Skin Picking Disorder

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Skin symptoms in dermatillomania

Skin picking disorder is a condition that is characterized by repeated touching, squeezing, and scratching of diseased skin areas due to an irresistible urge. Editing the skin can cause significant tissue damage. Further consequences are shame and feelings of guilt as well as increasing social isolation.

The technical term dermatillomania is common in German-speaking countries . This term comes from the Greek and is composed of derma (= skin), tillein (= plucking) and mania (= enthusiasm, madness). The English skin picking and neurotic excoriations or the French acne excoriée have a similar meaning . The term skin picking is now used most often in the German-speaking self-help scene .

History and prevalence

In 1875 the English doctor Sir Erasmus Wilson spoke of neurotic excoriation for the first time . In France it was also observed that young girls of puberty in particular suffer from this disease. Hence the term Acne excoriée des jeunes filles ( scratchy acne in young girls).

So far, there has been very little research into skin picking. Statistics, empirical data and figures are still rare and the following information on frequency should only be understood as approximate estimates. In addition, there are still no uniform criteria for determining exactly when someone suffers from skin picking and when not.

According to the current state of research, women predominate among those affected. Depending on the examination, their share is between 60 and 90%. However, it cannot be ruled out that the proportion of men is underestimated, as men generally seek psychological help less often than women.

The disease can occur at any time, but it is particularly common in late childhood or early adolescence, as several studies have shown. It is often related to acne at the beginning . In addition to those affected since childhood and adolescence, there is a second group in whom skin picking in need of treatment occurs between the ages of 30 and 45.

Symptoms

People affected by skin picking work on pimples, hairs or crusts, but also healthy skin with fingers, tweezers, needles or other sharp objects, so that wounds and scars can arise. Those affected follow an impulse to which they can hardly offer any resistance. This action leads to distress and impairments in everyday areas of life. The reasons for these actions vary, but stress is usually discussed as a trigger.

The time that is spent working on the skin per day differs from person to person and is not the same every day. Figures range from a few minutes to several hours for a skin-picking episode. Most people report having multiple episodes a day. In extreme cases, this can be up to 150 episodes a day.

consequences

Often the affected areas cannot heal, leading to inflammation, increasingly severe injuries, tearing open wounds and ultimately scarring .

Dermatillomania patients often suffer from great shame and guilt because of the scars, wounds or red spots and try to hide the affected areas or avoid contact with others. This can lead to social isolation and thus a considerable loss of quality of life.

classification

In the ICD-10 and DSM IV , dermatillomania is classified as an impulse control disorder, but in the newer DSM-5 it is classified as an obsessive-compulsive spectrum disorder .

It is believed that those affected find working their skin pleasant and relaxing. Meanwhile, they experience a trance-like state in which warning thoughts and negative consequences are ignored. The act is like a valve, releasing stress, boredom or anger and sadness. Only when this ecstatic surge is over can they take their hands off their skin and feelings such as regret and shame take their place.

Diagnostic features of "Impulse control disorders not classified elsewhere" according to DSM-IV

  • Failure to resist an impulse, urge, or temptation to perform an action that is harmful to the person or to others
  • Increased feeling of tension or excitement before performing the action
  • Experience pleasure, satisfaction, or relaxation while performing
  • After the act, remorse, self-blame, or guilt may or may not arise

Other diseases that are classified in this group are e.g. B. Trichotillomania (repeated pulling out of the hair to such an extent that suffering or impairment in everyday tasks and activities arise) or kleptomania (stealing objects that are not needed).

Therapy options

Even if the disease has so far been little researched and is still insufficiently known among experts, cognitive behavioral therapy is recommended because the effectiveness of behavioral therapeutic methods in skin picking has been scientifically proven.

In addition, the habit reversal training has proven itself, which can also be used independently by those affected. According to recent research, 50% of users reported a clear decrease in skin picking.

In the similarly stored trichotillomania, a more recent approach consists in the administration of N-acetyl-cysteine , which is said to have a positive effect on impulse control by regulating the glutamate metabolism. Some case studies and smaller studies have shown a reduction in skin picking by the administration of N-acetyl-cysteine.

See also

literature

  • K. Vollmeyer, S. Fricke: Saving your own skin: Help with skin picking. Psychiatrie Verlag, Bonn 2012, ISBN 978-3-86739-071-2 .

Web links

  • Self-help instructions from the Hamburg-Eppendorf University Hospital

Individual evidence

  1. ^ A. Bohne, S. Wilhelm, NJ Keuthen, L. Baer, ​​MA Jenike: Skin Picking in German Students. In: Behavior Modification. 2002, 26, pp. 320-339.
  2. CA Flessner, DW Woods: Phenomenological characteristics, social problems, and the economic impact associated with chronic skin picking. In: Behavior Modification. 2006, 30, pp. 944-963.
  3. ^ S. Wilhelm, NJ Keuthen, T. Deckersbach, IM Engelhard, AE Forker, L. Baer, ​​RL O'Sullivan, MA Jenike: Self-injurious skin picking: clinical characteristics and comorbidity. In: Journal of Clinical Psychiatry. 1999, 60, pp. 454-459.
  4. JE Grant, BL Odlaug: Update on pathological skin picking. In: Current Psychiatry Reports. 2010, 11, pp. 283-288.
  5. T. Deckersbach, S. Wilhelm, NJ Keuthen, L. Baer, ​​MA Jenike: Cognitive-Behavior Therapy for Self-injurious Skin Picking. A case series. In: Behavior Modification. 2002, 26 (3), pp. 361-377.
  6. ^ Skin Picking Disorder (Excoriation). In: WebMD. Retrieved June 8, 2016 (American English).
  7. ^ MP Twohig, DW Woods: Habit Reversal as a treatment for chronic skin picking in typically developing adult male siblings. In: Journal of Applied Behavior Analysis. 2001, 34, pp. 217-220.
  8. T. Deckersbach, S. Wilhelm, NJ Keuthen, L. Baer, ​​MA Jenike: Cognitive-Behavior Therapy for Self-injurious Skin Picking. A case series. In: Behavior Modification. 2002, 26 (3), pp. 361-377.
  9. K. Vollmeyer, S. Fricke: Save your own skin: Help with skin picking. Psychiatrie Verlag, Bonn 2012, p. 45.
  10. Diagnostic and Statistical Manual of Mental Disorders - Text revision - DSM-IV-TR. Hogrefe, Göttingen 2003, p. 727.
  11. T. Deckersbach, S. Wilhelm, NJ Keuthen, L. Baer, ​​MA Jenike: Cognitive-Behavior Therapy for Self-injurious Skin Picking. A case series. In: Behavior Modification. 2002, 26 (3), pp. 361-377.
  12. ^ S. Moritz, S. Fricke, A. Treszl, C. Wittekind: Do it yourself! Evaluation of self-help habit reversal training in pathological skin picking. A pilot study. In: Journal of Obsessive-Compulsive and Related Disorders. 2012, 1, pp. 41-47.
  13. K. Schuck, GPJ Keijsers, M. Rinck: The effects of brief cognitive-behavior therapy for pathological skin picking: A randomized comparison to wait-list control. In: Behavior Research and Therapy. 2011, 49, pp. 11-17.
  14. Brian L. Odlaug, Jon E. Grant: Pathologic skin picking . In: The American Journal of Drug and Alcohol Abuse . tape 36 , no. 5 , September 1, 2010, ISSN  1097-9891 , p. 296-303 , doi : 10.3109 / 00952991003747543 , PMID 20575652 .