COMPULSIVE SKIN PICKING
People with Excoriation Disorder (aka Dermatillomania) pick their skin to the point of causing wounds. They have a tough time stopping in spite of attempts to do so and even though it impacts them negatively. For those with Dermatillomania, picking causes distress or impairment.
As with those who have other Body-Focused Repetitive Behaviors, like Trichotillomania, those with this disorder often find picking to be soothing and satisfying. Thus, while picking may appear to be a form of self-harm, those with Dermatillomania do not, by and large, pick to hurt themselves.
People may also pick to make their skin smooth because they enjoy that feeling and dislike the sensation of uneven skin. Still others who pick are driven by their desire to perfect their skin. They may keep picking at acne or flaws in order to fix them, even when their efforts lead to more damage. Some of those with Dermatillomania pick to manage feelings, like fear or sadness. Others pick to promote focus and quiet the mind. What’s more, Excoriation Disorder is often maintained as a result of associated places and that support picking (e.g. the bathroom mirror) or postures that promote picking (e.g. resting your hand on your chin).
THERAPY FOR EXCORIATION DISORDER
Lauren uses two evidence-based treatments for Excoriation Disorder: The Comprehensive Behavioral Model of Treatment (ComB) and Habit Reversal Training (HRT).
The ComB approach addresses the many reasons people pick. The treatment identifies five domains that trigger picking and uses an acronym to help recall them: SCAMP. SCAMP stands for Sensory, Cognitive, Affective, Motor and Place.
When people pick between sessions, they log the domain(s) involved in the picking. This logging can reveal a number of things about a person’s picking. For instance, a blemish might trigger someone’s urge to pick (Sensory Domain). Some may want to pick when they have thoughts like “Oh, this one has to go!” (Cognitive Domain). Others might pick because they are anxious and want to self-sooth (Affective Domain). Another person might notice that physical touch – like their hands meeting in their lap – leads them to pick (Motor Domain). Others might tend to pick in the bathroom because they have picked in there so often that they now associate it with picking (Place Domain).
Once someone knows which domain triggers the desire to pick, they can support themselves in a way that meets their specific needs. Someone who’s triggered when they feel a blemish might wear tape on their fingers so they don’t get triggered in the first place. Someone who picks in the bathroom might set a timer to alert them in case they get sidetracked picking.
HRT also involves logging. That said, the main intervention, competing response training, is mostly meant to interfere with the ability to pick. In competing response training, people learn to tense their muscles in a way that precludes picking for one minute when the urge to pick arises.
HRT Plus describes HRT with the addition of other approaches. Habit blockers, stimulation replacements and stimulus control are all incorporated into HRT Plus. You can learn more here.
INTERESTED IN THERAPY?
Are you or a loved one struggling with skin picking and looking for help? Lauren use ComB and HRT to support individuals with Excoriation Disorder. You can learn more about the treatments and services she provides here.
Lauren is a licensed psychotherapist in
several states. Learn more about where
Lauren sees Clients, below.
When she is offering face to face, Lauren does in-person therapy in Newport Beach. She also provides online therapy for Excoriation Disorder throughout California. Her Clients span from San Francisco down to Southern Orange County and San Diego.
Lauren provides treatment for Excoriation Disorder in the state of Utah. Since she provides teletherapy, she works with people who live in different areas of the Beehive State – from Salt Lake City and its suburbs, like West Jordan, Syracuse, Highland and Riverton, to Park City and St. George.
Lauren also offers treatment for Excoriation Disorder online in Florida, and sees people from all corners of the Sunshine state. Whether you’re from Naples, Orlando, Miami, or Boca Raton, Lauren can provide specialized counseling remotely in your area.
Lauren also practices teletherapy in Arizona. If you’re seeking help in Phoenix, Sedona, Scottsdale or Tucson, Lauren offers specialized therapy for Excoriation Disorder online across the Grand Canyon State.
In addition to all of the locations previously listed, Lauren offers teletherapy for Excoriation Disorder to a number of countries internationally.
Online therapy isn’t right for everyone. An assessment must be done to determine if online therapy is appropriate for your needs. You can reach out here to learn more.
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©2021 by Lauren McMeikan Rosen, LMFT.
Disclaimer: The information contained on this website is intended for informational and education purposes only and is not meant to be a replacement for therapy. If you are interested in treatment, you can email me and I will happily provide you with more information