Dermatillomania (excoriation Disorder): Symptoms And Causes
Excoriation disorder also known as dermatillomania, involves scratching and tearing parts of the skin, usually due to intense feelings of anxiety.
In this article we will describe Symptoms, causes and treatment of dermatillomania ; In relation to this last aspect we will focus on the habit reversal technique.
Dermatillomania is a psychological disorder characterized by a intense and frequent urge to pick, scratch, or tear off parts of one’s own skin. The DSM-5 introduces it under the nomenclature “Excoriation Disorder” within the category of obsessive-compulsive disorder and other related disorders, in which trichotillomania is also found.
According to this diagnostic manual, excoriation disorder is defined as the habit of scratching the skin compulsively and repetitively until causing injuries. These can be considerable and there is a significant risk of infections occurring in the damaged regions.
Although most experts point out the closeness between dermatillomania and obsessive-compulsive disorders, Odlaug and Grant (2010) state that it is more similar to addictions because the act of picking or scratching the skin involves pleasurable emotions. On the other hand, in compulsive disorders, rituals have the objective of reducing anxiety.
This disorder was first described in 1875 by Erasmus Wilson, who referred to it as “neurotic excoriations.” Shortly after, in 1898, Louis-Anne-Jean Brocq described several similar cases in adolescent girls with acne. Despite multiple references in the literature, Until the DSM-5, dermatillomania had not been officially recognized.
Scientific literature reveals that feelings of anxiety and emotional tension trigger the episodes of dermatillomania. These usually target a part of the skin where the person perceives some type of imperfection, such as a pimple or peeling.
The face is the most common target of injuries, although they also frequently occur on the back, chest, scalp or extremities, especially the nails and fingertips. Usually excoriations are made with the fingers although sometimes the mouth or instruments such as needles are used.
These episodes can occur repeatedly during daily life, but it is also possible that only one a day occurs with a very high duration and intensity. In general, people with dermatillomania focus on a single part of the body, except when it is very damaged.
Dermatillomania can cause serious skin changes, mainly damage to affected tissues, appearance of pustules and infections which sometimes even reach the blood (septicemia). Excoriation can also scar or disfigure the skin, which increases the strong feelings of shame and guilt in people with dermatillomania.
Causes of this disorder
The motivations for episodes of dermatillomania vary depending on the person. However, a widely accepted hypothesis is that physiological activation, and in particular that derived from psychosocial stress triggers excoriation behaviors, which have an anxiolytic functionality.
While in obsessive-compulsive profiles dermatillomania is usually associated with the perception of skin contamination, in others closer to body dysmorphic disorder the purpose of these behaviors has to do with the attempt to eliminate physical imperfections.
A relationship has been found between dermatillomania and increase in dopamine levels, involved in motor control, in the brain reward system and in the development of addictions. The excessive presence of this neurotransmitter, which occurs when consuming substances such as cocaine, seems to promote excoriation.
On the other hand, it has been proposed that this disorder could have its biological basis in the frontostriatal motor circuit, which connects the regions of the frontal lobe on which cognitive functions depend with the basal ganglia, fundamental for automatic movements.
Psychological treatment: habit reversal
As with other disorders related to physical and motor habits, including tics, onychophagia, trichotillomania, stuttering or temporomandibular syndrome, dermatillomania can be managed through Azrin and Nunn’s habit reversal technique (1973), which is part of cognitive-behavioral therapy.
This procedure consists of several steps. Firstly, training is carried out to promote the detection of excoriation behaviors, which in many cases are automatic, as well as the stimuli that precede them, mainly sensations of emotional tension.
Next a response is practiced that is incompatible with the negative habit to execute it when the impulse appears to, in this case, scratch the skin; This new behavior must become a habit that replaces excoriation. An example could be making fists to prevent your fingers from touching your own body.
The rest of the components of Azrin and Nunn’s program consist of applying contingent reinforcement to the absence of excoriation (contingency management), teaching relaxation techniques to the client to reduce the anxiety that triggers the episodes, and finally systematically generalizing the skills to the client. context of everyday life.
