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If you have a problem with picking at wounds and injuries on your skin, you may be suffering from dermatillomania. It's a challenging condition, but it can be treated. Here we explain what it is and how you can get help.

What is Dermatillomania?

Dermatillomania is a problem of compulsive repetitive picking at one’s own skin, resulting in damage and wounds. The condition usually occurs in adolescence or young adulthood, but can also occur later in life and the problems are often exacerbated by various forms of stress. Behaviors can lead to feelings of shame that may prevent people from seeking help, but it can be treated.

Causes of dermatillomania

There are several reasons why people can develop dermatillomania. Research shows that both genetic and environmental factors contribute to the problem. Dermatillomania has a similar cause to trichotillomania, where hairs are pulled away from the body.

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Dermatillomania diagnosis

To find out if you have dermatillomania, you can answer some screening questions to get an idea of whether you need to seek help: “Do you pick, scratch, poke, pick or otherwise damage your skin? Do you do it often? Have you tried not to do it without success? Does it become a problem for you?” If you answered yes to these questions, you may want to seek help.

A study published in Psychology Today Ireland notes that “Excoriation disorder is relatively rare but is thought to affect up to 1.4 percent of the total population. Approximately 75 percent of those diagnosed with the disorder are female.” There are currently no studies on how common it is in children and adolescents, but the problem is also present in this population. It is also common to have other psychological conditions such as anxiety, depression, dysmorphophobia, obsessive-compulsive disorder, eating disorders and bipolar syndrome at the same time as dermatillomania. If you have somatic conditions like scabies or itching, you won’t get a dermatillomania diagnosis.

Dermatillomania and self-harm

Many people who have self-harming behaviors can also pick and scratch their body, but the purpose is to hurt themselves, so it is a little different from dermatillomania. Self-harm is not diagnosed as dermatillomania, but it is still important to seek help so that you can get treatment for your symptoms.

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Symptoms of dermatillomania

Dermatillomania involves compulsive picking at different parts of the body, such as the face, hands, nails, feet, arms, upper body or gender. Picking can be done consciously, i.e. there is a ‘need’ to do it, but it is also common to pick without thinking about it. This can lead to sores and injuries that are then picked at. Some of the symptoms of dermatillomania are:

  • Picking, scratching, poking, prodding, prodding or damaging the skin.
  • They have tried to reduce or stop and experience suffering and/or impairment.
  • If you have anxiety and stress, you may feel relief from picking.
  • Picking can be unconscious or conscious. Often it does not occur when others are present except with the family.
  • They may look for a particular scab to pick. Many people also examine, play with or swallow skin after it has been picked. Since people often pick in the same place, this can result in skin problems.
  • This behavior can affect daily activities and function. It can also lead to feelings of shame and guilt, as well as social withdrawal.

If you recognise the symptoms of dermatillomania, you may want to seek help. For milder symptoms, we have psychologists at Lavendla who can help you. If you have more severe problems, it is good to seek help via specialist psychiatry. Below you can read more about what treatment for dermatillomania means.

Treatment for dermatillomania

The most effective treatment for dermatillomania is a form of therapy called Habit Reversal Training (HRT). HRT seeks to find alternative behaviors to skin picking. In short, the treatment involves first making the client aware of when they are picking skin (mindfulness training). Then the client is taught an action (countermovement) that is physically incompatible with skin picking (for example, clenching their fists). For best results, family members are also given information on how to help the client if they pick. In the case of dermatillomania, it is also important to follow up the treatment and ensure that the results are good in the long term.

HRT treatment consists of three parts:

  1. Consciousness training
  2. Counter-movement training
  3. Social support.

Dermatillomania is a condition that comes in different degrees of severity, from mild to moderate to severe. For milder problems with skin picking where you do not experience such great suffering and/or have reduced function, you can go into treatment with a licensed psychologist or CBT therapist. If you have more severe problems, you should primarily be treated in specialist psychiatric care and then you can go to your health center to get a referral. If you have somatic problems as a result of skin picking, such as infections or other injuries, you can seek help from doctors and nurses. In terms of medical treatment with drugs, there is not yet enough research to make a recommendation.

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Seeking help can change your life

Dermatillomania is something you may need help to overcome. Talking to a licensed psychologist or psychotherapist can not only help you understand your condition better but also offer effective ways to manage it. You are not alone and it is okay to ask for help. On our website, we have qualified therapists and psychologists who are happy to help you get out of compulsive behaviors.

Common misconceptions about therapy

Many people think that therapy is only for ‘serious’ problems or that seeking help is a weakness. In both cases, these are misconceptions. Rather, therapy is a step towards improvement and we make the hard stuff easier by connecting you with licensed psychologists and therapists online and onsite.

Your next step

If you or someone you know is struggling with compulsive behaviors, it’s a good idea to talk to a professional therapist or psychologist. We assure you that all therapists and psychologists on our platform are qualified and that your conversation is always confidential. Don’t be afraid to take the first step.

Living with dermatillomania can be a daily struggle but there is help available. With the right support and tools, you can significantly improve your quality of life. If you are ready to take the plunge, we are here to support you. Book your first session today and start your journey towards a better future.

12 frequently asked questions about dermatillomania

What is dermatillomania?

Dermatillomania is a problem of compulsive repetitive picking at one’s own skin, resulting in injuries and wounds.

How is dermatillomania diagnosed?

A diagnosis of dermatillomania is usually made by a licensed psychologist or psychiatrist through various tests and assessments. This may include questionnaires and clinical interviews.

Is dermatillomania hereditary?

Research shows that dermatillomania may have a genetic component but it is not the only factor. Environment also plays a role, as well as stress and anxiety.

What are the symptoms of dermatillomania?

In dermatillomania, people may compulsively pick at different parts of the body, such as the face, hands, nails, feet, arms, upper body or gender. The picking may be conscious, i.e. there is a ‘craving’ to do it. It is also common to jerk or pick without thinking about it.

How is dermatillomania treated?

Treatment can include Cognitive Behavioral Therapy (CBT) with specific habit reversal training (HRT), which has been shown to be particularly effective.

Is there a cure for dermatillomania?

With the right treatment, symptoms can be managed and quality of life significantly improved. It is important to monitor results over time.

Can children get dermatillomania?

Yes, children and teenagers can also be affected. It is important to seek professional help as soon as possible for the best possible treatment outcome.

How common is dermatillomania?

About 1-5% of the Irish population have some form of dermatillomania.

Does dermatillomania affect my ability to work?

Yes, in severe dermatillomania it can affect functional capacity. However, it is possible to return to normal function with proper treatment.

Is dermatillomania more common in women or men?

Research has shown that dermatillomania is more common among women.

Can you have other problems at the same time as dermatillomania?

It is also common to have other psychological conditions such as anxiety, depression, dysmorphophobia, obsessive-compulsive disorder, eating disorders and bipolar syndrome. It is important to have an assessment by a licensed professional.

Where can I go if I need help?

At Lavendla, we have experienced psychologists and therapists working with CBT who can help you feel better if you have mild symptoms. If you have more severe symptoms, you can contact your health center to get a referral to a specialist psychiatrist. If you have thoughts of self-harm or suicide, contact 112 or the nearest emergency room.

What does treatment for dermatillomania involve?

Seeking help is a big step towards better health, it’s a positive thing to decide to take control of how you feel. Here is an overview of the steps typically involved in CBT treatment.

Step 1: An initial assessment session

The first meeting with your psychologist or therapist is an assessment to review your mental and physical health. You may be asked questions about your life situation, feelings, thoughts and behaviors. You may also be asked to complete assessment forms.

Step 2: Goal setting

This is where you and your therapist set concrete goals for the therapy, both short and long term.
It can define which areas of your life are most affected by your wellbeing and how you would like to change them.

Step 3: Treatment with different techniques and tools

This is the start of the actual treatment phase, which involves exercises aimed at giving you tools to overcome and work through the problem you are suffering from. Habitual reversal training (HRT) is often used to find alternative behaviors for dermatillomania.

Step 4: Monitoring and evaluation

Treatment is monitored regularly to see how well the therapy is working. If necessary, the treatment plan can be adjusted or renewed.

Step 5: Ending and looking ahead

As the therapy comes to an end, it is time to reflect on the progress made. You will also receive a maintenance plan for how to use the tools and strategies you have learned in the future. It is also important to monitor the results over time.

If you or someone close to you is looking for professional help, don’t hesitate to book a session with one of our licensed psychologists or therapists.

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Written by Ellen Lindgren

Licensed psychologist

Ellen is a licensed psychologist and has experience mainly in clinical psychology where she has worked with various conditions such as stress, anxiety, depression, insomnia, crises and trauma in primary care and psychiatry. She has also worked with research while studying in the US and with affective disorders and insomnia at Karolinska Institutet, Sweden.