Tools for Temptation: Essentials to Combat Dermatillomania Urges

If you live with skin picking, you’ve probably tried more than once to keep your hands away from your skin. And there’s no shortage of people, while well-intentioned, giving you advice like: 

Just stop. (OK that doesn’t work or help but people say it.)

Don’t touch your face. (If you could do that, you would already be doing that.)

Keep busy doing something else. (This one might have some promise, but what?)

The skin damage that comes with having a skin picking disorder creates quite a dilemma. You want to be socially engaged. You don’t want to have to answer questions or feel judged or ashamed. You just want to be able to look and feel comfortable. And you want to be able to deal with urges so that you can manage your picking. 

One of the things that people often talk about is how to avoid picking triggers and reduce or avoid picking. It might surprise you that some of their best suggestions are about more than just a good skincare routine, although that is important too. While there’s no one strategy that is “the one”, people living with skin picking are among the best experts for finding things that work. Maybe some of their tips can work for you too. 

Be Prepared 

It might sound a little cliché but having tools and techniques at your disposal is a critical part of managing your skin picking. Skin picking is highly heterogeneous meaning that it is not the same for everyone. People experience it in different ways. And you may also experience your picking in different ways at different times. For example, you may find that certain situations trigger a certain feeling while others don’t. You might find that a fidget works great in class but doesn’t help when you’re at home. 

Episodes of picking can be triggered for any number of reasons – a sensation, a feeling, or thoughts that are bothersome, or something else. And those urges can strike at some of the most inopportune moments. They can be sudden and downright overwhelming. You may not have much time to ponder a strategy. 

So, the key to using strategies is to be prepared. That’s where having a toolkit comes in handy. Having multiple go-to strategies can be helpful when the urge comes. 

Building Your Toolkit

So how do you choose your tools and techniques? One way is to consider your unique triggers and experience. One way of thinking about your toolkit might be to think SCAMP.

BFRBs like skin picking are more than just the act of picking or pulling. The Comprehensive Model for Behavioral Management of BFRBs (ComB) recognizes five distinct components (SCAMP) of BFRBs:

Sensory
Cognitive
Affective (emotions)
Motor
Place (environment)

Viewing coping strategies through the lens of the SCAMP approach might also be helpful in interrupting or even preventing an episode of picking. You can read more here but some of those strategies identified include:

Sensory –

• Touch-toys /fiddles/fidgets
• Music
• Drawing
• Popping bubble wrap
• Pay attention to the sensory experience of other tasks (like the Zen practice of washing dishes with focus.)

Cognitive – 

• Checking in with yourself. Identify sources of worry. What’s on your mind? Be on the lookout for rumination.
• Visualize using your tools.
• Practice acceptance and gratitude. 
• Talk to a friend first.
• Wait 15 minutes

Affective (emotional) –

• Use positive affirmations
• Journaling
• Co-counseling – a kind of peer counseling that provides a safe space to express feelings.
• Find a Support Group
• Plan for risky times (e.g., downtime, bedtime)
• Breathing Exercises

Motor (movement) –

• Fiddle/fidget toys
• Rubber bands
• Exercise
• Arts and crafts (e.g., cross stitch, knitting)
• Band-Aids or “thimble pads” on fingers

Place (your environment) – (depends on where you tend to pull/pick)

• Remove or avoid mirrors if they tend to trigger urges
• Bathroom lights off or dimmed
• Keep fiddle toys (or other preferred tools) in obvious trigger spots
• Visual reminders/notes
• Be around others or get support when you can
• Remove tools from easy access

What goes into your kit will be up to you. You may love fidgets. Maybe you find them frustrating and annoying. Maybe you prefer tactile tools like Velcro. Find what works for you. 

The idea here is to build a toolkit that is readily available and flexible enough to quickly cope with the urges to pull in multiple ways. Developing those alternatives to picking is also an important part of the treatment process too. Having a toolbox of strategies that you can pull from means you can be prepared no matter where you are. 

References

1. Fidget toys to help stop skin picking? (n.d.). Reddit. https://www.reddit.com/r/fidgettoys/comments/5py3x3/fidget_toys_to_help_stop_skin_picking/

2. Viera-Newton, R. (2022, October 31). The (Mostly not-skin-Care) tools I used to break my skin-picking habit. The Strategist. https://nymag.com/strategist/2022/10/everything-i-used-to-break-my-skin-picking-habit.html

3. Yeomans, A. (n.d.). List of strategies for skin-picking. Retrieved from https://www.bfrb.org/learn-about-bfrbs/treatment/self-help/127-rs-list-of-strategies-for-skin-picking-49-im-using-42-i-could-try