Genre: Instruction

The primary characteristic of Compulsive Skin Picking ( CSP ) is the repetitive picking at one's own skin to the extent of causing bleeding or damage to the skin to relieve anxiety or urges . Skin-picking is often preceded by a strong itch or urge , which the sufferer believes can only be relieved by picking . Then , of course , a feeling of depression or hopelessness follows when the damage caused by the picking is realised . Paradoxically a kind of compulsive perfectionism may convince the sufferer at the time that picking is a necessary means to achieving a clear complexion . In this way a vicious circle arises that is hard to break . Thus CSP may be seen to have obsessive-compulsive aspects that are similar to OCD , Body Dysmorphic Disorder ( BDD ) and trichotillomania . In fact research has shown that around a quarter of those diagnosed with OCD or BDD also have CSP . CSP is thus sometimes described as an Obsessive Compulsive Spectrum Disorder , along with , for example , BDD , eating disorders such as anorexia nervosa , and movement disorders such as Tourette's Syndrome ( TS ) . Skin-pickers often feel the need to camouflage their blemishes with make-up or cover bad areas with clothing . Social embarrassment can lead the sufferer to stay indoors , avoid friends , be late for work as their picking and make-up routine takes so long , or even to take sickness leave from work when their skin is in a very bad state . What treatment is available ? The best advice initially is to consult your GP . Many sufferers are very embarrassed by their symptoms and not all doctors are well-informed , so one idea would be to write down your problem , without minimising it , or print out this webpage for your doctor to read . Very often patients are referred first of all to a dermatologist , which may be appropriate if there is a skin disorder that needs treating but may also delay treatment of the compulsive psychological element . There is evidence that skin-picking may be caused by biological factors such as brain structure and you may be prescribed serotonin enhancing drugs such as Prozac or one of the other SSRIs . This may be augmented with one of the neuroleptics , for example Risperdal , as these often suppress the tic-like behaviour that may be involved in picking . The second and very important treatment for Compulsive Skin-Picking is Cognitive Behavioural Therapy ( CBT ) . If your case is severe you may be referred to a trained therapist who will teach you a technique of CBT called Habit Reversal . Habit Reversal was developed in the 1970s by psychologists Nathan Azrin and Gregory Nunn for treating nervous habits such as tics , stammering and skin-picking which are done automatically . Therapy should focus initially on developing Habit Awareness and patients may be asked to keep records of when , where and under what circumstances they normally pick . Many people believe that if they stop one bad habit it will be replaced with another bad habit . However , one of the key ideas of habit reversal is to replace the harmful habit with another harmless habit that makes the bad habit impossible . This new behaviour is known as a competing response . A suitable competing response for skin-picking might be clenching one's fist , as this is incompatible with skin-picking . Another important part of habit reversal training is practising a suitable method of relaxation such as meditation , abdominal breathing or progressive muscle relaxation . Successful CBT will also involve stimulus control . Once the sufferer has identified the particular environmental factors or mood states that lead to picking , steps can be taken to deal with such triggers . For instance this might mean avoiding or covering mirrors or challenging automatic thoughts and emotions connected with picking and replacing them with less negative responses . Further ideas on breaking the habit of skin-picking : - Get advice on skin care . If you have a skin complaint see a dermatologist . - When tempted to pick , care for your skin by applying a moisturising lotion instead - Stimulus control : cover or remove mirrors if they act as a trigger and get rid of all implements such as tweezers and pins used for picking . - Consider the use of artificial nails to make picking more difficult - it may work for some . - Wear rubber fingertips or cotton gloves whenever possible if you feel the urge to pick . - Try replacing some of the sensory aspects of skin-picking with a more desirable alternative . For example , keep an object by you that you can manipulate ( squeeze or pull ) such as a soft rubber ball or some Blu Tak . - Keep your hands busy with something else such as a puzzle or knitting . - If you bite the inside of your cheeks try eating crunchy snacks when you feel the urge to bite . - Reward yourself for making progress with some kind of treat . - As you gain more confidence gradually begin to expose your hands , arms , face or legs to others starting with family and friends . You will no doubt benefit from their support but at the same time the negative consequences of engaging in your habit will be increased . Source : This article was written for OCD Action by Louise with the assistance of Dr James Claiborn co-author of The Habit Change Workbook