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Excoriation disorder: The skin picker’s survival guide

Also called Dermatillomania, skin picking refers to the repetitive urge to pick, peel, pluck, and dislodge swathes of skin from the face, limbs, and torso. The senses process signals apparently highlighting minute imperfections or faultiness in the skin surface that call for immediate correction. The fingers then manipulate the surface by a rubbing, scraping, peeling action which significantly damages the skin.

Surveys indicate 2 to 5 percent of the American population is affected by this disorder, and three-quarters of the victims are women. Many report significant tissue damage because of the compulsively abrasive action.

What precipitates the disorder remains largely speculative. Theorists say that it could be one or all of biological (inherited) triggers and environmentally provoked factors like the emotional trauma that lead to excoriation disorder. The body starts resembling the cratered surface of the moon. Anybody who has personally experienced the horrors of skin picking needs a survival guide.  We present the best survival tips suggested by skin pickers who lived to tell their tale.

Your strategic guide to prevent skin picking

The tips to avoid recurrence of skin picking compulsions can be broadly classified under five main categories:

1. Pressure- touch stimulation: the sensory strategy

Using competing activities for tactile stimulation is an important strategy that addresses skin picking directly. The idea is to keep the fingers from probing the skin. Get hold of one of those palm-sized devices that function as skin stimulators and massagers rolled into one. A soft-tipped brush gently exfoliates the topmost layer of skin while toning up the exposed surface. The pleasant sensation drives away the itch factor and prevents skin damage.

Setting quality time aside for a regular face caring (cleansing, toning, moisturizing) ritual delivers a tactile sensory experience that distracts the mind from skin harming behavior. You will find yourself actually enjoying the routine.

This may sound weird but gardening, particularly the act of weeding patches of fruits and veggies, delivers a therapeutic high for skin pickers. From peeling skin to pulling weeds, it’s a transition that guarantees a better world and a body full of intact hair.

The fiddle/fidget toy we played with in childhood would be the ideal distractor for the skin picker submerged in a sea of tactile sensations. Examples are the outsized cube with raised buttons that emits a clicking sound on pressing; a fluffy stress ball that produces squeaky sounds on squishing; nontoxic viscous slime is another great fiddle toy that keeps both hands busy and senses engaged as you mold different shapes.

The key to the sensory strategy is to keep fingers off the skin, using gadgets to deliver tactile sensations in a gentler fashion.

2. Manipulating thought and mental imagery: the cognitive strategy

Just as we exercise a muscle to become fitter, we can also change thought processes to become smarter at combating repetitive behavior. As the urge intensifies to pick the skin, train yourself to pop the question, “What is worrying me at this precise moment?” Once the mind is engrossed in finding a solution to a pending anxiety, the urge recedes into the background.

It may help to categorize the skin surface into three areas. C category refers to all healthy skin surfaces; these areas are a strict no-go zone. Their sanctity just cannot be violated. B category areas are diseased, infected or bruised areas that may be healing under medication. These are generally avoided; else it would worsen the problem. That brings us to Area A where you may encounter small boils, blisters, and acne that a normal person would automatically clear. So, when the urge dominates, simply convince yourself you’re not obliging unless it is an A spot.

It would be a wise move to strengthen the thought process with the line, “I will resist the urge and not succumb to the temptation.” To further reinforce your resolve, you may allow 2 to three minutes of dedicated skin picking time daily, leaving no room for the impulsive picking. It also helps to be alert to moments of reflectiveness, daydreaming or inattentiveness. The quicker you snap out of such moments, the better are your chances of avoiding the urge.

3. Healing disturbing emotions; the emotive strategy

You can benefit from the power of thinking positively through the gentle art of affirmations; repeatedly tell yourself that you will succeed in getting over the obsession. This is a powerful strategy because being emotionally positive and upbeat leaves you little time to dwell on the negatives or what might go awry.

Keeping a personal diary listing all the positives that happened to you each day has a hugely therapeutic effect on disorders of the mental plane. Give yourself a gold star when you break the spell of an exceptionally powerful urge.

Peer counseling (seeking the company and guidance of fellow skin pickers) is an excellent remedy for loneliness.  These sessions also pave the way for exchanging feedback on strategies that work.

Skin pickers usually have trouble retaining normal sleep patterns as their condition worsens. Spend the hours before bedtime engaged in pleasurable and emotionally fulfilling activities like reading or listening to music. This makes you less vulnerable to negative thoughts. Follow up with a healthy cup of relaxing chamomile tea.

4. Controlling external factors: The environmental strategy

Other than biological and behavioral issues (ADHD, OCD), certain external factors such as the environment in the home or workplace can trigger this disorder. It helps to identify and isolate these triggers and take evasive action as quickly as possible.

Emotional and sexual abuse, for example, carries bedrock of trauma that makes way for skin picking tendencies. Cognitive behavioral therapy in combination with medication, as prescribed for OCD, is extremely effective. Combating other factors needs simple adjustments to one’s lifestyle;

The compulsion to groom and exfoliate the skin can be nullified by following a skin care ritual where you pamper the skin with creams, conditioners, toners, and moisturizers.

It works wonders to avoid or minimize mirrors, at least in the home, to lower the chances of receiving and responding to visual cues that may trigger skin picking.

Dimmer or diffused lighting present one’s body in a positive light, hiding the blemishes that trigger an attempt to achieve grooming perfection. By consciously avoiding opportunities to scrutinize your face and body in harsh lighting, the better your chances are of reducing the compulsively destructive behavior.

Avoiding gluten and sugar-rich foods pave the way for a healthier body unaffected by allergies and serious skin conditions.

The Bottom-line:

These and many other tips will be forthcoming if you join a self-help group of skin pickers. Close interaction with similar sufferers will go a long way in creating a unique and customized model for behaviorally managing your Body focused repetitive behavior.

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