The excoriation disorder is a disorder characterized psychopathological suffering from a dire need for touching, scraping, rubbing, scrubbing or rubbing the skin. People who suffer from this disorder are unable to resist performing such behaviors, so they scratch their skin impulsively to mitigate the anxiety that does not do it.
Obviously, suffering this psychological alteration can greatly damage the integrity of the person as well as provide a high level of discomfort and have a significant impact on their day to day.
In this article we will review what is known today about dermatilomania, what characteristics this disease has and how it can be treated.
What is the relationship between the skin and mental disorders?
Dermatilomania is a psychopathological disorder that was first described by Willson under the name of skin picking.
At its core, this psychological alteration is characterized by the need or urge to touch, scratch, rub, rub, squeeze, bite, or excavate the skin with nails and / or accessory tools such as tweezers or needles.
However, dermatilomania is still a little known psychopathological entity today with many questions to answer.
During the last few years, there have been many debates about whether this alteration would be part of the obsessive compulsive spectrum or an impulse control disorder.
That is, if dermatilomania consists of an alteration in which the person performs a compulsive action (scratching) to mitigate the anxiety caused by a certain thought, or an alteration in which the person is unable to control their immediate friction needs your skin.
At present, there seems to be a greater consensus for the second option, thus understanding dermatilomania as a disorder in which, before the appearance of itching or other skin sensations such as burning or tingling, the person feels an extreme need to scratch, for which ends up doing the action.
However, the relationship between the skin and the nervous system seems to be very complex, which is why there are multiple associations between psychological disorders and skin disorders.
In fact, the brain and the skin have many associative mechanisms, so that, through its lesions, the skin can account for the emotional and mental state of the person.
More specifically, a review by Gupta revealed that between 25% and 33% of dermatological patients had some associated psychiatric pathology.
Thus, a person who suffers from alterations in the skin and in the mental state, as is the case of individuals who suffer from dermatilomania, must be evaluated as a whole and guide the explanation to the alterations suffered in two aspects.
1. As a dermatological disorder with psychiatric aspects.
2. As a psychiatric disorder with dermatological expression.
Characteristics of dermatilomania
Urge to scratch
Dermatilomania is also known today by other names such as compulsive skin scratching, neurotic excoriation, psychogenic excoriation or excoriated acne.
With these 4 alternative names for dermatilomania, we can already see more clearly what is the main expression of mental alteration.
In fact, the main characteristic is based on the feelings of need and urgency that the person experiences at certain moments of scratching, rubbing or rubbing their skin.
Defects, anemone and other dermatological conditions
Normally, these sensations of the need to scratch appear in response to the appearance of minimal irregularities or defects in the skin, as well as the presence of acne or other skin formations.
Compulsive scratching that causes damage
As we have commented previously, scratching is done in a compulsive way, that is, the person cannot avoid scratching the determined area, and it is done through the nails or some utensil.
Obviously, this scratching, either with the nails or with tweezers or needles, usually causes tissue damage of varying severity, as well as skin infections, permanent and disfiguring scars, and significant aesthetic / emotional damage.
Initially, the defining clinical picture of dermatillomania appears in response to itching or other skin sensations such as burning, tingling, heat, dryness, or pain.
When these sensations appear, the person experiences immense needs to scratch that area of skin, which is why they initiate compulsive scratching behaviors.
Inability to resist
It should be noted that whether we understand the alteration as an impulse control disorder or an obsessive compulsive disorder, the person cannot resist performing the scratching actions because if he does not do so he is not able to get rid of the tension that supposed not to.
Thus, the person begins to scratch the skin in a totally impulsive way, without being able to stop to reflect on whether or not he should do it, and obviously, causing marks and wounds in the skin area.
Impulses to scratch appear with observation of the skin
Subsequently, the impulses to scratch do not appear after the detection of itching , acne or other natural elements of the skin, but by the permanent observation of the skin itself.
In this way, the person with dermatilomania begins to obsessively analyze the condition of the skin, a fact that makes controlling or resisting the urge to scratch become a practically impossible task.
Feelings of gratification
During observation the nervousness, tension and restlessness increases, and can only decrease if the action is carried out.
When the person finally performs the action of scratching or rubbing his skin impulsively, he experiences heightened sensations of gratification, pleasure and relief, which some patients describe as a trance state.
However, as the scratching action progresses, the feelings of gratification diminish while the previous tension also disappears.
Similarity to addictions
Thus, we could understand the functioning pattern of dermatilomania as extreme feelings of tension which are eliminated through the action of rubbing the skin, a behavior that provides a lot of gratification in the beginning, but that disappears when there is no longer so much tension .
As we can see, although we have to bridge many important distances, this pattern of behavior differs little from that of a person addicted to a certain substance or behavior.
Thus, the smoker who spends many hours without being able to smoke increases his state of tension, which is released when he manages to light the cigarette, at which time he experiences a lot of pleasure.
However, if this smoker continues to smoke one cigarette after another, when he is smoking the fourth in a row, he will probably not experience any kind of tension and most likely the reward from nicotine will be much less.
Returning to dermatilomania, as the action of scratching the skin takes place, the gratification disappears, and instead feelings of guilt, regret and pain begin to appear, which progressively increase as the action of scratching is prolonged .
Finally, the person suffering from dermatilomania feels shame and self-reproach for the injuries and injuries resulting from their compulsive scratching behaviors, a fact that can cause multiple personal and social problems.
What data is there on dermatillomania?
So far we have seen that dermatilomania is about an impulse control disorder in which the person is unable to resist scratching certain areas of their skin due to the prior tension caused by self-observation and the detection of certain skin aspects.
However, what areas of the body are often scratched? What feelings does the person with this alteration have? What behaviors do they normally perform?
As mentioned, there is still little knowledge about this psychological disorder, however, authors such as Bohne, Keuthen, Bloch and Elliot have contributed more than interesting data in their respective studies.
In this way, from a bibliographic review carried out by Doctor Juan Carlo Martínez, we can draw conclusions such as the following.
-The sensations of prior tension described by patients with dermatilomania rises to levels between 79 and 81%.
-The areas where scratches are performed most frequently are pimples and blackheads (93% of cases), followed by insect bites (64%), scabs (57%), infected areas (34% ) and healthy skin (7-18%).
-The behaviors most frequently performed by people with dermatillomania are: squeezing the skin (59-85%), scratching (55-77%), biting (32%), rubbing (22%), digging or removing (4- 11%), and puncture (2.6%).
-The instruments most used to carry out this action are nails (73-80%), followed by fingers (51-71%), teeth (35%), pins or brooches (5-16%), tweezers (9-14%) and scissors (5%).
-The areas of the body most affected by the compulsive behaviors of dermatilomania are the face, arms, legs, back and thorax.
-People with dermatilomania try to cover the wounds caused through cosmetics in 60% of cases, with clothing in 20% and with bandages in 17%.
How many people have it?
The epidemiology of dermatillomania has not yet been well established, so the currently existing data are not redundant.
In dermatological consultations, the presence of this psychopathological disorder is found in between 2 and 4% of cases.
However, the prevalence of this problem in the general population is unknown, in which it is understood that it would be lower than that found in dermatology consultations.
Likewise, in a study carried out on 200 psychology students, it was found that the majority, 91.7% admitted having pinched their skin during the last week.
However, these figures were much lower (4.6%) if the action of pinching the skin was considered as a response to stress or a behavior that produced functional impairment, and up to 2.3% if said action was considered to have some relation with some psychiatric pathology.
Today we do not find in the literature a unique and totally effective treatment to intervene this type of psychopathology. However, the most widely used methods among mental health services to treat dermatillomania are as follows.
Antidepressant medications such as selective serotonin inhibitors or colomipramine are commonly used , as well as opioid antagonists and glumatergic agents.
This therapy focuses on looking for the underlying cause of the disorder, as well as the effects that it can cause.
The patient is helped to develop skills to control impulse without damage and to reduce scratching behaviors.
Cognitive behavioral therapy
This therapy has obtained very good results for the treatment of obsessive compulsive disorder, for which similar effects are expected in the intervention of dermatilomania.
With this treatment, behavioral techniques are developed that prevent the appearance of impulsive acts, and at the same time obsessive thoughts of scratching are worked on so that these are experienced with lower levels of tension and anxiety .
- Bloch M, Elliot M, Thompson H, Koran L. Fluoxetine in Pathologic Skin Picking. Psychosomatics 2001; 42: 314-319
- Bohne A, Wilhelm S, Keuthen N, Baer L, Jenike M. Skin Picking in German Student. Behav Modif 2002; 26: 320-339.
- Gupta MA, Gupta AK.The use of antidepressant drugs in dermatology. JEADV 2001; 15: 512-518.
- Keuthen N, Deckersbach T, Wilhelm S, Hale E, Fraim C, Baer L et al. Repetitive Skin – Picking in a Student Population and Comparison with a Sample of Self – Injurious Skin – Pickers. Psychosomatics 2000; 41: 210-215
- Wilhelm S, Keuthen NJ, Deckersbach T, et al. (1999) Selfinjurious skin picking: clinical characteristics and comorbidity. J Clin Psychiatry 60: 454–459.