Everybody pops a pimple. Or picks a scab. Right?
For the most part, that’s true. But people with Chronic or Compulsive Skin Picking (CSP) have uncontrollable urges to pick their skin; sometimes up to hours a day, causing emotional distress and visible damage to their skin. The face is usually the primary location for picking, but can occur on anywhere on the body. Picking is not like cutting. They don’t want to hurt themselves. Skin picking is their response to unpleasant emotions like anxiety, stress, or depression.
“Everyone picks at their skin on some level,” says Bryan Bugay, a professional counselor who specializes in CSP in his private practice in Northfield. “The difference is, a person without CSP picks their skin and feels pain–it hurts. But for the 2 percent of the population that suffers from CSP, the act is pleasurable. It feels good.”
Sufferers pick, pull, or squeeze their skin to find relief from emotional distress. Some use “tools” like tweezers, pins, or paper clips, in addition to using their fingers and nails. It’s described like being in a trance, or zoning out in front of a mirror until they’re satisfied with their progress.
Considered a Body-Focused Repetitive Behavior, it’s not yet clear what causes CSP. Some research links CSP to genetics. Other studies report evidence that chemical or hormonal issues may cause this self-injurious behavior. Girls are seen in treatment more often than boys, and it’s been known to occur in children as young as under 10 years old.
When it’s over
A frantic, desperate attempt to hide or fix the damage occurs when they realize what they’ve done to their skin. Their strong guilt leads to avoiding responsibilities, social isolation, and a decline in self-confidence.
“Everybody has fidgety habits like chewing pens, or playing with jewelry,” says psychologist Karen Cassiday, owner and director of the Anxiety & Agoraphobia Treatment Center in Northbrook. “But skin-picking is a very absorbing behavior.”
Having a secret
Young children often lack insight to their harmful habits, or are ashamed to reveal them. Cassiday says some children have “no shame or embarrassment” telling their parents. Others are “very aware of their parents’ disapproval, and try to hide it.” According to Cassiday, refusing to go to school may indicate how severe a child’s picking might be. The visible sores and scabs can cause “exquisite embarrassment.”
About 75 percent of the time, kids pick when they’re alone or bored,” says Bugay. “The most common times kids pick is when watching T.V., reading, at school, and before bedtime.” Bugay adds, kids often visit his office for unrelated issues, but with time, they disclose their picking.
The mom of 8-year-old Katie, who asked to not use their last names, says she noticed Katie wearing band-aids and long-sleeve shirts to school more frequently–a common indicator that a child may be picking, Burgay says.
She couldn’t stop picking mosquito bites on her arms,” says Katie’s mom. “A scab would form, she’d pick it, then it would bleed. Another scab would form, and she’d pick again, and again, and again. She couldn’t stop.”
According to Bugay, “Picking and scratching mosquito bites is the biggest precursor for kids to develop a skin-picking habit.
When she realized Katie’s classmates were questioning the scars on her arms, she asked Katie why she’d been picking. Katie responded that “she liked it.” That it was “kind of cool and felt good.”
Treatment
“No two skin pickers are alike,” says Cassiday. “Treatment will be different for every person.” Treatment typically involves a combination of therapy, support groups, and sometimes, medication.
Identifying what initiates a picking episode is crucial, says Bugay. When an individual becomes aware of their “triggers,” new thoughts and behaviors patterns can curb the urge to pick.
Cognitive-Behavioral Therapy (CBT) incorporates new, positive thinking and behavior strategies to help reduce stressful emotions; therefore, decreasing picking episodes and associated shame. Things like fidget toys to keep the hands busy, wearing cotton gloves, or covering fingertips with band-aids are a few ways to divert any urges. Medication may also be necessary, usually when anxiety or depression issues exist.
Determining the underlying cause of a child’s skin picking is crucial; It may be a symptom of an unrelated disorder. Cassiday says skin picking can indicate a developmental, or sensory integration issue.
Attempting to stop skin picking alone is often unsuccessful. The best thing parents can do if their child picks their skin, is to find a professional familiar with Cognitive-Behavioral Therapy or Body-Focused Repetitive Behaviors. Never tell a child who’s picking to, “Just stop doing it!” or “Why can’t you stop?” Support and positivity about their improvements is the most beneficial therapy a parent can offer a child.
List of sources
Bryan Bugay, LCPC
Karen Cassiday, Ph.D.
Stephanie van Eekeren, mother
