Many children, teenagers and even adults pick at their skin from time to time. It is not uncommon for a person to occasionally pick at pimples, scabs, or even healthy skin according to iocdf.org. But what if your child’s skin picking lasts for long durations of time, results in lesions or scarring, causes significant distress or starts to interfere with their life? This could be an indication that your child is struggling with an actual disorder.
What is Dermatillomania? Dermatillomania, a.k.a. Excoriation disorder, is when a person (at any age) picks at their skin over and over again. The picking is often bad enough to cause tissue damage and can cause a lot of distress and/or problems in other areas of life (social, emotional, physical). According to the iocdf.org, people with Dermatillomania exhibit symptoms that include repetitive rubbing, scratching, picking and digging into their skin.
Dermatillomania is classified as a Body Focused Repetitive Disorder. These are disorders in which the person’s behavior may harm or damage their body and physical appearance. Although there are many behaviours that fall under BFRB’s, skin picking and hair pulling (a.k.a. Trichotillomania) are among the most common, according to Trich.org.
The site of picking can by anywhere on the body however some of the more common places include the face, hands and legs. People can engage in skin picking behaviour in various ways. People may pick their skin in a fully focused way, for example, planning to go home or the bathroom to pick at a scab. However, individuals also report engaging in the behaviour in a more automatic manner, for example when watching TV or reading, only realising what they’ve done once there are scratches on the skin or their face is bleeding, according to Skinpick.com.
For some there may be a sensation that draws people to the site of picking or pulling, including itching, tingling or pain however for others there is no sensation prior to the picking, their fingers just ‘find’ their way to the site and the behaviour begins. A vast majority of people report that they are searching for a particular irregularity of the skin (rough or bumpy) in order to fix or remove the perceived problem, according to Trich.org.
Age of Onset BFRB’s effect a surprising number of people worldwide. Though the research is not set in stone, most findings suggest that 2% to 4% of Canadians live with a Body Focused Repetitive Behaviour. That equals 1-2 million children and adults in Canada alone according to CanadianBFRB.org. This does not include the many cases that go unreported which means that the actual prevalence of BFRBs could be significantly higher.
Although Dermatillomania can begin at any age, it is important to note that the average age of onset occurs in childhood, between the ages of 9 – 13 years. According to Skingpick.com, some professionals attribute this to the onset of acne as a teenager in which the acne is scratched at and picked at. The compulsion to scratch and pick the skin continues even after the acne has vanished. Other types of skin conditions can also act as the onset for Dermatillomania including eczema, psoriasis, etc.
Given the average age of onset is so young, it is imperative for parents, caregivers, family and friends to be made aware of this disorder in order to help identify the symptoms and allow for early intervention.
Why Does My Child Pick? A common question that crosses the minds of many is ‘Why do you pick’. Although the origins of BFRB’s still remain unknown, research indicates that some people may have an inherited predisposition to skin pick (or hair pull), according to Trich.org. It is important to note that even if a predisposition toward BFRBs exists there are also other factors that can play a role including; temperament, environment, age of onset, and family stress factors that may make someone more susceptible to this disorder according to iocdf.org.
The Physical and Emotional Scars People underestimate the danger of Dermatillomania and other BFRBs. The results of skin picking can be detrimental and may result in deep lesions, scarring, mild to severe pain during or after picking and physical infections (cellulitis, staph), according to CanadianBFRB.org.
Aside from the physical damage, Dermatillomania can bring other mental illnesses with it including anxiety and depression. The emotional and social effects can be devastating with feelings of guilt (why did I do this to myself), shame (why can’t I stop), negative self talk (I hate myself when I do this), isolation (I can’t let anyone find out).
Many may not want to be seen in public for fear that others will see their wounds and will avoid social activities, school, etc.
What Can I Do? As parents, caregivers, family, friends we often feel the need to ‘fix’ the problem for a child. It is understandable that you may feel very frustrated and not understand why your child can not stop picking, especially given the effects it has on them.
The bad news is, there is no fix. If they could stop then, they would. The good news is you can help. Below is a clear list of ways you can help your child that we’ve compiled from various sites (as cited in our resources below):
- listen in a sympathetic, nonjudgmental way; it is important the child feels comfortable to openly what they are doing and what they are feeling
- educate yourself, accurate information is power. It will help you know how to support your child and help ease your own frustration
- be positive and show your child through example; yes although it is difficult it is not a tragedy, just an obstacle
- research treatment options, although your child’s main support, you are not enough. Someone who is professionally trained and has specific expertise in this area is key to help better manage this disorder
Slowly (but surely) as more is known, more help specific to this disorder, is becoming available. Although more research is needed on treatments, below is a list of various treatments that research has shown to be effective for Dermatillomania:
- Cognitive Behavioral Therapy (CBT)
- Behavioural Therapy: Habit Reversal Training (HRT)
- Acceptance and Commitment Therapy (ACT)
Unfortunately, because many people do not know that there is help for skin picking disorder, many people with the disorder continue to suffer with it.
It is important to keep wounds clean and treat them with a topical cream to help heal the wound, reduce the pain and decrease the risk of infection. Make sure the topical cream or ointment is specifically formulated for children.
Resources For Information and Support: