Excoriation Disorder, also known as Compulsive Skin Picking (CSP) is a Body Focused Repetitive Behavior (BFRB) in which the client compulsively picks at the skin on their face or body, oftentimes causing scarring and bleeding in the process. Those suffering from Excoriation Disorder report a trance-like state, and often times can go hours without noticing that they are engaged in picking. The picking is oftentimes precipitated by an urge, with then causes the individual to turn to picking as a way to relieve the pressure and discomfort of that urge. Oftentimes, those with compulsive skin picking have perfectionistic ideas of what “perfectly” clear skin should look like, and can worry excessively about how others see their skin.
Signs and symptoms of Excoriation Disorder
· Excess scarring on the face, arms or other parts of the body
· Open wounds where pimples or cysts have been picked
· A deep urge to cleanse at the sight of pimples on the face
· Scanning with fingers to find places to pick
· Excessive time spent in the mirror examining skin
· Significant amount of time spent engaged in trance like picking
· Repeated and unsuccessful attempts to stop picking behavior
Treatment for Excoriation Disorder
Excoriation Disorder and the damage that can be caused is oftentimes accompanied by shame and embarrassment, which are important emotions to address in the therapeutic process, as the shame and embarrassment can lead to yet another picking cycle. Compulsive Skin Picking is treated using Cognitive Behavioral therapy (CBT) to challenge perfectionistic thought patterns, Mindfulness and Acceptance therapies to learn to tolerate the urge to pick, and Habit Reversal Training (HRT) to bring awareness to the behavior and provide alternate behaviors which are less damaging. Many people recover from Compulsive Skin Picking and begin to develop more functional coping strategies to manage anxiety, stress and boredom.
What is Habit Reversal Training (HRT)?
HRT is a behavioral strategy that combines a number of techniques to help reduce the damaging behaviors in Body Focused Repetitive Behaviors (BFRB's). HRT uses awareness training along with the use of an alternative behavior (substituting pulling for knitting for example) to gradually reverse the habit of pulling and skin picking. Awareness is the first step in changing any behavior, and by increasing awareness of all aspects that precede the pull/pick (triggers), including thoughts, sensations, urges, behaviors, and emotions, the client becomes better able to recognize that the pull/pick is about to occur. Eventually, rather than giving into the urge, the individual learns to engage in a competing response. A competing response (CR) can be any behavior which the individual engages in, such as squeezing a ball, drawing, meditating etc. to avoid feeding into the habit of pulling/picking. Because the habit of pulling and picking is strengthened every time the individual gives in, the competing response when used correctly, will weaken the urge and habit over time and eventually the individual will begin to feel more choice, awareness and freedom in relation to the behavior.