BACKGROUND: RELATED DISORDERS
Finding Commonalities with Other Disorders and Learning from Them.
Body Dysmorphic Disorder
Tammy: It might have been a teenager thing at that point cause you just don’t know how to handle the new hormonal changes that make your face break out?
M: True, but I knew I was hurting myself and did it anyway.
Tammy: The whole time, while picking it – it would be getting red – I would think I shouldn’t be doing this., but did it anyway. It wasn’t just like some kids who would pick if they got a whitehead, and you just get rid of the whitehead and put some clearisil on it and that’s it. I didn’t stop with just the whitehead…
M: You dug deeper?
Tammy: Yeh. And picking at blackheads that nobody would see. Except that when you look real closely in the mirror, you see it and I noticed that my girlfriends weren’t doing that. My girlfriends had beautiful skin, or if they had a zit it would just go away.
M: But you were so critical with your skin , you would go looking for something to mess with. Because that’s the way that I’ve been. Cause if I would leave it alone, no one would even know that it was there.
Although one kind of picking will not necessarily lead to another, they do relate at the causal emotional level. And they all have something in common with two other disorders: Body Dysmorphic Disorder and Obsessive Compulsive Disorder.
Health practitioners distinguish between organic or physical diagnosis and pyschiatric diagnosis. So when does acne or dry cuticles become a pyschopathologic skin disease? When do the exacerbations of an individual become more important than the actual symptoms of a dermatological condition?
Current hypotheses suggest that BDD is part of a spectrum of obsessive-compulsive disorders. The symptoms of BDD may be significantly blunted by serotonin reuptake inhibitors or behavior therapy
Body Dismorphic Disorder (BDD) has only just recently been looked at with close attention. Recent tests have been developed to measure the scale of severity and more research is just beginning to be done. It is also becoming increasing prevalent in our changing and demanding times.
Symptoms of BDD include most obviously unhealthy mental attitude towards and distorted view of the self, and acting out in accordance. Anorexia Nervosa and Trichotillomania are types of BDD as well as Dermatitis Factitia, the obsessive concern with slight or unimagined defect.
Body Dysmorphic Disorder – Trichotillomania
When the symptoms of dis-ease manifest themselves with ‘picking’ of the hair it is known as Trichotillomania. ‘Trich’, as it also known, is the recurrent pulling of hair out of one’s body resulting in noticeable hair loss. Like habitual picking, the disease of trich is more present in adult females than adult males. And the pulling of hair is usually done in private or at most when family members are around, rarely in public.
It is quite a paradox that a disease like trich is even mentioned, because we in western culture are taught all sorts of conflicting things about our hair. It is good on some parts of our bodies and not on other parts where it naturally appears. Both men and women go through great lengths to have hair removed through shaving, waxing, electrolysis, etc. and it is considered socially acceptable. Trich however crosses over the line of what is considered the social ‘norm’. Individuals who have trich suffer from the same set of psychological responses that habitual skin pickers suffer. Often there is an increased stress or tension immediately following a pulling hair session that is relieved by the act of pulling hair. Or the hair pulling may take place during periods of restful distraction (tv, driving), But in each case the action of pulling is irresistible and there is a sense often a feeling of satisfaction, pleasure, or relief when the hair is released, even though you know it’s not the right thing to do.
Body Dysmorphic Disorder – Psychodermatosis and Dermatitus Ficta
Psychodermatosis is a disease or problem of the skin caused by the person suffering from the disease due to psychological reasons first and foremost with medical reasons being secondary.
As the disease’s definition progresses into more serious picking it is termed Dermatitis factitia [artefacta] or Dermatitis ficta literally meaning fictional or artificial skin disorder. It is considered ‘artificial’ because the patient has self-inflicted wounds. Sufferers of this disorder in extreme cases inflict a wide variety of injuries by cutting, piercing, tearing, burning, freezing, or slashing themselves. This form of self abuse may also include head banging, nose or scab picking, genetil mutilation and bruising.. Examples of distantly related disorders are Autism, Personality Disorders, and Munchausen’s Disease. Tourette’s Syndrome, which is characterized by involuntary physical compulsions, often includes Dermatitis factitia through compulsive skin picking in response to an excessive and unreasonable fear of contamination. Picking pimples or tearing cuticles is a very mild form of dermatitis factitia, but it is still self inflicted injury.
Body Dysmorphic Disorder – And Finally… Acne Excoriee… Face Picking
Nervous, obsessive, compulsive, and habitual picking is not just the result of responding to an unbalanced physical situation, but a response to a deeper unbalance of the spirit. It is a dis-ease with the self that compels us to ‘do something’ to ourselves to fix it.
The medical term for picking at one’s face is “Acne Excoriee” literally meaning picked pimples which comes from “Acne Excoriee des Jeunes Filles” literally translating from the French to mean “acne created by young girls.” It was titled so because of the abundance of young girls who ‘fiddle’ with or aggravate their skin to the point where they cause major problems where there were only minor problems or even no problems at all. The result is scabs and various ulcerations usually on the front of the face. And interestingly enough, the habit of skin picking is far more prevalent among women then men.
When this habit of picking is taken to the extreme on other parts of the body it is termed Neurotic Excoriations or “Picker’s Nodules”. The name explains it what it is, but fails to express how painful and debilitating this disease can be. Self inflicted or self aggravated open sores and scabs appearing all over the body are not uncommon. Neurotic Excoriations usually begin with a chronic fungal skin infection or Lichen Simplex Cronicus. When the scabs fail to heal in a timely manner , the patient feels a irrepresible need to pick off the scabs feeling it is better to live with the open sores than the scabs. Sometimes it is felt that the wounds will heal better if the scabs are picked off. This is not an uncommon feeling in the case of Acne Excoriee des Jeunes Filles as well.
Acne Excoriee is recognizable because the lesions left behind from picking have a pronounced look to them. The upper and lower epidermis are usually scraped off leaving raw looking scrapes and flat lesions of hyperpigmentation.
Obsessive Compulsive Disorder
What differentiates habitual picking from a true OCD is that OCD is done in response to a belief a specific obsession or a self imposed rule systems, i.e. ‘I have to wash my hands 3 times before taking in the laundry.’ Skin pickers are generally less structured. It can be ritualistic, but it is more of a mindless drive to look in the mirror for flaws or the distracted act of pulling hangnails while doing another activity.
Habitual picking is a form of compulsion. It is a voluntary, but irresistible action or behavior usually in response to an obsession, that relieves stress or is meant to prevent something bad (like contamination) from happening. The patient recognizes these compulsions as excessive or unreasonable. Examples of compulsions include:
- skin picking/hair pulling – response to itching or skin obsession
- hand washing, wearing gloves – responses to contamination obsessions
- touching self, others, or objects – haphemania
- checking locks – response to “doubting” obsessions
- hoarding objects
- perfection obsessions.
There have been numerous books written about Obsessive Compulsive Disorder (OCD) and many of them have been listed in the back bibliography/resource appendix of this book.
And as many as 10% of the population are effected with some form of compulsive behavior.
While there are differences between habitual picking and OCD, much can be learned from the causes and cures for OCD.