When someone creates lesions and sores on their body by compulsively picking at their skin without being able to control the behavior, they could have a disease called excoriation disorder. Excoriation disorder, also known as skin-picking disorder, is a mental health condition that can benefit from professional treatment. Fortunately, therapists and psychiatrists have numerous strategies, interventions and medications available to decrease symptoms and repair the damage caused by excoriation.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT), a type of talk therapy, is currently the most effective therapeutic approach for excoriation disorder. CBT helps people better understand the connection between their thoughts, feelings and behaviors to help combat unwanted mental health symptoms.
Problematic thoughts and behaviors are the foundations of excoriation disorder. CBT challenges the client to form new beliefs about themselves and the world. Over time, this decreases the thoughts that trigger skin picking behaviors.
Habit Reversal Training
Rather than being a separate form of therapy, habit reversal training (HRT) is a specific form of CBT used to treat excoriation disorder. Building on the same principles as CBT, HRT features:
- Habit Awareness Training: Heightens understanding and attention to behaviors linked to picking
- Competing Motor Response: Teaches clients how to perform movements that make picking impossible
- Relaxation: Allows the person to calm their body and mind when triggers are present
- Social Support: Improves individual’s ability to call on friends and family to assist with symptoms when triggers arise
Acceptance and Commitment Therapy
Another variation of CBT used for excoriation disorder is called acceptance and commitment therapy (ACT). Instead of a strong focus on decreasing and replacing negative thinking patterns, ACT strives to help people accept their current thoughts as a core aspect of their personality. With this acceptance in place, the client can search for ways of thinking that are more in line with their individual beliefs and goals. Having accepted their thoughts and committed to improving their feelings and behaviors, the person will engage in fewer instances of picking.
Medications can be a useful addition to any excoriation treatment plan. Prescription substances can help manage symptoms, making therapy more effective and reducing symptoms of co-occurring conditions like depression and anxiety.
Some medications used for excoriation treatment include:
- SSRIs: Selective serotonin reuptake inhibitors (SSRIs) work by increasing the amount of serotonin in the brain. Prescribers often recommend SSRIs for anxiety and depressive disorders, and it seems this class of medications help with excoriation as well. Some useful SSRIs include Celexa, Lexapro, Luvox, Prozac and Zoloft
- NAC: N-acetylcysteine (NAC) is an agent that interacts with glutamate, a brain chemical that manipulates the nervous system. Studies show the drug to reduce picking behaviors.
- Lamictal: A medication used for seizures and bipolar disorder, Lamictal shows some promise in treating excoriation, but the findings are inconsistent.
- Opioid Blockers: Though the use of this class of medication is not well-studied, some case reports support the idea of giving a person with excoriation an opioid blocker like naltrexone to reduce skin-picking behaviors.
Alternative Excoriation Management Strategies
Some people with excoriation disorder benefit significantly from therapy alone or a combination of therapy and medication. Others explore additional and alternative excoriation disorder management strategies to improve their symptoms.
- Stimulus Control. Stimulus control for skin-picking disorder investigates way a person can identify and avoid the triggers of picking. For example, if someone normally picks while watching TV, they’ll be instructed to limit their TV viewing. If they pick when stress is high, they can learn relaxation techniques to use to stop tension before it reaches a level that triggers skin picking.
- Hypnosis. Using hypnotherapy could help reduce behaviors linked to excoriation in the same way that it can limit the actions connected to other problematic behaviors, like smoking cigarettes or overeating. One study showed that hypnosis could help counteract stress that triggers picking behaviors when used as a channel for different types of interventions, like psychotherapy.
- Exercise. By engaging in physical activity, a person could lessen the influence of excoriation disorder on their life. Excoriation symptoms are often caused by anxiety and stress. Yoga and aerobic exercises like walking, biking and swimming are possible treatments can help reduce negative moods, thereby decreasing the urge to engage in skin picking.
- Support Groups. Support groups are another way to boost the effectiveness of other professional treatments. Usually led by others with the condition, an excoriation disorder support group provides people with the disease with the opportunity to hear the challenges and successes of others while building a support system of understanding people. Local and online skin-picking support groups are also available.
Treating Excoriation and Co-Occurring Disorders
Skin-picking disorder may occur on its own, or it may present with one or more other mental health and substance use disorders. Excoriation disorder commonly co-occurs with:
- Obsessive-compulsive disorder
- Body dysmorphic disorder
- Anxiety disorders
- Mood disorders, like bipolar and depression
After undergoing a comprehensive assessment from a mental health professional, an essential element of treating excoriation is addressing all co-occurring mental health conditions simultaneously. If a person with depression and excoriation disorder only targets the picking, there is a possibility that their depression will intensify or trigger skin picking behaviors after treatment.
Similarly, those with excoriation disorder and a substance use disorder will need targeted interventions to resolve both issues. If you or a loved one is in this situation, consider calling The Recovery Village today. The Recovery Village is a treatment center focused on providing addiction and co-occurring disorder services to people in need.
American Psychiatric Association. “Diagnostic and Statistical Manual of Mental Disorders.” 2013. Lochner C, Roos A, Stein DJ. “Excoriation (Skin-Picking) Disorder: A Systematic Review of Treatment Options.” U.S. National Library of Medicine. July 14, 2017. Accessed on March 17, 2019. National Center for Biotechnology Information. “Alternative Therapies for Excoriation (Skin Picking) Disorder: A Brief Update.” 2017. Accessed March 27, 2019. Massachusetts General Hospital OCD and Related Disorders Program. “Excoriation.” (n.d.) Accessed on March 17, 2019. Philips, K.A. and Stein, D.J. “Excoriation (Skin-Picking) Disorder.” Merck Manual. June 2018. Accessed on March 17, 2019.
American Psychiatric Association. “Diagnostic and Statistical Manual of Mental Disorders.” 2013.
Lochner C, Roos A, Stein DJ. “Excoriation (Skin-Picking) Disorder: A Systematic Review of Treatment Options.” U.S. National Library of Medicine. July 14, 2017. Accessed on March 17, 2019.
National Center for Biotechnology Information. “Alternative Therapies for Excoriation (Skin Picking) Disorder: A Brief Update.” 2017. Accessed March 27, 2019.
Massachusetts General Hospital OCD and Related Disorders Program. “Excoriation.” (n.d.) Accessed on March 17, 2019.
Philips, K.A. and Stein, D.J. “Excoriation (Skin-Picking) Disorder.” Merck Manual. June 2018. Accessed on March 17, 2019.