By; Sathish. M. Sc (N). R. Lecturer Babe Ke Institute of Nursing – Distt Moga. (Pb)

Pathological Skin Picking disorder (PSP) or Neurotic excoriation, Compulsive Skin Picking Disorder (CSP) and Psychogenic Excoriation are the other names of Dermatillomania. This is a neurotic condition which is


characterized by repeated urge to pick at one’s own skin, often to the extent the damage is caused. History of PSP / Dermatillomania The origin of the term Dermatillomania is from Greek Word: Derma means Skin, Till is Pull, and Mania is known as Madness. The first known mention of dermatillomania in the print can be found in 1898 by the French dermatologist Brocq, describing an adolescent female patient who had uncontrolled picking of acne Prevalence of Dermatillomania Recent community prevalence studies suggest that skin picking disorder appears to be as common as many other psychiatric disorders, with reported prevalence’s ranging from 1.4% to 5.4%. (Jon. E et al., 2012. The American Journal of Psychiatry Nov. 2012)


Causes of Dermatillomania


Heredity – In addition to the role of physical, mental and pharmacological in causing PSP Disorder, the genetic role is also much

significant. Any Family history of Compulsions can be a cause.

Stress -.

Feelings of guilt, recrimination, and anger

fuel the compulsion to pick. 3.

Trauma - Emotional trauma can lead to feelings of
helplessness and insecurity

Signs and Symptoms of Dematillomania


Dermatillomania symptoms are characterized by a compulsive urge to pick at skin. Symptoms vary in the areas of body affected by the picking.  Face Picking  Scalp Picking  Acne Excoriee  Lip Picking  Nails and Cuticle Picking  Picking Scabs  Nose Picking (Rhinotillexomania)

Diagnosis Dermatillomania is not specifically

defined in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). The addition has been proposed for the fifth edition of the DSM as a condition where there is an intrusive compulsion to pick at one's skin that cannot be accounted for by another medical condition or mental disorder; where feelings of tension or anxiety precedes picking; where picking causes damage; and where the picking

results in immediate pleasure or relief but later causes distress or impairment to the subject.

Treatment The most effective is treatment for




Therapy (CBT). When treating Dermatillomania with CBT, the two most useful techniques are Habit-Reversal Training (HRT)

and Mindfulness Based CBT. 1. Habit – Reversal Training (HRT) Increasing awareness of one’s picking

patterns is central to the process of Habit Reversal Training, and is generally done by keeping skin picking logs. These logs help the individual to identify picking patterns that they previously may not have realized or understood. For many with Dermatillomania, Habit Reversal Training may also be made easier if they use “habit-blockers” such as gloves, which help to provide a barrier to unconscious picking.

2. Mindfulness Based CBT The central thesis of Mindfulness Based CBT is that much of our emotional distress is a function of over-reacting to unpleasant, unwanted feeling states that are a normal part of the human experience. The goal of Mindfulness Based CBT is to learn to accept and tolerate these normal feeling states, despite the fact that they are unpleasant.

Antidepressants Antidepressants are often used to treat people with Dermatillomania and obsessive compulsive disorder. The antidepressants work by affecting levels of serotonin in the brain; therefore, improving the patient's mood. Antidepressants also work for these patients by diminishing obsessive thoughts and diminishing their the need to continue behaviors.



Commonly prescribed antidepressants are


(fluoxetine), Zoloft

Anafranil (sertraline), Paxil


(paroxetine), and Lexapro (escitalopram). It can take up to 12 weeks to relieve OCD and Dermatillomania symptoms once

antidepressant treatment begins.


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