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| Compulsive Skin-Picking
& Scratching Ted Grossbart PhD Everyone pulls off the odd bit of skin or
squeezes a random pimple. But for some people the squeezing, scratching,
or picking becomes an absolutely monstrous compulsive behavior that
threatens to take over their lives. Concealing
what they are doing and its impact, can trigger desperate attempts at
camouflage and the avoidance of activities and relationships.
As a practicing skin psychologist for 30
years, I have seen a huge recent increase in people coming in with skin
picking and scratching problems. Some
have an underlying skin disease, but the behavior itself may be the whole
story. Feeling great shame, people become isolated, rarely talking to
friends and neighbors about their problem. This makes it hard for them to
connect with others for support. The
Internet may become their key source of support and information. Pickers and scratchers range from very
emotionally troubled, to otherwise quite healthy and successful people.
PICKING PROBLEMS THAT LOOK THE SAME FROM THE OUTSIDE CAN BE VERY
DIFFERENT ON THE INSIDE. Treatment needs to be carefully
individualized--simple formulas and stock programs are often not enough.
The treatment approach MUST be matched to both what is fueling the
picking and the individual’s personal psychology. Many different paths can lead to a picking
problem. Any area may be the
target; some people use tweezers or nail files and produce deep permanent
scars. Many people describe looking for self-soothing, and go into a
trancelike daze when they pick. Some
people do most of their picking when they are bored, reading, or watching
a movie, and little is going on. For
others as the stress ratchets up, so does their picking. For yet another
group, what starts as a well-intentioned attempt to smooth out or improve
an area of skin may quickly
turn destructive when it combines with a relentless perfectionism. Deep guilt and shame can easily compound
the problem. Sarah G.
told me, "Over the years I have gradually shared all my secrets with
my husband except one. Ever
since college I have been disappearing into the bathroom to tear at my
skin. I don't know if he
suspects or not. I feel like a
freak, I know I should tell him, but..."
For her, ‘coming out’ was a critical step.
Probably no treatment approach would have worked without it. Not seeing their problem as a serious
'real' disorder, some deny themselves serious treatment.
Picking can become a major focus of life and can seriously erode
relationships, work, and leisure and really make people feel crazy and out
of control. People who are hard on their skin are typically also hard on
themselves about it. Fiona O. put it sharply, "I'm doing it to
myself, so I deserve what I get." When Julia B. got out her magnifying mirror
and bright light she knew trouble was coming.
Deep scaring, recurrent skin infections and an overwhelming sense
of shame were no match for her compulsion to keep digging deeply at the
skin on her arms. At first picking would bring her a blissful, trancelike
sense of peace, and then as the blood flowed this would change into
revulsion and self-reproach. Intriguingly, a high percentage of pickers
I’ve work with were picked on by others when they were growing up.
They may have been scapegoated at school or the victim of critical,
perfectionistic parents. Being
picked on then becomes a pattern that people loyally continue by
internalizing the problem and picking on themselves.
Emma L. described her erratic parents and
chaotic childhood, "Picking
was the one stable thing I could depend on."
As she was able to build a more solid identity and sense of herself
in therapy, she was able to let go of the picking. Natalie M.’s focus on her picking as part
of a lifelong pattern of obsessions and compulsions let her use medication
and behavior therapy very effectively.
The very specific prescriptive style worked very well for her.
In contrast Brent L. came to think of his picking as an
“addiction without a substance” and adapted parts of the AA 12-step
approach. He found he could
stop picking if he was able to focus on, and sit with, the emotional pain
that it was masking. For others really pushing to get at the
emotions that are lurking when picking starts is key.
Picking can be an angry act, as I suggested to Brad K., if he did
to someone in the street what he did to himself, they would put him in
jail. Anne R. usually picked
only in private, but when she got a cell phone call in a crowded car
telling her that her boy friend was also dating someone else, the picking
started and her blood started to flow. Her skin took the beating she
wished she could have delivered to him.
People like Anne and Brad need help to feel their feelings in their
hearts instead of in their skins. TREATMENT:
WHAT WORKS I have been most impressed with the
effectiveness of three treatment tools: 1.) MEDICATION:
Antidepressants (SSRI’s) and mood stabilizers have been very
helpful for some of my patients, and a disappointment for others.
If you want to go this route it is important to be persistent and
expect to experiment with different drugs and dosages. 2.) PSYCHOTHERAPY:
With literally hundreds of different approaches, it is hard to be
an educated consumer. Look for
good personal chemistry: someone
you feel ‘gets’ you. Look
for a depth of experience working with picking and scratching.
Someone can be a great therapist for people with other problems,
yet ignorant and ineffective in this area.
Ideally a therapist should be competent to address behavior change,
cognitive (thinking) issues, and also the emotional side of the problem.
A therapist who is too strictly committed to one approach or
technique may have major blind spots. 3.) HYPNOSIS and SELF-HYPNOSIS:
These adjunctive techniques are best taught by a qualified
psychotherapist. With an
impressive record of success for habit control, these approaches are
especially useful for people who go into a spacey trance state when they
pick. You can learn to
turn this “inadvertent negative hypnosis” into an effective treatment
technique. About the Author:
ted@grossbart.com Ted A. Grossbart, Ph.D. is a licensed
clinical psychologist in private practice in He has been a pioneer in the use of
relaxation, imaging, hypnosis, and psychotherapy for skin problems.
His best known writing is his book SKIN DEEP: A Mind/Body Program
for Healthy Skin, now in its second edition.
The SKIN DEEP WEB SITE http://grossbart.com
is a major resource on skin psychology and psychodermatology. Note the book chapter “Breaking the
Itch-Scratch Cycle” |