Obsessive Compulsive Disorder (OCD) is the name given to a condition in which people experience repetitive and upsetting thoughts and/or behaviours. OCD has two main features: obsessions and compulsions.

Obsessions are involuntary thoughts, images or impulses. Common obsessions include, but are not limited to, fears about dirt, germs and contamination; fears of acting out violent or aggressive thoughts or impulses; unreasonable fears of harming others, especially loved ones; abhorrent, blasphemous or sexual thoughts; inordinate concern with order, arrangement or symmetry; inability to discard useless or worn out possessions; and fears that things are not safe, (e.g. household appliances). The main features of obsessions are that they are automatic, frequent, upsetting or distressing, and difficult to control or get rid of.

Just as with obsessions, there are many types of compulsions. It is common for people to carry out a compulsion in order to reduce the anxiety they feel from an obsession.

Common compulsions include observable actions such as excessive washing and cleaning, checking, repeatedly touching, counting, arranging and ordering, hoarding, ritualistic behaviours that lessen the chances of provoking an obsession (e.g. putting all sharp objects out of sight) and acts which reduce obsessional fears (e.g. wearing only certain colours).

Compulsions can also be mental rituals that are not observable. These include repeating words or phrases, counting, or saying a prayer. Again, not all types of compulsion are listed here. The main features of compulsions are they are repetitive and stereotyped actions that the person feels forced to perform.

People can have compulsions without having obsessional thoughts but, very often, these two occur together. Carrying out a compulsion reduces the person’s anxiety and makes the urge to perform the compulsion again stronger each time.

Almost everybody experiences the type of thoughts that people with OCD have (e.g. wanting to double-check the front door or the gas). However, most people are able to dismiss these thoughts.

People with OCD cannot ignore unpleasant thoughts and pay undue attention to them. This means that the thoughts become more frequent and distressing and, over time, they can affect all areas of a person’s life, often their job and their family and social life. A person with OCD can, however, appear to function perfectly normally despite being greatly distressed. This often makes it possible for people with OCD to hide their OCD (because of this, OCD has often been called the ’secretive disorder’).

It is important to remember that severity of OCD differs markedly between people but each person’s distress is very real. People with OCD are not ‘mad’ or dangerous and do not carry out their unpleasant thoughts. Most people with OCD know that their thoughts are excessive or irrational but the anxiety they feel makes the thoughts difficult to ignore.

OCD is much more common than was previously thought. Prevalence estimates suggest that 2-3 per cent of the UK population has OCD. One reason why the prevalence of OCD has been underestimated in the past is that people with OCD are often afraid to seek help. They worry that other people will think they are mad, and often do not know that their disorder is a recognised condition with effective treatments. Young people also suffer from OCD. In fact, many adults with OCD had symptoms in childhood.

The cause of OCD is much debated but it is likely to result from a combination of factors in addition to this the cause for one person may differ from that for another. OCD can run in families and, in some cases, may be associated with an underlying biochemical imbalance in the brain.

Psychological factors such as susceptibility to stress or exposure to an emotionally traumatic experience are also likely to be in evidence. The good news is that, for the majority, OCD can be effectively controlled and treated.

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.