Hypnotherapy for skin picking, dermatillomania and excoriation (skin picking) disorder

Is your skin picking resulting in permanent damage? Perhaps you have a sense that you must remove imperfections to create smooth, blemish-free, perfect skin? Does your skin picking/scratching take up a lot of time and energy? Have you tried to use willpower to stop, but not been able to? Are you wearing clothes and make up specifically to cover up scars, infections or scabs? Do you feel ashamed, that you have to keep your skin picking a secret?

We specialise in hypnotherapy for Body Focused Repetitive Behaviours (BFRBs) like hair pulling (trichotillomania), skin picking (dermatillomania), nail biting (onychophagia) and thumb sucking. Sian is a Professional Member of The TLC Foundation for Body Focused Repetitive Behaviours, and has completed their professional training for treatment of BFRBs.

What is skin picking?

Skin picking is one in a set of disorders categorised as Body Focused Repetitive Behaviours (BFRBs), which occur on the Obsessive Compulsive spectrum. It is three times more common than anorexia, with a prevalence of between 1-4% in the general population. Typically, people will regularly engage in repetitive self-grooming habits that end up damaging their bodies, for example, pulling, picking, biting or scraping of the hair, skin or nails. It's important to note that the intention is to remove perceived imperfections, so this is not self-harm - any damage is a by-product, rather than desired outcome.

In addition to the physical impact of skin picking, people often also experience a sense of shame and isolation, frustration, anxiety and low self-esteem related to the behaviour. This often creates a vicious cycle, as the skin picking has a negative effect on relationships, work and overall quality of life, which often leads to more skin picking to alleviate the uncomfortable feelings being experienced.

While there are instances of people who have started skin picking much earlier than adolescence, most people who pick their skin (or engage in other BFRBs) start between the ages of 11 and 13. It tends to occur more frequently in women, but this may be due to that fact that men tend to under-report health issues. Over time, skin picking often features cycles of varying severity.

What's in a name?

This behaviour has a range of associated terms eg skin picking, dermatillomania, Skin Picking Disorder. In May 2013, the latest edition the Diagnostic and Statistical Manual (DSM-V) was released and skin picking was added to a new category called Obsessive-Compulsive and Related Behaviours. It was also agreed that the new medical term for skin picking would be Excoriation (Skin Picking) Disorder, over and above Skin Picking Disorder, or the more commonly used term, dermatillomania.

Symptoms of skin picking (dermatillomania)

Skin picking can happen when a person is awake and aware of what they're doing, frequently resulting in highly focussed picking/scratching sessions that can last several hours. Skin picking also occurs when a person is unaware, or focussed on something else; for example, when watching TV, reading, using a computer or phone. It can also happen when people are asleep. Often the experience of skin picking is pleasurable or satisfying as a person does it, making it more challenging to change the habit.

Skin picking follows the classic negative cycle: generally, an urge to pick/scratch arises, caused by a trigger (obvious/not, internal/external). The trigger can be active (eg grooming behaviour such as scanning for imperfection) or just a sensation (tingling, itching) that occurs. Attempts at resistance are made, followed by giving in and picking/scratching until reaching a point of satiation, which may take minutes or hours.

Afterwards, immediate feelings of relief start to give way to a strong awareness of the damage done, along with feelings of failure, shame, self-criticism, anxiety and being out of control, and resolution to not pick again. These negative reactions lead to uncomfortable feelings, which often triggers more skin picking.

You may experience all or some of the following symptoms as part of your skin picking:

• Sense that skin must be made smooth, perfectly blemish-free, along with a high sensitivity to any perceived imperfections
• Strong urge to pick, scratch, or otherwise act to remove imperfections from your skin (with nails or implements), often to the point of pain and/or bleeding
• Scabs, scars, tissue damage, infections
• Repetitive strain injuries or joint damage from regularly holding picking/scratching positions for long periods
• A lot of time and effort spent on your skin picking activity, routines and its consequences
• Concealing the impact of your skin picking, for example lying about causes of marks; using make up, clothing and accessories to cover up, and avoidance of situations where skin may be exposed
• Feelings of relief immediately after picking, followed by a sense of being out of control, weak, frustrated, uncomfortable in your own skin/body dysmorphia
• Low self-esteem, anxiety, isolation, depression, which have an ongoing negative affect on your work, relationships and health

Causes of skin picking (dermatillomania)

Currently there is no clear understanding of exactly what causes skin picking. The following are likely to be causal factors, though no single cause has yet been established: genetic predisposition, disruption of common grooming behaviours, environmental factors (stressful events). It seems reasonable to assume that skin picking tends to be the result of a combination of these variables at any given time.

Skin picking (and other BFRBs) often appear to run in families, which means there may be a genetic predisposition to them. However, there is not yet any conclusive research to indicate that this is the case. It is also worth noting that even if there is no genetic basis to a behaviour, early exposure to important figures having these responses can contribute to an individual modelling their own behaviour after this example eg all the women in our family pick their skin.

Another possible cause may be that skin picking (and other BFRBs) is the result of disruption to the natural grooming behaviours common in most living beings. It has been established that animals in stressful situations can develop similar behaviours eg licking skin too much resulting in scabs, or eating their own fur. Further research is necessary to understand these similarities and how they can further understanding of the conditions and treatment approaches.

Temperament may also have a bearing on the development of skin picking. Recent

research has shown that traits such as perfectionism, anxiety, and low tolerance for boredom and frustration are more prevalent in people who pick their skin (and other BFRBs).

Environmental factors (stressful events) are often clear triggers for an increase in skin picking (and other BFRBs), though it is not clear whether they can function as a single cause that initiates the behaviour. Stress tends to reduce our ability to be in control and increases our focus on short term relief from the unpleasant impacts on mind and body. This can make it challenging to tolerate the discomfort of an urge to pick, or to stop a picking cycle before it gets worse.

Stress and anxiety often also creates a focus on the negative, so self-esteem can drop, and withdrawal and social isolation increase. Strategies to manage stress and anxiety on physical, emotional and mental levels are generally very effective for skin picking, both in the moment and over the long term.

How hypnotherapy can help skin picking (dermatillomania)

When skin picking, individuals often show many of the characteristics of being in trance. Their attention is narrowly focused, they are powerfully engaged with the activity using all senses and time may seem to disappear. And all this is often triggered by a powerful suggestion/cue that has been built and reinforced over time when in this trance-like state. So, in many ways, people who pick their skin already have a lot of experience at going into trance and using it to reinforce behaviour and its benefits - they just need a bit of help to turn that power in a positive direction.

Hypnotherapy is very effective for skin picking (and other BFRBs), as it can help you regain control, increase your awareness and ability to choose more beneficial responses. The hypnotic trance is also good for deep relaxation, so your stress and anxiety levels are reduced, which in turn makes it less likely that you'll want to pick your skin.

In the deeply relaxed state of hypnosis, your subconscious is more receptive to revising thoughts and actions, so you can:

• increase your awareness of how skin picking operates, especially increasing awareness of your hands
• regain control of your focus, so you can tolerate thoughts and urges more readily and consistently
• create and rehearse a new, personalised response that is incompatible with skin picking
• identify trigger situations and people, and rehearse using your new response in these situations
• increase your calm, confidence and relaxation, so the need for skin picking is reduced
• develop a "stop at one" response in case you do start to pick
• build a robust, personalised plan for dealing with any relapses quickly and constructively
• learn how to use self-hypnosis as a direct substitute for the habit/behaviour, as appropriate
• safely and easily identify and work with any past experience/s that may be contributing to your picking

Hypnotherapy can also help you develop the determination, confidence and patience to go through the process of your skin healing and the challenges that are part of the process, such as not picking at scabs or cuticles, keeping going even if you do pick again, and beginning to feel more comfortable with letting light and air onto your skin.

For more information about hypnotherapy for skin picking, or to book an appointment, contact Sian on 07725 732810 or email.

...I can honestly say my sessions with Sian have changed my life. I have not rubbed my eyebrow at all since my first session (it has now grown back) and we progressed to addressing other habits, particularly picking my skin...
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...since the session, I've noticed a really dramatic change, especially with the tendency to pick & scratch my arms when I get anxious or nervous. It's like my hands just don't want to do it any more, instead they just glide over. It's a really amazing change!...
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...I found the sessions very useful, as I'm much more relaxed now and pulling my hair less and less. I was very nervous beforehand, but you put me at ease straight away. I have to say I was pleasantly surprised at the results: I feel more in control, my scalp is looking much better, and I even have some new hair growing back!...
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...I cannot thank Sian enough for helping me overcome my fear of speaking French. This resulted in me being able to enjoy a great holiday, unmarred by any major worry about speaking the language when required. I never thought that would be possible!...
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...since our last session over 5 weeks ago, I have carried on with the success from the first session, with only 2 nights of disturbed sleep in this period. This is an unbelievable change from sleep walking and talking every night for almost 20 years!...
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...I have to say that my recent therapy achieved far more than my expectations. After only three sessions, I have managed to put some very negative past experiences behind me, and I can already see huge positive changes in my outlook and ability to cope with anxiety and stressful situations...
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