Excoriation Disorder
Excoriation disorder, also known as compulsive skin picking (CSP), is a body focused repetitive behavior (BFRB) in which the sufferer feels an overwhelming urge to pick the skin on any part of their body, often resulting in scarring and bleeding. The picker often reports being in a trance-like state while picking, and can go hours without noticing that they are engaged in a pick session. Due to the damage that can be caused by excessive picking of the skin, excoriation disorder is frequently accompanied by and exasperated by feelings of shame and embarrassment. The sufferer might avoid social interactions and limit their lives due to their scarring or bleeding, and due to the fear that others may notice and judge them, especially after a particularly bad pick 'session.' Frequently, those with compulsive skin picking have perfectionist ideas of what “perfectly” clear skin should look like, and can worry excessively about how others see their skin or judge their appearance. Sometimes, excoriation disorder is accompanied by social anxiety, and is almost always underscored by unresolved anxiety.
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
Excess time spent in the mirror examining skin for imperfections
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 is causes often produce deep feelings of shame and embarrassment. It’s important to address these underlying emotions in the therapeutic process, as they can lead to yet another picking cycle if left unexplored. Excoriation disorder is treated using cognitive behavioral therapy (CBT) to challenge perfectionist thought patterns, acceptance and commitment therapy (ACT) to tolerate unwanted urges and sensations, and habit reversal training (HRT) to bring awareness to the behavior and offer competing responses which are less damaging and do not contribute to the cycle. The focus of treatment at CAOCD also includes an exploration of the underlying anxiety that fuels picking behavior, as long term management requires facing our fears rather than numbing out through these damaging behaviors. With the right intervention, many people significantly reduce their compulsive skin picking and develop coping skills to manage the underlying anxiety, stress and boredom that exasperate it.
What is Habit Reversal Training (HRT)?
Habit reversal training (HRT) is a behavioral intervention that combines a number of techniques to help increase awareness and reduce the damaging behaviors seen in body focused repetitive behaviors (BFRB's). HRT is the gold standard of treatment for BFRBs such as trichotillomania (compulsive hair pulling) and excoriation disorder. HRT aims to first increase a client’s awareness of their behaviors before introducing the use of a competing response to gradually replace the habit and urge to pull or pick. A competing response can be any behavior which the individual engages in, such as squeezing a ball, drawing, meditating, or the use of gloves while driving, to avoid feeding into the habit of pulling/picking. Because the habit and urge to pull and pick is strengthened every time the individual gives in, the use of a competing response weakens this urge over time. Although the goal is not to gain complete elimination of any pulling or picking behaviors, significant reduction is possible. With the evidence based treatments used at CAOCD, you may may begin to feel more choice, awareness and freedom and can opt for a different path the next time you feel an urge.