Comprehensive Behavioral Intervention (ComB) for Excoriation Disorder

Until recently, there hasn't been a treatment for body focused repetitive behaviors (BFRBs), such as compulsive skin picking disorder. Dermatillomania, aka excoriation disorder, is the picking of one's skin repeatedly, which leads to damage. The face is the primary area where the skin picking occurs, but skin picking can happen at any part of the body. People with this disorder may pick at normal skin variations, such as moles and freckles, where there are pre-existing blemishes, sores, or scabs. These people with this disorder would use their teeth, fingernails, pins, tweezers, or other devices. And as a result,  bruising, bleeding, infections, or permanent damage would occur.

Repetitive behaviors were classified as someone with acute stress, tension, and anxiety with a strong itch or urge. And the first time dermatillomania was mentioned is when a French dermatologist named Brocq in 1898 described an adolescent girl patient uncontrollably picking her acne.  Dermatillomania has obsessive-compulsive aspects that are very similar to Trichotillomania, OCD, and BDD. And it was only since May of 2013,  that this disorder has since been classified under its own separate condition in the DSM5 under the Obsessive Compulsive and Related Disorders which is now termed as the excoriation (skin-picking) disorder.

Different treatments are available

With this skin picking disorder, there are various methods that can be used for treatment, and they consist of the following:

• Anxiety/depression medicines: in some cases, this alone does the trick in relieving patients of their strong itch or urge.
• Natural resources: sometimes sources such as meditation, eating right, and taking different herbs will help for some patients.
• Habit Reversal Training (HRT):  is a four-step process that teaches how to relax,  breathe, and feel centered.  Performing muscle response exercises is also implemented. HRT includes social support, self-monitoring and stimulus control.
• Self-Monitoring: patient becomes more aware of his/her behaviors by starting a log of picking behaviors, and recording the behavior alone can interrupt the process and reduce the picking.
• Stimulus Control (SC): patients can identify, eliminate, change, or avoid the moods, environmental factors, or circumstances that trigger the picking.
• Cognitive Restructuring: this helps a patient learn to think differently upon responding to the urge of skin picking.
• Competing Response: a tool designed to give the patient an alternative to picking, such as beading, knitting, fidget toys, or other activities that keeps the hands busy.
• Online Support Groups: some support groups use the 12-step Alcoholics Anonymous program to assists patients  to stop picking
• Group Therapy for the Treatment of Skin Picking Disorder:  this is in addition to individual therapy where six weekly therapy support groups for adults with OCD and similar conditions meet for a low fee.  These types of groups are led by professional therapists.
• Telephone and Online Therapy for the Treatment of Skin Picking Disorder: with the use of webcams or phones, patients worldwide can get assistance in this form that is more cost effective and that is more viable for those who have limited means to visit the professional staff therapists in their offices. Through a plethora of research studies, these methods have proven to be safe and effective. It's also legal in many states. 
• Intensive Treatment for Skin Picking Disorder:  this program is authorized for children, teens, and adults, and it's designed for patients who need more than standard outpatient care, or if standard outpatient care isn't available. With this program, rigorous treatment may be needed. This program is also ideal for out of state or foreign patients who can't find effective treatment near their residence.

ComB & its Method of Intervention

ComB stands for comprehensive behavior intervention. It includes the implementation of the different treatments to control different types of disorders, such as various OCD disorders. All of the treatments listed above are used for the skin picking disorders.  Also, some of those treatments are used for other OCD disorders. Dr. Fred Penzel has plenty of books, recorded interviews, and articles throughout the search engines concerning the comprehensive method of intervention.

ComB helps people to become aware but also to understand why they are picking or pulling. The strategy is divided into 4 stages

1. Understand and monitor the behavior
2. Identify targets
3. Implement strategies and skills
4. Evaluate and modify

There is still much to learn concerning this skin picking disorder.  As a matter of fact, there hasn't been a treatment for repetitive behaviors, such as dermatillomania, until recently.  And the first time skin picking was mentioned is when a French dermatologist named Brocq in 1898 described an adolescent girl patient uncontrollably picking her acne. Also, it was only since May of 2013,  that this disorder has since been classified under its own separate condition under the Obsessive Compulsive and Related Disorders which is now termed as the excoriation (skin-picking) disorder.  With all this in mind, there is still much to be learned about dermatillomania. Nevertheless, therapists are making great strides to having effective methods of treatment for the patients with this skin picking disorder.

Continued Research Needed

So far,  these health professionals have found that patients with these skin disorders are discovered to derive from certain neurological medical conditions. A recent study has also found that 27% of BDD patients, and 23% of OCD patients also had dermatollomania (excoriation).  Therefore,  there are even more ways to resolve more people from these issues with discovering even more treatment plans. So far, the treatments, including antidepression/anxiety medicine, natural sources, the different cognitive behavioral therapy treatments mentioned above, group therapy, online/phone therapy, and intensive treatment, have exponentially increased the success rates of patients recovering and coping from this skin disorder. And optimistically speaking, these new discoveries and research would most likely lead to even more breakthroughs and higher success rates for patients.

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