Ever had trouble stopping picking at your skin? Or maybe you were absent-mindedly scrolling your phone only to realize that you’ve scratched yourself a new rash?
If you feel this might sound like you, you might have a skin-picking disorder! Although it may sound harmless, if untreated, it can lead to constant issues with your skin, such as bruises, wounds, infections, and even scars.
So, strap in as we will explore its causes and effects and try to answer why it feel so-o-o good.
Let’s dig in!
[What is skin picking?] What is skin picking disorder?
Skin picking disorder (SPD), a.k.a dermatillomania or excoriation disorder, is a condition in which a person cannot stop picking at your skin.
SPD doesn’t specify the reasons for picking at your skin and is also a subset of what is known as body-focused repetitive behaviors (more on that later).
And you might be thinking: “Well, whenever I have scabs, I just can’t stop picking at them, does it mean that I should add another notch to my diagnosis belt?”
Let me stop fellow hypochondriacs in their tracks here!
SPD is about compulsory and sometimes even unconscious desire to pick your skin. So there is no “objective” (a new scab or a bite) reason behind it - you just do it.
In fact, it is the obsessive skin-picking that will often cause new scratches and wounds to appear as the person just can’t stop going at it.
Well, why does this disorder occur in the first place, and how does ADHD come into play here?
[What causes skin picking?] What causes skin picking disorder?
The prevalence of SPD is quite substantial among people with mental health conditions. Per one research, more than 50% of those with depression and anxiety have some form of SPD, whereas prevalence is around 25% for people with ADHD.1
So, what gives?
Before we answer that, let’s establish one common denominator with skin picking: it feels really good and stimulating.
(For the most part) that’s the reason why this behavior occurs. But people may crave simulation for different reasons!
Now, let’s look at these reasons in more detail.
Anxiety and depression
Anxiety and depression disorders cause many complex feelings, including losing the sense of control, increased stress, and emotional distress.
The main problem here is that these feelings are caused by something intangible.
It’s not like a fire you can put out or a dangerous situation you can get out of. For that reason, depression and anxiety can be extremely difficult to cope with.
In such a scenario, SPD offers a stimulating sensation that can also divert attention from the more abstract stress. Picking at one’s skin thus provides distraction, temporary relief, and a momentary sense of control. Instead of something unmanageable, you turn your attention to something that is.
In a certain way, SPD here is not unlike using nicotine. Smoking doesn’t reduce your innate stress levels, after all! The only stress that’s being reduced is that of nicotine withdrawal. But because the effect is immediate and apparent, it “masks” the underlying stressors.
And now, let’s get back to the star of the show. Now, assuming you don’t have anxiety or depression, why can ADHD make you want to pick your skin?
Well, that’s because we have issues with dopamine! The short of it is that our dopamine receptors are a bit out of order, making it difficult for us to receive satisfaction from most activities. Hence, our constant pursuit of stimulation leads to skin picking and other body-focused repetitive behaviors (BFRBs).
Other types of BFRBs include biting your nails, pulling your hair, biting on your cheeks, lips, etc.
What’s even more interesting is that this behavior can often be unintentional. In the same way I often catch myself fidgeting my leg (without realizing I’m even doing it), some may be picking at their skin out of boredom or as a subconscious attempt at focusing!
Now, this reason isn’t fully tied to ADHD, but given that hypersensitivity to stimuli is quite a common ADHD comorbidity2, it’s worth mentioning.
A short version is that overstimulation occurs when a person is overwhelmed by external stimuli - lights, sounds, smells, etc. So, a person might freak out, panic, etc.
In such a situation, picking at your own skin can act almost as noise masking - pulling the brain’s attention away from what’s happening elsewhere to the immediate sensation of skin picking.
[How to deal with skin picking] How to deal with skin picking?
Well, that will depend entirely on the cause behind your skin-picking!
Because, ultimately, SPD is more of a symptom of a bigger issue. If you don’t fix the underlying cause, your urge to pick at your skin won’t go anywhere. Worst case, it can get replaced by another similar habit!
The treatment, thus, will depend on the underlying cause. It may be medication, therapy approaches (e.g., CBT), or a combination!
In any case, it would be best to consult with your healthcare provider for a proper assessment.
But in the interim, here’s what you can do to manage skin-picking
Identify your triggers and avoid them
Time for some introspection. What causes you to pick your skin? Is it stress, itchiness, or some specific stimuli? Maybe it’s some kind of hypochondriac response to having a rash and needing to constantly “check” on it?
Maintaining proper hygiene and using a moisturizer can help with one trigger type.
For others, there is a thing called habit reversal therapy (HRT), an approach that has been proven to be effective in the treatment of SPD.3
In short, HRT is about recognizing triggers and replacing them with less harmful behavior.
Self-care and mindfulness
If your skin picking is a byproduct of fidgeting and nervousness, practicing mindfulness and moving your body can provide a more useful outlet for your energy while calming your nerves.
Accountability is one of the greatest motivators out there. You’re less likely to relapse into your habits if friends watch you. Not only will they stop your urges, but you, too, will have a sense of “responsibility” not to let your friends down.
That’s why we have created Numo.so - digital ADHD village if you will.
Here, you will find a community of fellow ADHDers who can share their experiences dealing with fidgeting and SPD and lend you a shoulder to lean on when you feel like urges get too much.
If anything else fails, you can just exchange ADHD memes. That helps, too!
So, come along if you’d like. We’d be happy to have you!
Skin picking joins the array of surprising yet persistent ADHD symptoms, demonstrating how untreated ADHD can impact almost all aspects of our lives. Yet, with the right approach, treatment, and the help of a friendly ADHD community, it’s possible to deal with SPD.
I’m not saying it’s going to be easy. But it’s certainly possible!
2 European Psychiatry. Atypical sensory profiles as core features of adult ADHD, irrespective of autistic symptoms