Compulsive behavior that leads to frequent scratching or grinding on the skin, dermatillomania is one of the obsessive-compulsive disorders that need to be evaluated and treated with behavioral therapies and drug treatments. This pathology can damage the skin and cause mental suffering. Explanations.

Dermatillomania is listed in the obsessive-compulsive disorder (OCD) defined in the DSM V (Diagnostic and Statistical Manual of Mental disorders) of the American Psychiatric Association. This behavioral disorder is characterized by the checking and pounding or scratching of the skin which is compulsive and repeated, that is, the patient cannot control. It’s stronger than him. 

These behaviors relate to one or more parts of the body, in particular the face, whether or not there is acne. But they can also be worn on the scalp, neck, shoulders, armpits, chest, back, arms, hands, stomach, buttocks, legs or feet. In short, all areas accessible to scratching. It is a fairly common pathology (around 1,4%) which mainly affects women (3/4 of patients). Its function is to more or less consciously reduce a state of internal anxious tension.

This behavioral disorder is therefore part of a more or less severe obsessive compulsive disorder (OCD) carried by an anxiety background. A stressful situation or post-traumatic shock can exacerbate this trichotillomania in an attempt to reduce the feeling of internal tension. It can occur at any age but it is particularly present in children and adolescents.

Three stages are often found in dermatillomania behaviors.

The cheking process 

It consists of looking at the body and the skin very closely, sometimes with a magnifying glass in front of the mirror and a light in order to check if the skin is perfect. If this is not the case, the check will detect all defects, even the smallest (pimples, scabs, redness, irregularities, spots, etc.).

Crushing

Crushing consists of scratching, pinching, rolling the skin until it is damaged in order to modify its appearance. This behavior is usually done in a state of so-called hypnotic semi-consciousness which can last several minutes or several hours. The patient may realize that he is abusing his skin, but will continue with his deleterious behavior due to his hypnotic state and the relief that this behavior provides in a transient manner.

Scratching

Scratching consists of running your hand and fingers over different parts of your body to identify any roughness (bumps, irregularities, pimples, etc.). Then the patient will try to remove them with his fingernails or tools such as tweezers, a needle, a razor, a comedone puller, etc. He can also try products like alcohol to try to erase stains, redness, folds. It will also be difficult for him to stop there until he has dealt with all the imperfections found. Scratching also induces a feeling of relief.

These irrational scratching / pounding behaviors are often accompanied by a feeling of pleasure or relief at the moment of the impulse, preceded by a progressive feeling of tension, anxiety or stress.

They are sometimes organized in a ritualized, invasive and uncontrolled manner (compulsion) by repetitive sequences of gestures, recognized as irrational by the patient himself. This disorder causes difficulties in daily life by disabling social, personal, professional or school life.

Behaviors of avoidance of certain outings or meetings are observed such as at the swimming pool or intimate and sexual life. At the level of the face, when it is a question of moderate acne, the lesions can become extensive, alter the patient’s image and reinforce the grinding behavior in an attempt to erase the wounds.

These compulsions can last several minutes and up to several hours per day in front of a mirror, for example, and the patient is not always aware of the duration of his scratching / crushing behaviors on his skin (temporal rupture which testifies to a said hypnotic).

Three approaches are possible and complementary.

Cognitive-behavioral and family therapies 

Among cognitive-behavioral therapies (CBT), there are global approaches which attempt to understand and thwart (progressive desensitization) the physical and emotional triggers, the circumstances of occurrence of these dermatillomania behaviors. The family approach will also seek to make the entourage adopt empathic behaviors such as not to make the patient feel guilty knowing that he is not doing it on purpose and to support him in his treatment by encouraging his progress.

Drug treatments

Drug treatments such as specific antidepressants for OCD such as selective serotonin reuptake inhibitors (SSRIs). Possibly the intermittent intake of anxiolytics to contain the compulsions. 

Relaxation techniques