Dermatillomania

Dermatillomania, also known as trophic skin tearing or exfoliative disorder, is a mental disorder in which a person unknowingly or consciously rubs, scratches, or pulls skin from their own body. This action can lead to skin damage and even ulcers and infections. This disorder belongs to a group of disorders known as body disorders (or body dysmorphic disorder), in which a person is highly concerned about the appearance of their body and fixated on finding and removing the slightest "blemishes" on their skin.

People suffering from dermatillomania may feel intense anxiety, shame, and dizziness related to their behavior. This disorder often requires professional help, such as psychotherapy, to help the person manage their actions and cope with the psychological aspects of the disorder.

Treatment may include cognitive behavioral therapy (CBT), medication, and support from mental health professionals.

Causes of the dermatillomania

The causes of dermatillomania can be multiple and can include physiologic and psychological factors. A few possible causes include:

1. Stress and anxiety: Dermatillomania may be associated with increased levels of stress and anxiety. Activities that target skin damage may be a way to relieve stress or alleviate anxious feelings.
2. Perfectionism: People prone to perfectionism may worry about the slightest imperfections on their skin and feel a strong desire to remove them.
3. Habit: Dermatillomania can become a habit like other compulsive behaviors. Repetitive behaviors may become more severe over time.
4. Genetic factors: In some cases, dermatillomania may have a genetic predisposition if family members also have a history of similar problems.
5. Neurochemical factors: Some studies have linked dermatillomania to neurochemical changes in the brain, including changes in levels of neurotransmitters such as serotonin.
6. Self-assurance: People with dermatillomania may feel satisfaction or relief after the act of scratching or pulling the skin, even if it causes physical pain.
7. Self-esteem and body image: Low self-esteem and negative perceptions of one's own body may be associated with dermatillomania, as people may feel better about themselves when their skin looks "better."
8. Traumatic events: Sometimes dermatillomania can be linked to past traumatic events or psychological trauma.
9. Psychiatric disorders: Dermatillomania may be accompanied by other psychiatric disorders such as depression, anxiety, or disruptive control disorders.

Symptoms of the dermatillomania

Symptoms of dermatillomania may include the following:

1. Excessive scratching, scraping, pulling, tearing, or other actions intended to damage the skin.
2. Repeated and uncontrolled attempts to remove the slightest imperfections on the skin such as acne, scars, flakiness or blemishes.
3. Addiction to the act of scratching or kicking, which can be similar to addiction to drugs or alcohol.
4. Consciously or unconsciously performing these actions, even in the presence of physical or psychological pain.
5. Increased anxiety and stress associated with dermatillomania.
6. Damage to the skin, which can lead to ulcers, infections, scarring, and other problems.
7. The tendency to hide skin lesions from others because of shame.
8. No satisfaction from the act of scratching or kicking, but rather a sense of relief afterward.
9. The impact of dermatillomania on daily life, social relationships and psychological well-being.

Forms

Dermatillomania can have different forms and manifestations depending on the individual characteristics of the patient. The following are some of the forms and manifestations:

1. Scratching the skin: The patient repeatedly scratches the skin using fingernails or sharp objects. This can lead to skin damage, abrasions and ulcers.
2. Skin abrasion: The patient removes the top layer of skin by abrading it with fingernails or other sharp objects. This can lead to the formation of deep sores.
3. Skin pressure: The patient repeatedly presses or rubs the skin in an attempt to "clean" it of imaginary defects.
4. Hair manipulation: Some people with dermatillomania may also manipulate their hair by pulling it out, twisting it around their fingers, or nibbling on it.
5. Sucking or chewing on the skin: In rare cases, dermatillomania can manifest itself by sucking or chewing on the skin, which can also cause damage.
6. Use of tools: Some people may use tools, such as tweezers or scissors, to perform skin manipulations.
7. Plucking pimples and blackheads: People with dermatillomania may uncontrollably pluck pimples, blackheads, and other skin rashes, which can make the condition worse.
8. Manipulation of mucous membranes: In rare cases, dermatillomania may also involve mucous membranes such as the lips or inner cheeks, sucking or scratching which can cause lesions.

Diagnostics of the dermatillomania

Diagnosis of dermatillomania may be made by a psychiatrist or a psychologist specializing in psychotherapy and mental disorders. The following methods and criteria are commonly used to establish a diagnosis:

1. Clinical Assessment: The clinician interviews the patient to identify the characteristics and symptoms of dermatillomania. The patient may talk about his or her skin manipulation habits and their impact on his or her life.
2. DiagnosticCriteria: The diagnosis of dermatillomania can be made based on the criteria established in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). According to these criteria, dermatillomania is part of the impulse control disorder category.
3. Ruling out other causes: The doctor may also rule out other physical or mental causes that could explain the patient's symptoms.
4. History: A review of the patient's history and medical history is important, including the duration of symptoms and their impact on daily life.
5. Self-assessment: The clinician may use specific questionnaires and scales to assess the severity of dermatillomania and its impact on the patient.

Diagnosis is usually made based on clinical presentation and meeting DSM-5 criteria. Once a diagnosis is made, the patient may be referred for treatment, which often includes psychotherapy such as cognitive behavioral therapy (CBT) and, in some cases, medication.

Treatment of the dermatillomania

Treatment for dermatillomania usually involves psychotherapy and, in some cases, medication. Here are some of the treatment approaches:

1. Cognitive Behavioral Therapy (CBT): CPT is one of the most effective treatments for dermatillomania. In this therapy, patients learn to recognize and control their skin manipulation skills, identify triggers and stressful situations that may provoke the condition, and develop coping strategies and alternative behavioral responses.
2. Group support: Participating in group support sessions can be beneficial for patients with this disorder. Sharing experiences with others suffering from the same disorder can help reduce feelings of isolation and provide additional support.
3. Medication: In some cases where dermatillomania is associated with co-occurring psychiatric disorders, a doctor may prescribe medications such as antidepressants or medications to reduce anxiety.
4. Self-help: Patients can also use various self-help techniques such as mindfulness (meditation and relaxation) to manage stress and anxiety, which can reduce the desire to manipulate the skin.
5. Adherence to skin care regimen: It is important for patients to pay special attention to skin care at the sites of injury to avoid infections and speed up the healing process.

Treatment should be individualized to each patient.

Prevention

Prevention of dermatillomania may include the following measures:

1. Psychological support: If you have a predisposition to dermatillomania or notice the first signs of the disorder, it is important to see a psychologist or psychiatrist for counseling. Seeing a professional early can help prevent the disease from developing.
2. Self-control: Try to be aware of the moments when you start manipulating your skin or plucking your hair. Try to develop coping strategies to manage stress or alternative ways to relax to replace destructive behaviors.
3. Stress reduction techniques: Learn and practice stress reduction techniques such as meditation, yoga, deep breathing and relaxation. These techniques can help you better manage emotional tension.
4. Exercise: Regular physical activity can help reduce stress and anxiety, which can be helpful in preventing this condition.
5. Support from others: Discuss your pain and anxiety with close friends and family. They can provide support and understanding, which can reduce feelings of isolation.
6. Skin Care: Proper skin and hair care and minimizing irritants (such as harsh chemicals) can help prevent irritation and redness that can trigger the condition.
7. Avoid being alone: Try not to be alone with yourself in situations where you feel you may start to manipulate your skin or hair. Socializing with others can distract you from such actions.

Forecast

Prognosis can vary depending on a variety of factors, including the severity of the disorder, the duration of the disorder, the availability of treatment, and the patient's motivation to adhere to the specialist's recommendations. It is important to note that this disorder, like other body dysmorphic disorders, can be a chronic condition, but with the right help and support, most people can improve their condition and learn to control their symptoms.

The prognosis may be as follows:

1. Complete recovery: Some patients manage to completely overcome dermatillomania through psychotherapy, medication and self-control.
2. PartialImprovement: For other patients, partial improvement is achieved with a reduction in the frequency and intensity of skin or hair manipulation.
3. Chronic: In some people, the disease may be chronic and they may continue to experience relapses even with treatment. However, even in this case, managing symptoms and improving quality of life through treatment and support is possible.

It is important to see a therapist regularly to monitor the progress of treatment and to follow the specialist's recommendations and prescriptions. The earlier treatment and support begins, the better the prognosis and the better the chances of improvement in dermatillomania.

Literature used

Neznanov, Aleksandrovsky, Abritalin: Psychiatry. National manual. GEOTAR-Media, 2022.