Mental Health and Illness

Excoriation (Skin Picking)

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Excoriation disorder, also known as skin picking disorder, is a mental health condition characterized by recurrent and persistent picking at one's own skin that results in skin lesions, tissue damage, and significant distress or impairment in social, occupational, or other areas of functioning. Excoriation disorder is classified as an obsessive-compulsive and related disorder in the DSM-5, which is the diagnostic manual used by mental health professionals to diagnose and classify mental disorders.

 

DSM-5 Diagnostic Criteria for Excoriation Disorder:

A. Recurrent skin picking resulting in skin lesions.

B. Repeated attempts to stop or decrease skin picking.

C. The skin picking causes significant distress or impairment in social, occupational, or other areas of functioning.

D. The skin picking is not due to the direct physiological effects of a substance (e.g., cocaine) or a general medical condition (e.g., scabies).

E. The skin picking is not better explained by symptoms of another mental disorder, such as delusions or tactile hallucinations in a psychotic disorder, attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder, stereotypes in a stereotypic movement disorder, or a focus on aspects of the body in an eating disorder.

 

Psychological Therapy for Excoriation Disorder:

  1. Cognitive-behavioral therapy (CBT): CBT is a type of therapy that helps individuals identify and change negative thought patterns and behaviors. In the case of excoriation disorder, CBT may focus on identifying triggers for skin picking and developing alternative coping strategies.

  2. Habit reversal training (HRT): HRT is a behavior therapy that helps individuals learn to identify and interrupt automatic skin-picking behaviors. HRT involves identifying specific triggers and developing a plan to replace skin picking with a different behavior.

  3. Acceptance and Commitment Therapy (ACT): ACT is a type of therapy that helps individuals accept uncomfortable feelings or sensations and commit to values-driven action. In the case of excoriation disorder, ACT may focus on helping individuals learn to tolerate the discomfort associated with not engaging in skin picking behaviors.

  4. Mindfulness-Based Stress Reduction (MBSR): MBSR is a type of therapy that focuses on developing mindfulness skills to reduce stress and improve overall well-being. In the case of excoriation disorder, MBSR may help individuals learn to identify and manage triggers for skin picking behaviors.

  5. Dialectical Behavior Therapy (DBT): DBT is a type of therapy that combines cognitive-behavioral therapy with mindfulness skills. DBT may be particularly helpful for individuals who experience intense emotions that trigger skin picking behaviors.

 

Self-Help Strategies for Excoriation Disorder:

  1. Identify triggers: Keep a diary to identify when and where you are most likely to engage in skin picking behaviors.

  2. Develop alternative behaviors: Identify alternative behaviors that can help distract you from skin picking, such as holding a stress ball or playing with a fidget toy.

  3. Manage stress: Practice stress management techniques such as deep breathing, meditation, or yoga.

  4. Create a support system: Surround yourself with supportive family and friends who understand your struggles.

  5. Use self-soothing techniques: Find healthy ways to self-soothe, such as taking a warm bath or listening to calming music.

  6. Seek professional help: Reach out to a mental health professional who specializes in treating excoriation disorder.

  7. Set realistic goals: Set achievable goals for reducing skin picking behaviors.

  8. Reward yourself: Celebrate your successes and reward yourself for progress made towards your goals.

  9. Practice self-compassion: Be kind and compassionate towards yourself and avoid self-criticism.

  10. Practice good skin care: Maintain good skin hygiene to reduce the risk of infection and promote healing of any skin lesions caused by skin picking. This may include keeping the affected area clean and moisturized, applying topical treatments as recommended by a healthcare professional, and avoiding further skin damage.

In summary, excoriation disorder is a mental health condition characterized by recurrent and persistent skin picking that results in skin lesions and significant distress or impairment in social, occupational, or other areas of functioning. Psychological therapies such as cognitive-behavioral therapy, habit reversal training, acceptance and commitment therapy, mindfulness-based stress reduction, and dialectical behavior therapy can be effective in treating this disorder. Additionally, individuals with excoriation disorder can use various strategies to help manage their condition, such as identifying triggers, developing alternative behaviors, managing stress, creating a support system, using self-soothing techniques, seeking professional help, setting realistic goals, practicing self-compassion, and practicing good skin care.