Pick Sanity, Not Your Skin

Does Excoriation Disorder go only Skin Deep?

Skin Picking: Where Delight Supersedes Discomfort!

​Anxiety can get the better of anyone. You can lose concentration, develop gastric ulcers, graduate towards depression, get aggressive, pick at people or worst, pick at your own skin! Yes, you heard it right, pathological skin picking exists and is serious psychological disorder. If we look around keenly we will find almost every third person biting nails (onychophagy), breaking their acnes, chewing on their skin (dermatophagy) or picking at it. Such habits, which are often ignored as silly disgusting ones could be a consequence of stress, depression and anxiety. Also technically known as Excoriation disorder or dermatillomania, skin picking falls under the umbrella of Obsessive Compulsive disorders. It is as noxious a habit as substance abuse and can be shockingly fatal too if not treated with behavioral or pharmacological interventions.
 
As teenagers, we used to enjoy cracking acne and pimples on not just our own faces, but our friends’ too! It pained us like crazy after the first rupture, and the second, yet we would somehow find a deep satisfaction and pleasure in continuing to do so till our faces got sore with hemorrhaging eruptions! Skin picking was not alien to us, just that we didn’t know that it was a disorder. As young children, it was easier to break habits because we would invariably have our parents standing with whips around us, or perhaps small life bumps didn’t throw us off-guard. But as we progressed in age, our lifestyle, socioeconomic factors, interpersonal relationships, work pressure and lack of support turned our stress level into an ace tennis shot that could not be returned! Be it as gross as alcoholism and substance abuse or as subtle as biting nails and picking skin, more than often, psychological habits become untenable to break.
 
Your first reaction to someone earnestly picking at his skin would be to stop him. Next would be to find it repulsive and perhaps vanish from the sight. But any kind of revolting response from you would not deter the picker to stop. This is plainly because it is a compulsive action. There is a clear lack of control over the urge to pick since the act gives an initial sense of pleasure till a point a peeled skin breaks and a wound starts to stare back. Not that he is unaware of it, oh hell yes, it pains! The wound bleeds and soon invites infections to grow into purulent lesions, disfigurement and turn into septic tanks!

If you are an ardent skin picker, we are going to find your brain telling you things like these (in exact order of events!):

1. “I just cannot help it!”
   The urge is irresistible. You feel you are completely taken over by this demon and there is no way out of the tunnel but to go through it.
2.  “It pains but I feel good!”
   There erupts that extreme sense of satisfaction and pleasure as the first slice of skin is extricated.
3. “I want to do more of this!”
   That first bout of pleasure leads to a domino effect. To continue picking, often at the same spot or region is the natural cascade. You know it is a negative behaviour but you cannot hold back the compulsion.
4.  I feel light!”
   You feel relieved. Since the very root cause of excoriation disorder is stress and anxiety, this activity naturally has a relieving effect, although temporary.
5. “OK this is sore. I need a new spot!”
   After repeated picking, the wound and soreness automatically shifts your focus to new spots. From face to arms to soles to back, you spare no square inch!
6. “Ok body, I give up!”
   ​There is a breaking point for everything. Your sores are infected and hemorrhaging. Your body is giving up and your mind is anyway muddled. Do you hear the ambulance siren already?
   ​
   

​Pathological or purely psychological?
The neuroimage film of a picker will be as clean as a non-pickers. But the images will definitely show minor or major changes in brain activity for those suffering from acute/chronic anxiety disorders and lack of motor-inhibitory control. To say it in simpler terms, picking has been considered just a by-product of an underlying monstrous process and a shoulder to lean on. Yet, its severity in most of the cases has compelled experts to treat it as a primary disorder since it comes with distinct clinical features and an outstanding incident rate. Increased and constant dopamine concentration has been seen in pickers, which clearly indicated the compulsive intention to derive pleasure in picking despite pain receptors screaming at them to stop!
 
Pick your food to stop picking!
This crucial aspect always goes underestimated and unnoticed.

1. Neurotransmitters are proteins. Give your body sufficient amino acids through a good proteinaceous diet.
2. Low blood sugar is one of the most potent triggers of picking! A bad, little or no breakfast can make you irritable and resort to picking-habits.
3. The good fats are always waiting to empower your cerebral cortex. Don’t ever ignore your omega-3s and omega-6s.
4. Dehydration can make you sluggish and give you mind-blowing brain fog. Well, literally! Eat one less spoon of rice, but never one less glass of water.
5. Caffeine, alcohol and excessive sugary or processed foods are neuro-hyper-stimulants; perfect recipe for disaster! Don’t portion them, just stay away from them. 

Clichéd, but we undeniably are what we eat. Good food may not treat the symptoms completely but can definitely lower the severity of mood disasters.
 
Appease the Hercules
The only therapy for picking is treating the cause.

1. Knock the door of a therapist. Let him identify your distress and help you de-tress.
2. ‘Squeeze to Ease’: squeezing a rubber or foam ball is one of the best ways to keep hands occupied and distracted. This is termed as habit reversal therapy.
3. A more challenging approach is controlling the stimulus: changing the environment that triggers picking. Like, preventing the pickers to look at any deformities on their body or covering any prospective area of attack with fabric, etc. But it is cumbersome and has a lower success rate because it is totally under jurisdiction of the picker.
4. If nothing works, pharmaceutical industry is anyway always at your disposal. Depending upon the underlying psychological disorder, drugs can be prescribed to alleviate anxiety, stress and depression.

 
Skin picking can be as traumatizing as any other pathological condition; and it being catastrophic to the limit of turning fatal is alarming.

A 51 year old was wheeled in to the emergency for a possible stroke. On closer examination, a deep gash splitting right through her dermal layers and exposing her cranium was revealed. The neuroimages indicated an intracranial infection which caused her intense dizziness and headache for days before she collapsed.
With a history of severe acne and an uncontrollable urge to pick at them first with a sewing needle and finally with a knitting needle, she finally landed herself on a cruise close to death!
 
As I was rummaging through substantial information for this blog, reading this case report set my panic button on and I just managed to rip the cuticle off my index finger! I need a band-aid as much as the pickers need aid. And if you are one, leave your skin alone and grab your sanity back!

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