A lot of people pick at their skin once in a while, but there are some cases where they cross the line into a condition called scab picking obsessive-compulsive disorder (OCD). When this happens, skin picking can become so intense and frequent that it can cause scars, sores and bleeding. Repeated scratching occurs because the individual tries to remove what he sees as some type of imperfection in his skin.
How It Develops
Occurring in both adults and children, scab picking OCD can start at almost any age and develops often develops in 2 ways. First is when you had some kind of small injury, skin infection or rash, and you would then pick at the scab, keeping the wound from healing and even causing more injury to the skin. In some cases, there would be itching involved, which can lead to more picking, and the cycle continues. Another way that this condition would develop is when you are stressed, and then you may absently pick at a scab or the skin around your nails. Mostly, you would find this repetitive action to help you with relieving stress, but then it becomes a habit.
This condition is generally categorized as a type of repetitive self-grooming behavior called Body-Focused Repetitive Behavior (BFRB), along with picking or pulling of the nails or hair that gradually inflicts wounds to the body. Moreover, as what the name suggest, it is classified as a type of obsessive-compulsive disorder due to the compulsive urge to do certain repetitive behaviors.
Also known as dermatillomania or excoriation, scab picking OCD is primarily characterized by repetitive picking at one’s own skin to the point where it is already causing damage. Usually, the primary location for skin picking is the face, but it would also involve any other part of the body. Those who are suffering from this disorder tend to pick at actual pre-existing scabs, sores or acne blemishes; normal skin variations, such as freckles and moles; and even imagined skin defects that nobody else is able to observe. Also, these individuals would also use their teeth or fingernails, as well as pins, tweezers or other mechanical devices, to perform their habits, and as a result, they would inflict bleeding, new wounds, bruises, infections and permanent disfigurement of their skin.
In some cases, this condition is preceded by high levels of tension and a strong urge or itch, and may be followed by a feeling of pleasure or relief. An episode of scab picking may also be a conscious response to depression or anxiety, but most of the time, it is frequently done unconsciously. Sufferers could enter a trance-like state and pick at the scabs or skin without being fully aware of their actions, only to realize them with the results afterwards. Sometimes, they would even feel the need to create pick-able surfaces to allow themselves to satisfy their compulsions, which can lead to a type of self-harm where they would undertake cutting behaviors or self mutilation in order to produce scabs which they can then pick. As a result, these individuals would often try to hide the damage caused to their skin by wearing clothes or using make-up to cover subsequent scars and marks. At worst, they might avoid social situations just to prevent others from seeing the resulting bruises.
As demonstrated, scab picking OCD displays obsessive-compulsive features that are quite the same with trichotillomania, OCD and BDD, and is sometimes observed in individuals with such disorders and in patents with certain medical conditions.
Like other disorders, scab picking OCD can be dealt with a variety of treatment procedures, with the primary treatment modality being a combination of various types of cognitive-behavioral therapy (CBT), such as:
Habit Reversal Training (HRT)
This is considered as the most important of all types of CBT, which is based on the principle that skin picking is a conditioned response to a particular situation or event, and that the person suffering from the condition is often unaware of the things triggering the behavior. The method challenges scab picking OCD in a 2-fold process, with the first trying to let the person learn how to become more conscious of the situation and event that could trigger an episode and the other allowing the person to learn how to employ alternative behaviors in response to such situation and event. During the treatment, the therapist will help the patient identify the situation, stress and other factors that cause an episode. Then, the former will help the latter look for other things to do, such as squeezing a rubber ball, rather than scab or skin picking, to help occupy his hands and ease stress.
This is another CBT technique that can be used as an adjunct to HRT in treating scab picking OCD. This treatment method involves the use of specific physical items, such as habit blockers in order to restrict the patient’s ability to pick scabs, as well as means of making changes to the patient’s environment to help curb the behavior. For instance, a patient would be asked to wear gloves or band-aids to help prevent feeling his skin and having the urge to pick.
This is another effective way to cure this condition. Here, the therapist will try to help an individual suffering from scab picking OCD to learn how to think differently in response to the urge of performing such behavior.
Mindfulness-Based Cognitive Behavioral Therapy
This is regarded as one of the most effective developments in CBT designed for the treatment of scab or skin picking disorder, with the primary objective of helping the patient to learn not to judgmentally accept uncomfortable psychological experiences. From a mindfulness point of view, psychological distress would be the result of trying to eliminate or control discomfort of unwanted feelings, thoughts, urges and sensations. Simply put, the feeling of discomfort is not the problem, but the attempt to get rid of it. For those who are suffering from scab picking OCD, the ultimate goal of mindfulness is to develop the patient’s ability to be more willing to experience uncomfortable feelings, thoughts, urges and sensations, without picking scabs or the skin.
With regards to this condition, it is important to know if you are really affected by it. Well you will know this is the case when you pick your skin more when you are stressed or anxious, or when you feel that such an action leads to feelings of gratification or pleasure. Check with your physician if the problem arises.