Compulsive Skin Picking

Learn how to prevent and respond to skin picking, also called dermotillomania, often referred to as a form of self injurious behavior that can be seen in children with developmental disabilities and/or obsessive compulsive disorder -OCD. This type of behavior can lead to open sores and scabs on the body, resulting in scars and infections over time. The majority of cases occur in females and causes are said to be related to emotional and psychological reasons.

In my experience, I have found that a lot of times there is a very easy solution. Compulsive skin picking can often start out as simple scratching due to dry skin. The scratching and picking can result in relief from an itch and some scientists believe it can also release endorphins, which are feel good hormones.

When skin is at its optimal health it not only helps to relieve the need to scratch, but it also protects it from scratching and picking lesions. There are also sometimes little bumps caused by a condition called Keratosis Pilaris, which can lead to compulsive picking. 

When presented with little bumps either from this disorder or another problem, such as acne or eczema, the compulsion to pick can be very compelling for some individuals. Therefore, putting proactive practices in place to increase skin health, keep hands occupied, and increase alternative methods of releasing endorphins can work to decrease the problem behavior.

One individual I worked with had a compulsive skin picking problem for many years. After observing and questioning her, it was determined that she frequently felt itchy. An antihistamine was prescribed along with redirection efforts from her staff and the skin picking decreased substantially. I also worked with another individual in which dry skin was present. After applying daily lotion and changing body soap, there was a dramatic decrease in compulsive picking.

Tips for Decreasing Skin Picking

Utilize as many of the following tips together as much as possible for optimal results:

Increase water intake to aid in hydration of the skin.

Change to sensitive soap and laundry detergent. Using cheap soap and shampoo come at a greater cost than money. They can leave the skin dry and flaky, causing serious itchiness, dandruff, eczema and even hives.

Avoid using soap on large areas of the body by limiting their use to the important parts (underarms, private parts, hands, feet, creases, etc.) to avoid drying out the skin. Water is usually good enough to wash the larger parts of your body, unless you have come into contact with something that would require a more thorough washing.

Avoid long hot showers or baths. This can cause too much dryness.

Use a really good lotion every day twice a day if possible. 

My son has problems with eczema and other lotions actually made it even worse, but for some individuals Eucerin or even Aquaphor can also be a good lotion. However, if you are still having difficulties with the skin being damaged, it may be that the lipid barrier is damaged. There is actually a product created by world renowned dermatologists to help repair your lipid barrier. This would cause irritated skin that a child may be picking as a result. There are also products that can help with the appearance of scars from picking and to eliminate symptoms of the condition keratosis pilaris. If you are interested in learning more, please contact me for more information.

Avoid giving a lot of attention directly to the behavior, by saying stop or don’t do that in case it may be an attention seeking behavior. Instead try to redirect the child to a different activity that involves the use of hands.

Praise the frequent use of small manipulative toys- Keep hands occupied during times that compulsive skin picking is the worst. Use things such as a rubics cube, stringing beads, lacing boards, a handheld magnadoodle or handheld magnetic maze/game to occupy the hands. You will also want to redirect children to engage in these activities as soon as any compulsive skin picking occurs.

Keep as much skin covered as possible that is comfortable for the weather. If unable to access unexposed areas, there will ultimately be less compulsive picking.

Provide frequent compliments for nice skin. Praise children for not skin picking by frequently telling your child how great his or her skin looks, how proud you are, how proud your child should be of keeping his or her skin looking so good.

Engage in other endorphin releasing activities. Exercise, spicy food, listening to calm and soothing music for 30 minutes, laughing, and sun exposure all release endorphins and can effectively replace compulsive skin picking to contact endorphins.

When all of these strategies are used in combination together you are sure to help children decrease this type of self injurious behavior. If it continues despite efforts, please be sure to seek professional help as the behavior can eventually lead to serious infections and other complications.

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