Since CSP is still a largely misunderstood problem, few medical and mental health professionals are adequately trained to treat the behavior successfully. However, as chronic skin picking becomes a more recognized and understood problem, more professionals are becoming familiar with interventions that can help.
- The Trichotillomania Learning Center (TLC) keeps a database of treatment professionals who are knowledgeable about this disorder and can help you in your search for a local treatment provider.
- Psychologists and therapists who specialize in cognitive-behavioral therapy, which addresses both the thoughts of an individual and their behaviors, are good resources for skin picking problems.
- Dermatologists or psychiatrists can also prescribe medications that may help to eliminate skin irritations or reduce urges to pick, but results vary widely.
Habit Reversal Training (HRT)
This is the primary treatment approach for CSP and it is a form of cognitive-behavioral therapy.
Over the years, HRT has been expanded to become a comprehensive approach to understanding the physical and emotional triggers, situational factors, and associated behaviors involved in problems like chronic skin picking. Once these factors are understood, alternative coping strategies are taught.
This includes instruction in competing motor responses that actually prevent you from picking-for example, keeping your hands busy by holding and squeezing a rubber ball whenever you feel the urge to pick at your skin.
Stimulus Control (SC)
is another form of therapy that involves modifying physical aspects of a skin picker’s environment to reduce sensory input that leads to picking.
For example, if looking closely at your skin in the bathroom mirror causes you to pick your face, then the sensory input of seeing your pores needs to be modified. Try putting a piece of tape on the floor to remind you not to get too close to the mirror. If just touching your skin is a trigger for you, you might wear gloves, Band-Aids, or rubber fingertips to prevent you from feeling your skin and help you resist the urge to pick. Or you might be instructed to avoid or alter situations that are high risk to you, such as sitting for long periods of time reading or using the computer. Overall, it is important to recognize that skin picking can be a complex problem and might need to be approached from several different angles to treat it properly.
Although few studies have been conducted to assess the effectiveness of these treatments, several case studies and small investigations support the use of HRT and SC for skin picking.
There is some research support for the use of certain medications known as selective serotonin reuptake inhibitors (SSRIs), including fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram, and escitalopram.
Additionally, preliminary research indicates that the effectiveness of certain medications in reducing impulses for specific behaviors (such as alcohol abuse) may also be useful in treating CSP.
N-Acetyl Cysteine has been used with success to treat skin picking, and in a well-designed study there were no discontinuations due to side effects and no noted significant adverse effects. Read more
Other Treatment Concerns
If you are concerned with any medical aspects of your skin picking-a wound that may be infected, for example, or lesions that have not healed over time-it is important to first consult with your primary care physician or a dermatologist. (Do not be alarmed if your doctor is not familiar with CSP; you may have to educate him or her about your skin picking and its impact on you.) After any medical concerns are addressed, it is recommended that you seek help from a psychologist or therapist who can work with you to develop a behavioral program to address your chronic skin picking. The Trichotillomania Learning Center (TLC) provides listings of treatment providers.
Finding a Therapist
It also is important to determine the level of experience and the treatment approach of any professional you plan to go to for help. When interviewing a potential treatment provider, ask if he or she has specific training in treating body-focused repetitive behavior (BFRB) problems such as skin picking. Ask them to describe their treatment approach to you, and listen for terms like “cognitive-behavioral therapy,” “habit reversal training,” and “stimulus control.” Self-education and self-help are also options for people who are unable to locate trained professionals; TLC (www.trich.org) can provide additional information and help in locating or starting self-help support groups in your area.
If your insurance company does not have professionals trained to treat this problem, request that they provide out-of-network coverage for providers with this training. Insurance companies are required to make exceptions when they cannot provide services within their panel of providers. Ideally, you will want to find a professional who is trained specifically in cognitive-behavioral therapy for BFRBs.
If you are unable to find someone trained in BFRB treatment in your area, you may need to find a professional who is experienced with behavior therapy and willing to learn more about skin picking. Professionals trained in the treatment of obsessive-compulsive disorder are also often familiar with behavior therapy for conditions like chronic skin picking and may be well-positioned to adapt their skills to help with BFRBs.