Serious Note : Skin Picking

Sorry, nothing too fun today. Today is more for your information. I found this article about Skin picking which is a condition that is associated with OCD. Skin Picking is more common than you might realize, and who knows, you might have a friend, or a family member, who goes through this, or it might even be you. I hope this benefits someone out there.

SKIN PICKING AND NAIL BITING: RELATED HABITS

By Fred Penzel, Ph.D.

It may come as no surprise that there are other types of problem behaviors quite similar to trich in a number of ways. I am referring specifically to compulsive skin picking and nail biting (also known as onychophagia). These may not sound serious, but neither does hair pulling to some people. Since I have met quite a number of people who have one of these problems in addition to trich, I now routinely screen for them.

What I am referring to is not the kind of little bits of rough nail or cuticle that everyone picks at or bites from time to time, nor is it the occasional blemish that people might squeeze or pick. These nail-biters continually bite their nails past the nail bed and their cuticles until they bleed and are constantly walking around with red, sore, and sometimes infected fingers. Those who pick their skin compulsively have their faces and bodies covered, at times, with red sores and scabs known as acne excoria, a self-inflicted skin disorder that resembles acne. The smallest pimple or blemish must be opened and picked at or squeezed, either with the fingers or another implement such as tweezers, needles, pins, toothpicks, etc. Numerous scars are often the result.

Just as those with trich wear hats, scarves, wigs and makeup, nail-biters keep their hands behind their backs or in their pockets, and skin pickers wear makeup, put on clothing that covers bad areas, apply Band-Aids or just stay indoors when looking their worst. They feel the same shame and social embarrassment and experience that out-of-control feelings at times. They, too, wonder why they can't stop and they also question whether or not they are crazy.

Another similarity between these problems and trichotillomania is that they seem to happen when people are in one of two modes. Some do it in an automatic way, as if they are in a trance and not really thinking about what they are doing. Usually, they are involved in some other activity at the same time such as reading, talking on the phone, working at the computer, watching TV, etc. For others, the deliberate picking or biting is their main activity at the time, and they will frequently interrupt other activities to engage in it.

There is also a strong commonality seen in the various purposes behind these three problems. At the most basic level, they satisfy an urge. Many report an almost uncontrollable feeling of needing to do them. Pulling, picking or biting also seem to deliver a pleasurable or relaxed sensation. When sufferers feel stressed, doing these things has a kind of soothing effect on their nervous systems, and reduces levels of stimulation. On the other hand, when they are bored or inactive, they seems to provide a needed level of stimulation to the nervous system. This probably accounts for why so many people who dislike doing them find it so hard to stop. It simply "feels good" at the time, no matter what the consequences. These behaviors may really be all about self-regulation in certain individuals whose nervous system may not be doing a very good job of regulating itself (see the article "A Sensory Regulation Theory of Trichotillomania," on this website).

Another factor also seems to be at work for a subgroup of people. This involves a kind of compulsive perfectionism. Some hair-pullers must pull "special" hairs that feel "different" or as if they don't belong due to their look or feel. In the same way, nail-biters will often try to bite off rough-feeling or broken bits of cuticle or nail sticking out in order to make their nails feel smooth and look "perfect" or regular. Skin-pickers will stand for hours in front of mirrors closely examining their faces or other body areas for the tiniest bump, irregularity or enlarged pore and then try to eliminate it, or drain it, in hopes of achieving a 'perfectly' clear complexion. Paradoxically, all of those who pursue such goals always end up looking much worse in spite of their efforts, as a result of the damage that they do to themselves.

What all these similarities seem to point to is that these three behaviors are probably all different aspects of the same problem.Some have theorized that theret may be that the same out-of-control grooming mechanism in the brain underlies them all. My own theory is that there may be some type of dysfunction of a brain mechanism that regulates levels of stimulation within the central nervous system, and that these behaviors represent an attempt to control these internal stimulation levels externally. People seem to pull, pick, or bite when thery are either overstimulated (dus to stress or excitement) or understimulated (due to boredom or inactivity). Many similar behaviors can be observed in animals who are kept in confined or unstimulating environments, or who live in stressful conditions.

There are many that now believe that compulsive hair pulling, skin picking, and nail biting form a subgroup of what is becoming known as the Obsessive- Compulsive Disorder Spectrum. OCD has been previously been regarded as only a single disorder. It may in fact represent a range of related disorders, including classic OCD, Body Dysmorphic Disorder, Anorexia Nervosa, Bulimia, Trichotillomania, Onychophagia, Compulsive Skin Picking, Compulsive Nail Biting, and Tourette's Syndrome. Recently, a new term has been coined for these problems - Body-focused Repetitive Behaviors (BFRBs). As with trichotillomania, skin picking and nail biting are considered to originate within the chemistry of the brain, and may well have an underlying genetic cause.