Alternative Therapies for Excoriation (Skin Picking) Disorder: A Brief Update

Research for effective evidence-based therapies continues for excoriation disorder with promising results.

While the cause and mechanisms of excoriation disorder remain elusive, it is considered a body-focused repetitive behavior within the spectrum of obsessive-compulsive disorders (OCD). The research on effective treatments for OCD spectrum disorders and body-focused repetitive behaviors is helpful in addition to the research findings specific to excoriation disorder.

Current treatments

When treating excoriation disorder, evidence-based practice suggests a combined approach of pharmacology and psychotherapy.

Treatment is based on the way a person experiences excoriation disorder. For those who suffer from automatic, unconscious picking, treatment focuses on creating awareness, identifying triggers for picking behaviors, managing the triggers, and making conscious efforts to choose behavior. Those who suffer from picking behaviors in response to stressors, treatment focuses on recognizing stressors and managing stressors as well as changing habits and thinking related to picking behavior thereby giving someone power over impulses.

Alternative therapies

We know many body-focused repetitive behaviors are triggered or worsened by stress, mood and anxiety whether someone struggles with automatic or reactionary skin picking. Medications and psychotherapy strive to reduce impulsivity and manage stress, mood, and anxiety. Alternative therapies that promote awareness or mindfulness and reduce stress or anxiety show positive results when added to existing pharmacological and psychological treatments.

The difficulty with alternative therapies is that there are few, if any, randomized controlled trials (RCT) that show how well they work. These types of trials are the gold standard for research, the ones that can show that something works compared to something else. While research is useful to review when considering what to do for yourself, it often takes some time. Everyone’s experience with skin picking is different, and alternative therapies may benefit you more than the research suggests.

Yoga

Research suggests implementing yoga in combination with medication and psychotherapy showed significant benefits for those with obsessive-compulsive symptoms compared to those who only used medication.1 The practice of yoga focuses on mindful breathing, body awareness, and controlled movements, activities that help focus one’s attention on the present thereby disrupting automatic picking and improving the practice of mindful awareness for those who pick in response to triggers. Yoga also shows a reduction of anxiety symptoms. Studies that looked at brain imaging of those who practice yoga showed a difference in parts of the brain that helps to regulate emotions, where those who practiced yoga were better able to regulate emotion. While the research is not definitively saying that yoga helps with ED, it seems most effective when used in combination with medication and therapy. 1

Aerobic Exercise

The research on aerobic exercise is similar to yoga. Exercise shows improvements in mood and anxiety, two things that contribute to skin picking behavior. One study showed a significant reduction in symptoms with adults who took part in 6-12 weeks of aerobic exercise. 1

Acupuncture

Most research on acupuncture focuses on obsessive-compulsive symptoms. It works on the serotonin systems in the brain as well as the hypothalamus and limbic regions which are thought to contribute to body-focused repetitive behaviors. Acupuncture used in combination with medication and psychotherapy showed a decrease in obsessive-compulsive symptoms. 1

Biofeedback

Biofeedback is a self-regulation technique where people learn to control what was normally thought to be automatic processes such as heartbeat or skin temperature. 1 Learning this technique can help people pay attention to what is happening in the body as well as reduce stress and find new ways of relieving stress. The research is limited, but it does suggest effectiveness with disorders similar to body-focused repetitive behaviors.

Hypnosis

Hypnosis is another technique, when used in combination with other therapies, can help counter the stress, emotions, and behavioral habits that contribute to skin picking. 1 Research is limited on its effectiveness.

Application of research

While research contributes to the body of knowledge on what works and what does not work for particular disorders, it is important to consider it as a guideline. As research continues to search for answers about what works and what does not, the consensus seems to be that multiple therapies work in conjunction with each other. Do not be afraid to try new therapies and techniques that may help you with what you struggle with. The whole point is to find what works for you and others who suffer from excoriation disorder are a good place to find ideas and support. Also keep in mind that even if something does not work for you, keep trying and share what you learn with others who can benefit from what you learn.

In addition to sharing what works for you, think about participating in research studies. One of the challenges for researchers is finding people who struggle with ED to participate in research. The TLC Foundation has a listing of current studies throughout the country who are looking for participants:  https://www.bfrb.org/research-programs-news/research-studies

References

1 Torales, J., Barrios, I., Villalba, J. (2017). Alternative therapies for excoriation (skin picking) disorder: A brief update. Advances, 31(1),10-13.