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 person with CSP 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 person with CSP 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 (TTM). In fact research has shown that around a quarter ofthose 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 person with CSP 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.

Usually the behaviour takes the form of an extensive cleaning ritual (Van Moffaert,1992), and the aim is to remove irregularities on the skin such as moles, blemishes,scabs and dry skin. This is done using fingernails and/or small, sharp implements such as tweezers or pins. It can lead to bleeding, bruises, infection and or permanent disfigurement. Skin picking is done in the hopes of a clear complexion but sadly often more damage is done and people end up looking much worse in spite of their efforts. It can become a vicious cycle that is hard to break – the skin irregularity e.g. pimple, insect bite that is picked causes scabbing which is in turn picked at and so it goes on. In severe cases the habit is uncontrollable and may turn into an urge to dig deep into the skin. CSP has many similarities with OCD – it is repetitive, ritualistic and temporarily relieves tension.

The compulsive and self destructive quality of the behaviour also resembles nail biting and Trichotillomania (TTM). CSP most commonly begins in the early teens though it can start at a much younger or older age. CSP may well have an underlying genetic cause There are two types of picking that can occur: automatic and focussed. You may well experience both at different times.
CSP Symptoms include:

Recurrent skin picking (people pick different parts of the body, most commonly the face but other areas include feet, hands, arms, scalp, hands).
A build up of tension, a strong itch or urge which can only be relieved by picking.
Pleasure, gratification, tension decrease and relief when skin picking.

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