FAQs for Skin Pickers

FAQs for Skin Pickers

Over the years I’ve been asked many questions about excoriation disorder and other body-focused repetitive behaviors (BFRBs), along with details into my recovery. Here you can find the answers to the questions I get asked most often and ones that show up frequently in forums:

About Dermatillomania

Is there a cure for compulsive skin picking?

Similar to other mental health conditions, there is no cure for excoriation disorder. Psychotherapy combined with a variety of strategies can help a skin picker learn to manage urges and achieve a state of recovery.

Where can I get help?

The TLC Foundation for BFRBs has a global database of mental health professionals knowledgeable about BFRBs, many who have completed the training course from their Professional Training Institute (PTI) and are listed as graduates.

What medication is prescribed for excoriation disorder?

The most commonly prescribed type of medications for compulsive skin picking are Selective Serotonin Reuptake Inhibitors (SSRI’s), also known as anti-depressants, though studies have shown that SSRI’s may aggravate excoriation disorder. Psychiatrists and other qualified healthcare professionals may recommend low doses of second generation antipsychotic medication, anticonvulsants, or sleeping aides to treat chronic skin picking.

FAQs for Skin Pickers

In 2016, top BFRB researcher Dr. Jon E. Grant published a double-blind study on N-Acetyl Cysteine (NAC) for skin picking, concluding that significant improvements were observed in 12 weeks with those taking NAC versus the placebo group. His 2009 study using NAC for trichotillomania yielded a 56% success rate; with BFRBs being closely linked, research into trichotillomania is beneficial for skin picking. However, these studies are limited to under 100 participants and they only examine the short-term benefits of NAC.

NAC is an amino acid that increases levels of glutathione. It protects against oxidants by recycling vitamin C and vitamin E. In the high doses needed for the off-label pharmacological treatment of excoriation disorder, it is important to increase your intake of vitamin C through diet and supplementation to prevent kidney stones.

Consult a qualified professional before making medication changes or adding supplements to your regimen.

FAQs for Skin Pickers
A mutated SLITK1 gene was found in those with trichotillomania

Is skin picking genetic?

With excoriation disorder being a new condition in the most recent Diagnostic Statistical Manual for Mental Health Disorders (DSM-5) edition, more research needs to be done to determine a genetic link in skin picking. Trichotillomania research has discovered a mutated SLITK1 gene among hair pullers in 44 families, while their family members did not have the mutation. However, researchers believe that the gene only accounts for 5% of all trichotillomania cases.

Is dermatillomania a real medical condition?

Excoriation disorder was added to the DSM-5 under the Obsessive-Compulsive and Related Disorders category in May of 2013. In its previous version (DSM-IV), skin picking was listed as an Impulse Control Disorder Not Otherwise Specified (NOS).

The 10th edition of the International Classification of Diseases (ICD) includes excoriation (skin-picking) disorder, using the code F42.4. The current draft for the ICD-11 lists excoriation disorder under Body-Focused Repetitive Behaviour Disorders, a sub-category of obsessive-compulsive or related disorders, using the code F6B25 in the broader Mental, Behavioural or Neurodevelopmental Disorders category.

How can I find community support?

There are plenty of ways to find support from others who understand what you’re going through. There are various social media and independent forums that offer a place to talk about your disorder and read about others’ experiences.

If you’re interested in attending peer support meetings, there are many groups available based on geographical location along with ones based on age, gender, and more.

What fidget toys are best for skin picking?

With so many fidget toys to choose from, it can be hard to figure out which ones are right for you. While individuals have varying sensory needs and preferences based on which toy works in different situations, my recommended fidgets for skin picking can be found here along with information on where you can try out a variety of them to find what works best for you.

Is skin picking a form of self-harm?

No. One of the greatest misconceptions about skin picking is that it is self-harm because it can cause physical damage to the skin. However, the intention behind the behavior is not to cause pain or bodily harm; it’s a compulsive disorder that brings psychological relief. Skin pickers can dissociate from the pain when they’re in a “trance-like state” when they engage in the behavior and are often ashamed of the visible markings left behind.

What can I use to heal my skin quicker?

With so many products promising to heal a scab, it can be difficult to figure out what type of aftercare is best after a fresh pick-session. Natural products are important in avoiding breakouts caused by perfumes or strong chemicals. Found in many diluted and overpriced products, vitamin e oil alone hydrates skin, reduces redness, and minimizes the appearance of scars.

If you want to heal an open wound, first clean it with rubbing alcohol (or soap and water) and let dry. Apply an ointment with an antibiotic, such as Polysporin, to prevent an infection. When you’re finished, place a pimple patch or band-aid on it as a barrier to avoid being triggered by the healing process.

FAQs for Skin Pickers
Skin Picking is NOT

Is it normal to eat my scabs?

Approximately 1 in 4 skin pickers have scab eating disorder, a BFRB aptly named for its description of ingesting scabs or remnants of skin after a picking episode. While it is not formally diagnosed in the DSM, scab eating disorder is believed to share the compulsive trait of BFRBs. Unlike the trichotillomania equivalent of ingesting hair, trichophagia, which can cause life-threatening trichozeboars, scab eating is not physically dangerous but can cause additional shame for those with this disorder.

Where can I get reliable information to educate my therapist?

You can find the most up-to date research and information about excoriation disorder at the TLC Foundation for BFRBs (TLC), based in California, USA. TLC fosters the largest professional network of BFRB specialists, providing a training program for professionals to get trained in the treatment of BFRBs.

Other non-profit organizations who disseminate accurate information about skin picking and other BFRBs are Picking Me Foundation (Chicago, USA), and the Canadian BFRB Support Network (Ontario, Canada).

How do I get my spouse to understand?

Discussing dermatillomania with a romantic partner (or potential) can be extremely challenging out of fear of rejection, shaming, or a simple lack of understanding of this compulsion. Each relationship dynamic is different, but a healthy one is based on trust, communication, and empathy.

It is important to establish boundaries, talk about your feelings, and listen to your partner’s concerns so that both people feel heard. More tips on how to approach this conversation can be found here.

For Angela

How did you stop picking?

Along with other BFRBs, skin picking is a normal grooming behavior most humans do; being pick-free for the rest of your life is an unreasonable expectation. Though there is a diagnostic criteria for excoriation disorder, there are no set number of pick spots that determine if you’re routinely engaging in hygienic practices or becoming engulfed in an obsession with your skin, blurring the lines of what recovery means to each person.

FAQs for Skin Pickers
Eight months into recovery
December 2015

After appearing on The Doctors with Karen Pickett in 2015, she offered me 12 weeks of therapy- a combination of Cognitive-Behavioral Therapy (CBT) and Acceptance-Commitment Therapy (ACT). For the first week, I kept a skin picking log to observe my patterns and identify triggers. In the second week, I kept an upgraded log and began holding back on urges. Karen introduced ideas to lower my baseline anxiety such as fidget toys, barriers, and breathing exercises.

Learning about ACT in the second half of therapy helped solidify the skills I had just learned and taught me how to cope with uncomfortable feelings. I detail my weekly therapy sessions, homework, questions, and thoughts about the material in our upcoming book, EMBRACING DERMATILLOMANIA: Through Pain & Recovery.

How did you get rid of your scars?

I still have lots of scars, but they are now hypo-pigmented. I let nature take its course in healing instead of searching for products to erase my scars. After fifteen years of severe dermatillomania on my legs, seeing my spots fade to a shade lighter than my natural skin tone after recovery was so invigorating I didn’t care to try products that could potentially expedite healing (and likely trigger me).

Do you have any tips to stop picking?

“Tips and tricks” didn’t help me before therapy; it took a comprehensive treatment program to learn, and build onto, skills and strategies to find my success.

Challenging cognitive distortions was the most eye-opening part of my therapy. To slow down my thoughts enough to learn what each “permission-giving statement” I told myself was before giving into an urge was crucial because it allowed me the opportunity to re-frame them so they could already be in the back of my mind when the next similar urge occurred.

Finding your permission-giving statements is easier if you’re practicing mindfulness techniques daily and logging your picking, which makes you more aware of the statements that gives you permission to pick.

How do I attend your support group meetings?

Become a member of Skin Picking Support on facebook and RSVP to events pinned at the top of the group. Meetings take place one Saturday a month through and are hosted through a facebook rooms link provided in the event on the day of.

You can also like Skin Picking Support on Instagram for updates on upcoming meetings, along with information about the topics we discuss in monthly meetings.

Where can I get your memoir and documentary?

Paperback versions or digital copies of my 2009 memoir, FOREVER MARKED: A Dermatillomania Diary, can be obtained through the various venues listed here.

To see the trailer and learn more about the Scars of Shame, the first (and only) documentary about excoriation disorder, check out the documentary page.

When is your recovery book with Karen Pickett going to be released?

I want to thank everyone for their patience for the long-awaited release of EMBRACING DERMATILLOMANIA: Through Pain & Recovery. Due to many factors out of my control over the last few years, Karen Pickett and I are hoping to self-publish in late 2022 if we are unable to find a publishing company.

How do I get involved with dermatillomania advocacy?

There are many ways to raise awareness about skin picking. You can check out opportunities through the TLC Foundation for BFRBs, Canadian BFRB Support Network, and Picking Me Foundation or venture out to raise awareness on your own through various means:

FAQs for Skin Pickers
  • Make a video
  • Write to a magazine or local news paper
  • Blog for a non-profit organization
  • Contact radio stations or podcasts
  • Start a social media account dedicated to excoriation disorder
  • Create an awareness or fundraising campaign

Subscribe here to learn how you can raise awareness with Skin Picking Support in the future!

Top left photo: © Darryl Leblanc 2013
MODEL: Angela Hartlin

Photo (red background): © Gillian Drake 2015
MODEL: Angela Hartlin

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