Dermatillomania: What It Is, Causes, Symptoms And Treatment

Dermatillomania consists of repetitive behavior of scratching, picking, scratching, peeling, picking, or biting one’s own skin (Cruzado Rodríguez, JA, 2014)⁽¹⁾. It occurs mainly on the face, arms and hands and can be carried out with the nails or with an object such as a needle or scissors.

The repetitive behavior can be carried out for a long time (even hours) and causes skin lesions, lesions that the person may try to hide.

Dermatillomania, also called psychogenic excoriation or excoriation disorder appears in the DSM-5 (American Psychiatric Association) and ICD-11 (World Health Organization) diagnostic classifications:

• Within the DSM-5 it constitutes a diagnostic category in itself and is included within the group “Obsessive Compulsive Disorder and Related Disorders”.
• Regarding the ICD-11 classification, it is included in the category “Body-Focused Repetitive Behavior Disorder” within the group “Obsessive-Compulsive Disorders and Other Related Disorders”.

Is dermatillomania a type of obsessive-compulsive disorder? Although in both classifications it is grouped together with obsessive-compulsive disorders, the main difference with these is that there does not necessarily have to be an obsession even if compulsive behavior does appear.

However, similar to obsessive-compulsive disorder, the person finds their repetitive behaviors annoying and tries to get rid of them or at least reduce them.

Following Arnold, LM, Auchenbach, MB and McElroy, SL (2001, seen in Fernández Rodríguez, M., García Miranda, I. and Villaverde González, A., 2020)⁽²⁾ Before its inclusion in the diagnostic classifications, a classification within the excoriation disorder had been proposed that included three subtypes:

• impulsive subtype: in which the patient shows little resistance to performing the behavior and the scratching has more to do with excitement, pleasure or reduction of tension.
• Compulsive subtype: the patient does show resistance to performing the behavior and scratches to prevent a situation that he fears or to avoid increased anxiety.
• Mixed subtype: In this subtype, characteristics of the previous two appear.

Let’s see what the causes of dermatillomania are. The origin of dermatillomanic problems can be found in the response that the patient gives to certain itching and/or skin sensations from which impulsive-compulsive behaviors appear (Torales, J., 2020)⁽³⁾.

Torales Benítez, J., Rodríguez Masi, M. and Riego Meyer, V. (2014)⁽⁴⁾ proposed as the most common triggers for scratching looking and feeling the skin, boredom, tiredness or stress. unpleasant emotions like sadness or anger experimentation anxiety or other situations such as being in bed, talking on the phone or watching television could also cause the problem behavior to appear.

Finally, at a biological level another possible cause of dermatillomania has been suggested: a serotonergic deficiency It is related to repetitive behaviors on the one hand; On the other hand, it has also been proposed that neurotic excoriation may involve hygienic behavior that has survived throughout evolution.

The symptoms of dermatillomania are:

• The person scratches, pinches, pricks, bites, scratches or peels the skin of the body or scalp repeatedly.
• He feels scratching as an irrational behavior and it causes him discomfort.
• As a consequence of the previous point, try to reduce or eliminate the behavior.
• The person may try to hide the wounds caused by repeated scratching.

It is important to carry out treatment for dermatillomania since it is a disorder that tends to become chronic if it is not treated. How to cure dermatillomania? How to get rid of the habit of scratching your head? Let’s see how dermatillomania is overcome.

Cognitive behavioral therapy would be the treatment of choice for dermatillomania. Following Torales Benítez, J. and Arce Ramírez, A. (2014)⁽⁵⁾ The most appropriate techniques are cited, taking into account that the patient’s level of awareness of their repetitive acts must be considered when choosing one or the other:

• Stimulus control.
• Habit reversal training.
• Psychoeducation.
• Relaxation techniques, you can start practicing relaxation with a guided audio like the one you will find at the end of the article.
• Cognitive restructuring.
• Contingency control techniques.

The therapy of acceptance and commitment It is also recommended in cases of excoriation disorder.

The pharmacological therapy It can also help in those cases in which the patient does not respond to psychotherapy.

Finally, note that the yoga, aerobic exercise, acupuncture or biofeedback techniques They can add benefits to dermatillomania therapy (Torrales, J. et al, 2020)⁽³⁾.

This article is merely informative, at PsychologyFor we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

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