Compulsive Skin Picking - A Disease?

Skin Picking Disorder - Unleashed

The summer of 1994 produced one of the most grisly and well-publicized double murders in the history of the United States of America. Nicole Brown Simpson and her friend, Ronald Goldman, were murdered on the front lawn of her elegant, expensive condominium just miles from the world-famous glitz and glamour of Hollywood, California. Although accused in both criminal and civil trials for the double murder, Simpson’s husband, onetime football great and actor, OJ Simpson was acquitted of criminal charges but found responsible for their deaths in a civil court. While the entire country remained enthralled by the legal twists and turns that came about during the two trials, one of the biggest surprises came with the revelation that the beautiful, charming Mrs. Simpson was apparently living a tormented life replete with self-doubt, insecurities, and domestic abuse that included violence running the gamut from physical to verbal to emotional. In the aftermath, it’s become clear that Mrs. Simpson was silently broadcasting her fears to the world with almost every public appearance she made. Looking back on photos of the lovely Mrs. Simpson, and according to court transcripts, there is evidence that she habitually picked at her skin.

It is almost tragic to think, if the public were more aware that increased episodes of skin picking be a sign of emotional anguish, her frantic calls to 911 and other signals of distress might have been taken more seriously. Mrs. Simpson developed a compulsive skin picking disorder that was considered a bad habit, a girl thing.

Today, however, the compulsive nature of skin picking behaviors and the psychology involved, and the conversation contributes to increased awareness and more treatment options. People are more willing to acknowledge they struggle with skin picking disorder and now the “bad habit” has a name as a diagnosable health condition whereas, before, it was something to hide.

Picking at skin - a disease?

Doctors, particularly those specializing in mental health issues and dermatology, acknowledge that a compulsion for picking at skin on the face, and anywhere else on the body, is not only dangerous but also signifies deeper emotional turmoil that may require in-depth intervention. In fact, compulsive skin picking is now classified as a mental health disorder within a cluster of compulsive behaviors that fall under the diagnosis category of Obsessive-Compulsive Disorder (OCD). Other behaviors that may accompany skin picking are nail biting and hair pulling. Still others may be more severe, and even life threatening. Outside the spectrum of disorders falling under the OCD diagnosis, compulsive skin picking links to anxiety, depression, tic disorders, body dysmorphic disorder, and eating disorders. 

Complicating the diagnosis of the skin picking disorder are the circumstances under which different people feel compelled to pick. Those who pick in response to stress-provoking situations are referred to as having focused picking behaviors where the picking either relieves tension, regulates emotions, or distracts from disturbing thoughts. Others pick outside of conscious awareness, known as automatic picking, because it often occurs as a passive activity while mentally occupied with other relaxing activities, such as watching TV, reading, even driving.

Another misunderstood aspect of the diagnosis is the underlying reason to pick at skin. Why choose that behavior? Many people suffering from compulsive skin picking do so as a defense mechanism against bullying from other people in their lives, such as classmates, parents, or spouses. Others experience the skin picking disorder as an act of aggression against themselves. It is often difficult to determine if the patient is a victim or aggressor or both. However, each person experiences the disorder differently and health care treatment providers now realize that effective treatment needs to be comprehensive and tailored to each client. 

Technically, compulsive skin picking is referred to as a mental health disorder, yet medicine uses terminology that classifies it as a disease. To qualify as a disorder or a disease, the compulsive skin picking must meet these criteria: 

• Spends a significant amount of time picking, sometimes hours at a time. 
• Picking results in skin damage.
• Attempts to stop the behavior fail repeatedly.
• Picking and its effect cause significant distress.

Whether compulsive skin picking is called a disease or a disorder, it only matters because it informs research and treatment options. When a condition meets diagnostic criteria for a disease or disorder, researchers can justify spending money to find causes and treatments. More importantly, it opens the door for people who struggle with compulsive skin picking to gain access to treatment by qualified professionals.