Skin Picking Disorder
Excoriation (Skin Picking Disorder) is characterized, as the label implies, by repetitive and compulsive picking of the skin, leading to tissue damage. Many people pick their skin on occasion without any serious damage to their skin or any distress or impairment, but for somewhere between 1% and 5% of the population, noticeable damage to skin occurs, sometimes requiring medical attention. There can be significant embarrassment, distress and impairment in terms of social and work functioning. In one case one woman spent 2 to 3 hours day picking her skin, resulting in numerous scabs, scars and open wounds on her face. As a result, she had not socialized with friends for over a year. Excoriation is also largely a female disorder.
Psychological treatments, particularly an approach called “habit reversal training” has the most evidence for success with this disorder. In this treatment patients are carefully taught to be more aware of their repetitive behavior, particularly as it is just about to begin, and to then substitute a different behavior, applying a soothing lotion to the skin, or some other reasonable pleasurable but harmless behavior. Results may be evident in as little as four sessions, but the procedure requires teamwork between the patient and therapist and close monitoring of the behavior throughout the day. Drug treatments, mostly serotonin- specific reuptake inhibitors, hold some promise, but the results have been mixed with excoriation.
David H. Barlow, BOSTON UNIVERSITY
V. Mark Durand, UNIVERSITY OF SOUTH FLORIDA- ST. PETERSBERG
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