Excoriation (skin picking) L98.1

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 which 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

Four David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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Nonsuicidal Self Injury – Cutting to stop pain

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

Cutting – nonsuicidal self injury.
Photo courtesy of Pixabay.com

What is cutting – Non-suicidal Self-Injury?

Non-suicidal self-injury often called cutting, is another of those troubling conditions that send people to hospitals, physical and mental hospitals. Intentional self-burning, head banging, hair pulling, hitting yourself and repetitive skin picking are other examples of this thing we call Non-suicidal self-injury. Non-suicidal self-injury causes a lot of suffering for those who do it and for those around them, and yet this problem, like anger, does not get the recognition of a separate diagnosis. FYI Hair pulling has gotten its own diagnosis called Trichotillomania.

Deliberate self-injury is a behavior. Like many behaviors, it can be misunderstood. If someone waves at you, they may be calling you over, they may be telling you to get away from where you are or it may be a way to say hello. It might even have another meaning. Self-injury is like that, a behavior, which may have different meanings.

Non-suicidal self-injury is a condition that has been researched and has been proposed for inclusion in the DSM as a recognizable mental illness. Currently, it is not a “stand-alone diagnosis.” Non-suicidal self-injury is listed in the back of the DSM-5 as a “condition for further study.”

If someone engages in non-suicidal self-injury, the kind we think is a mental illness, the most likely way it gets categorized is as a symptom of Borderline Personality Disorder. Sometimes it is a symptom of Borderline Personality Disorder or Borderline traits, sometimes not. Borderline Personality disorder is the only mental health condition that lists both suicide and Nonsuicidal self-injury as symptoms despite the high or increased rates of self-harm in other disorders like depression, bipolar and alcohol use disorders. First, the things Nonsuicidal self-injury is not and then what we or I think it is.

What Non-suicidal self-injury is not.

Non-suicidal self-injury is not simply a teen thing.

The kind of thing we mean when we talk about Non-suicidal self-injury, the one that gets diagnosed and treated is not a fad or a rite of passage. I know there are those who cut, tattoo or brand themselves because they want to scar their body to look cool or to impress their friends. This is not what we are talking about when we say Non-suicidal self-injury – the disease.

Nonsuicidal self-injury is not a request for attention.

Yes, some people do this behavior to get noticed or to get something they want. One way to differentiate this is to ask where they self-injury. Most people who seek attention cut in places that are clearly visible. Those who do it as a result of an emotional or mental issue cut or otherwise self-injure in places that are not visible, the stomach or the thighs and they often wear long sleeves, even in the heat of the summer, to cover the cuts. The distinction is that those who develop the illness Non-suicidal self-injury often try to hide their cutting.

What Nonsuicidal self-injury is.

A way to cope with emotional pain.

Transforming emotional pain into physical pain can seem like a way to escape that emotional pain. While it does work, at least some of the time it is not a desirable way to cope. Good coping mechanisms need to be not only effective but safe also. Treatments for Non-suicidal self-injury include lots of learning and practice of alternative coping skills sometimes referred to as recovery tools.

A way to cope with dissociation

Some people report they self-harm to feel or to feel real. This numbing out is a symptom of dissociation and related disorders. Dissociation is not always recognized for what it is. Dissociation needs treatment for what it is not just for the behaviors like anger or cutting.

If you live in chronic emotional numbness then the only time you may be able to feel anything is when you substitute physical pain for the constant numbing emotional hurts.

Non-suicidal self-injury is a way to regulate emotions.

Some people have difficulty regulating their emotions. They may have suffered traumas, grown up in a dysfunctional home or have personality characteristics that make them more prone to be overloaded with emotions. Take a look at the post Emotional Avalanches and Feelings Landslides which discusses how people can be suddenly swept away by feelings floods.

Cutting or other types of non-suicidal self-injury is one way some people cope with these feelings avalanches. Violent outburst is another way. The topic of violent outbursts and emotional regulation is covered in the series on “Anger Management.”

Rumination plays a major role in depression, anxiety, and anger as well as in causing emotional landslides.

Some of the links above may not be active yet. The bold-underlined terms mean that a post is up or will be coming shortly. I will try to get the links in here as the new articles post. If any links (the ones in blue) do not work let me know and I will work on fixing them.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.