Compulsive Skin Picking (CSP)

Compulsive Skin Picking (CSP) or Dermatillomania is a habit disorder where a person repeatedly picks at their own skin, to the point where this causes damage to the skin. Picking can be done using fingers, fingernails, teeth, or sharp implements, such as tweezers or pins and can lead to bleeding, bruises, infection, and permanent disfigurement. People with CSP may or may not realise when they are skin-picking; lots of people with CSP have times when they are aware of skin-picking behaviour and times when it is automatic. However, lots of people with CSP find they are more likely to pick their skin if they feel anxious or stressed. Skin picking is often preceded by a strong itch or urge which the person with CSP believes can only be relieved by picking. The picking helps sufferers to relieve tension in the short term, but after the initial reduction in anxiety, the sufferer can feel depressed, hopeless, and unattractive, due to the damage caused to their skin.

People with CSP can pick the skin on different parts of their body. It is most common for skin picking to be carried out on the face but other areas include feet, hands, arms, back and scalp. A kind of compulsive perfectionism may convince the person with CSP that picking is a necessary means to achieving a clear complexion. However, in reality the skin picking leads to worse skin and then even more picking to try to fix it, causing the sufferer to become trapped in a vicious cycle. CSP can sometimes go alongside Obsessive Compulsive Disorder (OCD), Body Dysmorphic Disorder (BDD) and Trichotillomania.

People with CSP often engage in safety behaviours and avoidance strategies to avoid anxiety regarding their skin. For example, they may feel the need to camouflage their blemishes with make-up or cover bad areas with clothing. Worries about social judgement can lead the person with CSP to be late for school or work as their picking and make-up routine may take some time. Moreover, a person with CSP may stay indoors, avoid friends, or take sick leave from school or work because of their worries about their skin.

CSP is a treatable illness with the right help and hard work. The recommended treatment is called Cognitive Behaviour Therapy (CBT). This often includes working out what the triggers to skin-picking may be, so that these can be managed in a more helpful way (e.g. someone who picks their skin when they’re stressed may try exercise or meditation to ease the stress instead).  It also often involves helping the person with CSP to resist the urge to pick gradually, building up how long they can last without picking each time. It might just be a few minutes the first time but it’s all a step in the right direction. Treatment may also include elements of habit reversal therapy, where the person tries to find other things to do with their hands to prevent them picking.

A good first place to start in accessing treatment is to ask your GP to refer you to the Community Mental Health Team (CMHT) or the Children & Adolescence Mental Health Service (CAMHS) if you’re under 18. Your GP may also suggest you self-refer through an NHS service called IAPT which provides short courses of psychological therapies, like CBT. Unfortunately, we can’t provide treatment at OCD Youth but we have a helpline and peer support groups that can support you throughout your recovery.



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