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Caught! Compulsive skin picking.

Most of us have heard our parents say, "Don't pick at that, it will make it worse!" Did we listen? Nope, we still did it anyway. For most of us, we learned our lesson when the pimple on our face got more irritated and red, or when our cuticles started to bleed, and the embarrassment and shame we felt around our peers and from ourselves was enough to heed our parental advice next time we had the urge to pick at ourselves.

Most of the time, skin picking occurs as an impulsive reaction. There have been numerous cases that suggest that pickers remain unaware that they are in fact picking at blemishes or dry scabs. However, when this behavior results in noticeable tissue damage, and causes emotional distress, one is more likely to have developed a disorder that needs professional attention. How and when does random picking at a scab turn into a disorder?

What differentiates this as a phase rather than a full-blown disorder is how the habit, ritual or compulsion feels to the sufferer. If he experiences a lack of control over the urges to pick or pull, becomes overwhelmed with the need to engage in the behaviors, and lacks the coping skills to resist, then he may be diagnosed with a disorder known as dermatillomania or compulsive skin picking. Hair pulling, eyelash, eyebrow and pubic hair pulling are also a set of symptoms of a disorder called trichotillomania. Together, they are lumped into a newly used term called "body-focused repetitive behaviors."

About 1 in 20 people admit to suffering from a body-focused repetitive behaviors. The symptoms of both disorders share some aspects of obsessive-compulsive disorder since they are all on the obsessive-compulsive disorder spectrum, however, this does not automatically mean that your child has a diagnosis of obsessive-compulsive disorder.

For the majority of kids, body-focused repetitive behaviors is a passing phase that usually begins and ends in adolescence and you have nothing to worry about. However, if you notice constant damage on your child's body, observe your child spending time picking or pulling, and are aware that it is disrupting her normal life activities, you may want a professional assessment to confirm what is going on and to understand the etiology of these behaviors. Typically, they are an indicator of other mental health issues that your child is experiencing but cannot or will not convey to you.

Below are some signs parents can look for if they suspect that their child has compulsive skin picking:

* A scab, lesion, rash or pimple that seems to not be getting better, but actually getting worse

* A change in your child's mood. For example, your child is more irritable, nervous, anxious or withdrawn.

* Noticeable hair loss around the scalp and eyebrows.

* Attempts at covering the places he/she picks by wearing a hat to cover the scalp, drawing in eyebrows with makeup, wearing long sleeves or pants if the sores are on the arms or legs.

If your child does receive a diagnosis of compulsive skin picking or trichotillomania, there are a variety of established treatments to choose from.

The primary treatment approach for compulsive skin picking is a form of cognitive-behavioral therapy called habit-reversal training (HRT), which in its simplest form, involves monitoring and tracking of the skin-picking habit and then replacing that behavior with a competing response that the patient chooses to do in place of the undesirable behavior.

There is also some research support for the use of certain medications known as selective serotonin reuptake inhibitors (SSRIs). Research indicates that the effectiveness of certain medications in reducing impulses for specific behaviors may be useful in treating compulsive skin picking. Because reaction to medications is so individual, it is often necessary for you and your doctor to try more than one drug or combination of drugs before finding one that helps. Medications in the SRI or SSRI category have shown to be the most useful to date, but again, the decision is to be made with your doctor.

Lastly, it is important to reduce as much stress as possible because stress often triggers picking episodes. Reducing stress can be as easy as employing some breathing exercises. For example, instruct your child to take in a deep breath though her nose and exhale out her mouth. She should do this numerous times until she feels her body begin to relax. She can use this technique as a competing response to avoid picking her skin. Another way to reduce stress is to do things that increase the "feel good" chemicals in her brain, such as exercising and listening to her favorite music.

By Jordana Mansbacher, PsyD

Dr. Jordana Mansbacher is a licensed psychotherapist and human behavior expert specializing in the treatment of eating disorders, depression, anxiety, and relationship issues.
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Author:Mansbacher, Jordana
Publication:Pediatrics for Parents
Article Type:Report
Geographic Code:1USA
Date:Jul 1, 2014
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