Tag Archives: Excoriation

Excoriation (skin picking) L98.1

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Skin picking

Scab or skin picking?
Photo courtesy of Pixabay.com

Sometimes skin picking is a mental health problem.

Excoriation, also known as skin picking, is included in the DSM-5 in the chapter on Obsessive-Compulsive and Related Disorders. Excoriation is one of those unusual crossover kinds of disorders. Sort of a medical problem, but also a mental health issue. Most mental health disorders have either an F or a Z code.

What is Excoriation (skin picking?)

To meet the criteria for this disorder, the skin picking must be both recurrent and must result in visible skin lesions. People with skin picking disorder often spend a lot of time in this activity, and it made go on for years. The picking is commonly done with fingernails, but it may be done by using tools or instruments. While skin picking can take place anywhere on the body, is most often done on the face, the arms, or the hands. Some people try to hide the results of picking under clothing.

OCD mental health part involves attempts to control, reduce, or stop the picking.

Like other mental health diagnoses, the skin picking needs to impair social relationships, school or job function, interfere with other important activities, or be very upsetting to the person doing the picking. Skin picking often occurs in response to negative feelings. Excoriation can be triggered by unpleasant emotions and may be used to manage uncomfortable feelings.

Excoriation is reported much more commonly in females. Some reports estimate the rate of Excoriation at between one and two percent of the population. It is common for those with Excoriation Disorder to also have other OCD related disorders.

Excoriation is not the same thing as “Meth” or “Coke” bugs.

The kind of picking you commonly see among drug users is the result of abuse of stimulant drugs. Stimulant drugs create the sensation the bugs are crawling on the skin. If the user quits doing the drugs, the feeling of bugs crawling on the skin, he goes away. Long-term methamphetamine or cocaine users may have picked at their skin so much that there is permanent scarring.

What else could Excoriation (skin picking) be?

Before someone gets this diagnosis, medical causes and effects of drugs or other substances must be ruled out. If the picking is the result of a psychotic disorder or body dysmorphic, a stereotypic movement disorder, or is intentional, the picking gets diagnosed as part of these other disorders.

There are some similarities between Skin Picking Disorder and non-suicidal self-injury, also known as “cutting.” Nonsuicidal self-injury is currently considered a symptom of borderline personality disorder, but it continues to be studied and may one day be recognized as a separate disorder.

As of now, Skin Picking Disorder is recognized as a specific disorder that may coexist with other conditions. If you or someone you know has symptoms of Excoriation (skin picking), you need to get medical attention. If those urges to skin pick are being triggered by feelings, seeing a therapist could help.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Obsessive-Compulsive and Related Disorders.

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By David Joel Miller.

Obsessive-Compulsive Related Disorders.

Obsessive-Compulsive and Related Disorders.
Photo courtesy of Pixabay.com

Obsessive-compulsive is a label that is frequently misused. Most people, when they say they are obsessive-compulsive, mean that they have strong preferences for the way they want the thing to be done. In the mental health field, what we mean by Obsessive-Compulsive Related Disorders are a group of disorders which seriously interfere with a person’s relationships, their ability to work, cause them distress, or prevent them from engaging in other important activities.

A personal story about compulsions to illustrate this difference.

I have a preferred breakfast meal. It comes frozen and is relatively inexpensive. Each week when I do the grocery shopping, I buy enough for the following week. I tend to eat this meal every day. Should I end up traveling, or get behind schedule I’m open to eating something else.

Someone with OCD or a related disorder might feel that their failure to eat the required breakfast, could cause their day to be ruined. They might believe, even though they know it is illogical, that their failure to eat the required breakfast, in a specific order, could result in someone starving to death, or harm coming to a family member. These beliefs that their actions or inactions, can cause harm results in an overwhelming compulsion to perform actions.

I have used an extremely exaggerated example here, but I hope you can see the difference between an extremely strong preference and a compulsion. A compulsion is something you feel forced to do even when it makes no sense. It is as if the person with OCD is being controlled by an outside force.

Defining obsessions and compulsions.

Obsessions are persistent, unwanted, and intrusive thoughts, urges, or pictures that you can’t get out of your head. Compulsions are the things people feel required to do to reduce the tension caused by the obsessions. These behaviors are often done a specific number of times. Compulsions may involve inflexible rules which must be obeyed to prevent something bad happening. Some Obsessive-Compulsive Related Disorders involve self-injury, like hair pulling or skin picking, which continues despite efforts to reduce or stop the behavior.

Classifying Obsessive-Compulsive Related Disorders.

In the past, Obsessive-Compulsive Related Disorders were scattered throughout the diagnostic manual. Some of these disorders were in the chapter on anxiety; some were mixed in with impulse control disorders, others were under somatoform disorders. A few were not even recognized as mental illnesses in the past. In the most recent DSM-5, these issues were brought together in a single Obsessive-Compulsive and Related Disorders chapter.

Sometimes it’s hard for professionals to diagnose which disorder a person has. It is possible for one person to have several of the Obsessive-Compulsive Related Disorders. Many people with Obsessive-Compulsive Related Disorders also have anxiety disorders, trauma and stressor-related disorders, and some form of depression.

OCD leads the Obsessive-Compulsive Related Disorders parade.

Among the Obsessive-Compulsive Related Disorders, the best-known disorder is Obsessive-Compulsive Disorder, a serious mental health issue which is estimated to affect between 1% and 2% of the population worldwide.

Other Obsessive-Compulsive Related Disorders include Body Dysmorphic Disorder, Hoarding Disorder, Trichotillomania, (hair pulling), and excoriation (skin-picking). All of these disorders significantly interfere with people’s lives. Symptoms in these disorders recur, despite repeated efforts to control or stop the Obsessive-Compulsive Related Behaviors.

Substances and medications can cause, or induce, Obsessive-Compulsive Related Disorders. Some medical conditions can also cause obsessive-compulsive behaviors. In the DSM-5 they are also seven other conditions lumped together under the heading Other Specified Obsessive-Compulsive Disorders. One of those conditions is Obsessional Jealousy. This is one of the few times jealousy counts as a symptom of a mental health disorder. More on Obsessional Jealousy in a future post.

Treatment for Obsessive-Compulsive Related Disorders.

The primary treatment for Obsessive-Compulsive Disorder (OCD) is exposure and response prevention therapy. While exposure and response prevention therapy has some similarities to systematic desensitization, which is used to treat specific phobias, relatively few therapists are trained in exposure and response prevention therapy.

One resource you may want to consult is the WordPress blog ocdtalk.  http://ocdtalk.wordpress.com/

For more information on Obsessive-Compulsive and Related Disorders see:

Obsessive-Compulsive Related Disorders category

Obsessive-Compulsive Disorder (OCD)

Body Dysmorphic Disorder

Hoarding Disorder

Trichotillomania, (hair pulling)

Excoriation (skin-picking)

Obsessive-Compulsive Personality Disorder

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Hair Pulling is a mental illness- trichotillomania.

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Anxiety provoking.

Anxiety.
Photo courtesy of Pixabay.com

Hair-Pulling Disorder – Trichotillomania.

Yes Hair-Pulling Disorder, the repetitive uncontrolled kind of hair pulling is a mental health issue. Humans are not the only creatures who resort to this kind of self-mutilation when under stress. Caged animals, especially birds do this when stressed also.

Hair-pulling Disorder sounds like an odd problem to have at first glance unless you or someone you know has had this disorder and then it takes on huge importance.

The way we understand this one has been changing. This is in flux and will take some time to sort out.

In the past, as reflected in the DSM-4 this was seen as a form of impulse control disorder. Much of the way it was treated in the past was behavioral. The focus was on the behavior and not the meaning or function it had for the person pulling the hair.

As an impulse control disorder, it was in with Pathological Gambling and Intermittent Explosive Disorder. Hair pulling was for sure different than compulsive gambling but most people who had to treat clients with this problem didn’t know what else to do with it.

In the new DSM-5, when all the professionals switch to the DSM-5, this disorder will move to the section on Obsessive-Compulsive Disorders. This will put it more in the class of disorders with Hoarding and Body Dysmorphic Disorder. We are seeing that obsessions and compulsions are more driven than chosen behaviors.

This change in thinking makes a whole lot of difference in how it might get treated and it makes even more of a change in how the person who has the problem might react to that treatment.

Behavioral treatment is focused on the behavior and interrupting that behavior. So grandma might have used a treatment that consisted of slapping that hand each time the young person reached for the hair. The idea was that stop the behavior and you had the problem cured.

If we see this as OCD behavior, then this is not something the person is consciously doing. The behavior is functioning to reduce tension and there is this overwhelming need to do it. This would not be something that the person thought about beforehand and no amount of slaps or yells will change anything.

You might as well yell at someone for yawning. Once they yawn it is over. Besides we think yawning is about physical sensations, not inappropriate behavior. Despite that feeling, we still can get annoyed at people who yawn and we all try to stifle the yawn from time to time.

But if you got smacked for each and every yawn eventually you might give up and just avoid the person slapping you or you might feel that you were a bad person for not being able to control this sensation and you could punish yourself in some way.

So if this is a form of OCD we would want to know what the function of the behavior was. What anxiety or tension is the person trying to relieve by hair pulling? Reduce that tension; treat the anxiety and the hair-pulling stops on its own.

Young women are ten times more likely to get this diagnosis than young men. We do not mind seeing young men with very little hair but a young girl with bald spots, that gets noticed.

People who have Hair-Pulling Disorder (Trichotillomania) are also at higher than average risk to do other self-injurious behaviors. Someone with the hair-pulling disorder might also pick at their skin excessively, technically called excoriation, or they might nail-bite excessively.

There are also likely to become depressed and or develop another anxiety disorder.

So if you or someone you know is finding their life messed up because they are constantly pulling out hair, they develop bald spots for which there is no known medical cause and when they try to stop find they can’t, consider professional treatment.

Yes, absolutely Hair-Pulling Disorder (Trichotillomania) is a real mental illness of the obsessive-compulsive disorder type.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel