Stress can bring about many different reactions and behaviors, from agitation to drinking and smoking to binge eating. However, certain coping mechanisms can be harmful when dealing with stress; one such practice is dermatillomania.

Dermatillomania is a condition involving those who habitually and compulsively pick at their skin as a response to stress or discomfort. The practice can result in harm to the body and can lead to scarring, scabbing, and infections. There are those that believe it’s a form of self-harm and therefore its mental health condition. ¹

Throughout this article, we’re going to explore dermatillomania and understand the best ways to identify it and stop it. 

Dermatillomania Symptoms

Skin picking may seem an innocuous way to handle stress at first. However, repeated practice can create real damage to the body.

Understanding the warning signs and risks creates can better aid in responding to the harmful behavior in an apt fashion. The most common symptoms are: ²

• Unconscious poking, prodding, and peeling of the skin, sores, or scabs
• Scratching or picking at freckles, acne, scars, or moles in order to “perfect” the skin’s look or feel
• Agitating the skin during sleep 
• Causing undue harm to the skin through the picking resulting in bruising, bleeding, cuts, or tearing 

How is Dermatillomania Related to OCD?

Given the consistent behavioral pattern and need for “perfection” tied to dermatillomania, many have wondered if this practice is somehow tied to obsessive-compulsive disorder (OCD).

While it’s true that dermatillomania is an impulse control disorder, that is not to say that those with dermatillomania have OCD. In the same vein, it’s also true that those with OCD may not exhibit signs of dermatillomania. Instead, they may show symptoms of other body-focused repetitive behaviors, such as trichotillomania, a disorder of pulling out hair. ³

Still, it’s more common for those with OCD to exhibit signs of dermatillomania. Namely, as a response to stress as they develop trichotillomania as a behavioral response.

The best thing to do in regards to dermatillomania is reach out to a mental health practitioner for proper evaluation. 

What Causes Dermatillomania?

The main cause of dermatillomania is stress – thus it can arise in many kinds of people. However, it’s true that those with a psychological disorder already may have this behavioral response.

Most often it’s seen in those who have been diagnosed with OCD or an anxiety disorder. Large amounts of stress can trigger a long or bad dermatillomania episode. Especially in those where the only adequate response is to pick at the skin.

Picking at the skin may seem strange to those that don’t have such a behavioral response. However, for those that suffer from it, it is a form of control over an uncontrollable situation. ⁴

Still, it would be false to state that skin picking only arises as a response to stress. Those on psychoactive drugs such as methamphetamine and cocaine often have dermatillomania tendencies. ⁵

How is Dermatillomania Diagnosed?

Diagnosis for dermatillomania is done through an evaluation with a healthcare provider who will discuss with the patient the symptoms and look for signs of external damage to the skin. More so, if there are apparent breaks in the skin, infections, and scarring.

From there it is common for a physician to refer the patient to psychological services such as a therapist for behavioral modification and a psychiatrist for medication treatment. ⁶

Dermatillomania Treatment

For those that struggle with this phenomenon, the most obvious question is: How do you stop dermatillomania? Treating skin picking isn’t as simple as ceasing the activity – dermatillomania is a compulsion, a way of gaining control over an uncontrollable situation. 

The way to stop isn’t merely to stop but rather to identify why there’s a need to pick and treat the underlying triggers that spur the picking in the first place. This process often involves a multifaceted approach through a combination of therapy and medications to reach the optimal result. 

Medication

The approach for medicating a dermatillomania patient is to utilize SSRIs, a form of antidepressant that increases serotonin within the brain. The belief behind this is that by providing serotonin, the brain won’t be in such an agitated state that brings about skin picking.

Common SSRIs like Prozac, Zoloft and Lexapro have yielded positive long-term results, especially when paired with behavioral coaching and therapy. ⁷ 

Psychotherapy

Due to dermatillomania being a stress response, the obvious conclusion is to understand what is triggering the stress. Triggers can be a multitude of things, ranging from everyday complications to the impact of long-term trauma.

The best way to address and assess these triggers is through talk therapy. Talk therapy can take multiple different forms. However, all of them consist of sitting down with a mental health professional and having open, honest, and vulnerable discussions. Through these discussions, a therapist has the ability to adequately address mental health issues. 

One of the most beneficial therapies that can alleviate dermatillomania is cognitive behavioral therapy (CBT). This avenue of psychotherapy is finding ways to identify a potential trigger and modify the resulting reaction to said trigger.

It may seem simple, however continual therapy and monitoring show great promise in reducing and finally ceasing the repeated behavior. Studies have shown that CBT can reduce symptoms of dermatillomania and with a comprehensive treatment plan of CBT, medication, and even group therapy sessions, those results can be strengthened for long-term prognosis. ⁸

How to Cope with Dermatillomania

There isn’t one way to properly cope with dermatillomania. However, certain practices that are coached through CBT can ease the severity of dermatillomania.

Medications and sticking to the schedule of taking the meds for consistency can also calm the urge to pick. Practicing hobbies, and activities to do as a replacement can take the mind off of default behavior such as skin picking. 

There is also a benefit in distraction through sensory activities such as utilizing touch toys to keep the hands busy and creating a self-care routine that natures the body rather than harming it.

Hands-on activities such as gardening or weeding can mimic some of the same maneuvers as skin picking but put that energy towards something outwards productive that isn’t harmful to the body. The TCL Foundation for Body-Focused Repetitive Behaviors has a great list of alternative activities and coping mechanisms that can aid in not only distracting from skin picking but can also help in tackling the issue head-on. 

Final Word

Stress can be burdensome, it can create a swelling of anxiety, retention, and agitation. While it’s important to relieve stress as too much of it can be destructive it is equally important to handle stress in a responsible and healthy fashion.

Harmful techniques such as dertamillomania are not a long-term beneficial way to try and decompress. As we have learned, dertamillomania is recognized as a mental health disorder and should be treated as such.

So, if you or a loved one is exhibiting signs of dertamillomania, it is vital to create a safe environment to discuss the practice and be able to find ways to treat it.

Your Questions

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We invite you to ask them in the comments section below. If you have any further knowledge to share – whether personal or professional – we’d also love to hear from you.

Reference Sources 

¹ Cleveland Clinic: Dermatillomania Definition

² National Health Services UK: Dermatillomania Symptoms

³ International OCD Foundation: Is Dermatillomania Related to OCD? 

⁴ DermNet: Cause of Compulsive Skin Picking

⁵ AsanaRecovery: Drugs That Cause Skin Picking

⁶ Mental Health America: Excoriation Diagnosis 

⁷ TCL Foundation for Body Focused Repetitive Behaviors: Dermatillomania Medications

⁸ National Institute of Health – Clinical Trials: Treating Skin Picking With Cognitive-Behavioral Protocol in Individual and Group Format