayoclinic.org
Cleveland Clinic. (2024). Dermatillomania: Causes, Symptoms & Treatment. Retrieved from https://www.clevelandclinic.org
NHS. (2024). Skin Picking Disorder. Retrieved from https://www.nhs.uk
