Dermatillomania is an obsessive-compulsive disorder in which a person has an intense urge to scratch their skin. It is a disorder that consists of repetitive behavior focused on the body. For people with this disorder, the urge to scratch the skin is so strong that it often causes skin damage that does not heal properly or leaves scars. Touching the skin is a stress release and coping mechanism for people with this disorder.
Those with this disorder often feel shame and embarrassment about their behavior and try to hide evidence of their disorder. People with this disorder often try to camouflage the damage done to the skin by wearing makeup or wearing clothing to cover up the marks and scars that follow.
In extreme cases, people with this disorder may avoid social situations in an effort to prevent others from seeing the scars, scabs, and bruises that result from scratching the skin.
Fortunately, there is a growing interest in understanding and treating the disorder. Various treatment options for skin scratching are available, but there is much more to be said, even discovered, about this disfiguring and dangerous obsession.
Medications used to treat this disorder are also used to treat many obsessive-compulsive and anxiety-related disorders. For example, artificial nails (acrylic or gel) have been found to be helpful for some in stopping scratching behavior. It is recommended never to try any medication without first consulting a doctor.
The primary treatment modality depends on the individual’s level of awareness of the problem. If the disorder is usually an unconscious habit, the primary treatment is a form of cognitive behavioral therapy called habit reversal training (HRT). HRT is based on the principle that skin picking is a conditioned response to specific situations and events, and that the person with dermatillomania is often unaware of these triggers.
HRT challenges the problem in a dual process. First, the individual with this disorder learns to be more aware of the situations and events that trigger episodes of skin picking. Second, the individual learns to use alternative behaviors in response to these situations and events.
In many cases, cognitive behavioral therapy is most effective when combined with the use of mood-stabilizing medications. Hypnosis, self-hypnosis, and meditation have also been helpful for some patients.
There are a number of other therapeutic techniques that can be used in addition to HRT. These include exposure and response prevention (ERP) and stimulus control techniques. ERP, which is the main treatment for obsessive-compulsive (OC) and many OC spectrum disorders, is more valuable if the person with dermatillomania is already aware of the specific situations and events that trigger episodes of skin picking.
Stimulus control techniques involve the use of physical items such as gloves or rubber fingertip covers to reduce the client’s ability to scratch the skin. In addition, medications that are commonly used to treat OC disorders may be valuable adjuncts to cognitive behavioral therapy in the treatment of compulsive skin picking.