Excoriation Disorder

EXCORIATION DISORDER

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

At The Center for the Obsessive Mind, we use two evidence-based treatments for Excoriation Disorder: The Comprehensive Behavioral Model of Treatment (ComB) and Habit Reversal Training (HRT).

ComB

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

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? Therapists at the Center for the Obsessive Minduse ComB and HRT to support individuals with Excoriation Disorder. You can learn more about the treatments and services we provide here.