A little respect for skin pickers, hair pullers

01/06/2014 12:00 AM

08/08/2014 10:20 AM

Do you pick your skin until your arms are pitted with scabs? Bite your nails down to bloody nubs? Tear the calluses off your heels until walking is painful?

This year, you won a small, bittersweet victory.

Your condition made it into the 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Its name: “excoriation disorder.”

With this published acknowledgment of the problem, sufferers may now be eligible for health insurance coverage for the cost of treatment. But they also run the risk of feeling pathologized for behavior that may fall within the range of normal, said Doug Woods, director of the department of psychology at Texas A&M University.

When stressed or bored, it is natural to engage in some sort of self-soothing behavior such as twisting a lock of hair or biting a ragged cuticle.

“Any type of repetitive motor movement can calm people down,” said Woods, a national expert on body focused repetitive behaviors.

A 2006 study of 1,300 college students at the University of Delaware found nearly 15 percent pulled their hair occasionally and more than 30 percent picked their skin, with women far more likely than men to report the behavior.

At least 4 percent of the population take these habits to an extreme, said Woods, who noted the number could be higher because many are too embarrassed and ashamed to seek help.

“It’s a disorder. You keep quiet,” said Abby Shaine, 23, an aesthetician from Somerdale, N.J. Until recently, Shaine, who started picking at her face when she was 16, had never met anyone who shared the problem.

Incrementally, with help from social media, support networks, and glancing references in the public sphere, Shaine and others are feeling less alone – and less odd.

“It’s way more common than people think,” said Shaine, who has found hundreds of kindred souls on Facebook pages such as the Dermatillomania Support Group. As evidence that public awareness is growing, she also cites the recent film “The Internship.” Goofy as it was (starring Owen Wilson and Vince Vaughn, need she say more?), the plot featured a character, Yo-Yo, who tweezed his eyebrow into nonexistence.

Shaine could totally relate. “I finally threw out my tweezers,” she said.

Unlike those who cut themselves, people who pick and pull are not intentionally trying to punish or inflict pain on themselves, Woods said.

Until these activities begin to hurt, they feel good.

There is a primal satisfaction in evening out the rough edge of a nail or peeling off dead skin. This behavior, Woods said, is similar to hair-pulling, or trichotillomania, another disorder in the DSM, the psychiatrists’ manual.

You get tactile pleasure from the feeling of tugging on your hair, having the hair in your fingers, he said.

No medication has been found effective, although some studies have shown that in adults, the over-the-counter supplement n-acetylcysteine may help, said Marla Diebler, founder and director of the Center for Emotional Health of Greater Philadelphia, which specializes in treating anxiety-related disorders.

Behavioral treatments seem to offer the most promise, she said.

One technique, habit-reversal training, attempts to substitute a new, more benign habit for the old. People are given objects to hold or play with – rocks, rubber bands, clay, and Koosh balls.

A second method, stimulus control, makes the environment less conducive.

Diebler offers the example of a patient who pulled her hair while watching TV, always sitting with her elbow resting on the arm of the couch so she could reach her scalp. By merely shifting her position to the middle of the couch, Diebler said, the woman would at least be more aware of her behavior and perhaps less likely to do it.

And, finally, people who pick and pull without thinking are trained to be aware of their behavior. Those patients, Diebler said, may benefit from sensory cues, such as wearing bracelets that jingle when a hand begins to move toward the face.

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