What is Compulsive Skin Picking?

The primary characteristic of Compulsive Skin Picking (CSP) is the repetitive picking at one's own skin to the extent of causing bleeding or damage to the skin to relieve anxiety or urges.

Skin-picking is often preceded by a strong itch or urge, which the sufferer believes can only be relieved by picking. Then, of course, a feeling of depression or hopelessness follows when the damage caused by the picking is realised. Paradoxically a kind of compulsive perfectionism may convince the sufferer at the time that picking is a necessary means to achieving a clear complexion. In this way a vicious circle arises that is hard to break.

Thus CSP may be seen to have obsessive-compulsive aspects that are similar to OCD, Body Dysmorphic Disorder (BDD) and trichotillomania. In fact research has shown that around a quarter of those diagnosed with OCD or BDD also have CSP. CSP is thus sometimes described as an Obsessive Compulsive Spectrum Disorder, along with, for example, BDD, eating disorders such as anorexia nervosa, and movement disorders such as Tourette’s Syndrome (TS).

Skin-pickers often feel the need to camouflage their blemishes with make-up or cover bad areas with clothing. Social embarrassment can lead the sufferer to stay indoors, avoid friends, be late for work as their picking and make-up routine takes so long, or even to take sickness leave from work when their skin is in a very bad state.

What treatment is available?
The best advice initially is to consult your GP. Many sufferers are very embarrassed by their symptoms and not all doctors are well-informed, so one idea would be to write down your problem, without minimising it, or print out this webpage for your doctor to read.

Very often patients are referred first of all to a dermatologist, which may be appropriate if there is a skin disorder that needs treating but may also delay treatment of the compulsive psychological element.

There is evidence that skin-picking may be caused by biological factors such as brain structure and you may be prescribed serotonin enhancing drugs such as Prozac or one of the other SSRIs. This may be augmented with one of the neuroleptics, for example Risperdal, as these often suppress the tic-like behaviour that may be involved in picking.

The second and very important treatment for Compulsive Skin-Picking is Cognitive Behavioural Therapy (CBT). If your case is severe you may be referred to a trained therapist who will teach you a technique of CBT called Habit Reversal.

Habit Reversal was developed in the 1970s by psychologists Nathan Azrin and Gregory Nunn for treating nervous habits such as tics, stammering and skin-picking which are done automatically. Therapy should focus initially on developing Habit Awareness and patients may be asked to keep records of when, where and under what circumstances they normally pick.

Many people believe that if they stop one bad habit it will be replaced with another bad habit. However, one of the key ideas of habit reversal is to replace the harmful habit with another harmless habit that makes the bad habit impossible. This new behaviour is known as a competing response.

A suitable competing response for skin-picking might be clenching one's fist, as this is incompatible with skin-picking. Another important part of habit reversal training is practising a suitable method of relaxation such as meditation, abdominal breathing or progressive muscle relaxation.

Successful CBT will also involve stimulus control. Once the sufferer has identified the particular environmental factors or mood states that lead to picking, steps can be taken to deal with such triggers. For instance this might mean avoiding or covering mirrors or challenging automatic thoughts and emotions connected with picking and replacing them with less negative responses.

Further ideas on breaking the habit of skin-picking:

Source: This article was written for OCD Action by Louise with the assistance of Dr James Claiborn co-author of The Habit Change Workbook.