Skin picking, also termed dermatillomania, is an unsettling condition many grapple with. Notably, its prevalence among those with ADHD is a significant and growing concern. To navigate the complexities of ADHD-induced skin picking, one must understand its genesis and potential remedies.
What is Skin Picking?
Dermatillomania or Excoriation Disorder is an impulsive control disorder characterized by the repeated urge to pick at one's skin. This often leads to visible wounds, emotional turmoil, and can substantially interfere with a person's social and professional life.
What Causes Skin Picking?
- Stress and Anxiety: High stress levels and anxiety are common triggers. The act of picking provides a temporary distraction from internal turmoil.
- Boredom: Skin picking can serve as a mindless activity to fill moments of idleness.
- Sensory Stimulation: For some, the act of picking provides sensory feedback, a tactile response to inner restlessness.
BFRB and Skin Picking Related ADHD
Body-Focused Repetitive Behaviors (BFRBs) encompass a variety of compulsive actions. Two of the most commonly recognized BFRBs are trichotillomania (hair-pulling) and dermatillomania (skin picking). While these actions may seem purposeless or even self-destructive to outside observers, for those struggling with them, they often serve as coping mechanisms in response to internal emotional states.
Underlying many BFRBs is an intense, almost unbearable urge that's temporarily relieved upon completing the action. For instance, someone might feel escalating tension that only hair-pulling or skin-picking can alleviate. After the act, they may experience a fleeting sense of satisfaction or relief, but unfortunately, this is often followed by feelings of guilt or shame.
In individuals with ADHD, these behaviors can be exacerbated. ADHD, or Attention-Deficit/Hyperactivity Disorder, is characterized by symptoms like impulsivity, restlessness, and difficulties in self-regulation. These core ADHD traits can intensify the frequency and severity of BFRBs. A person with ADHD may impulsively engage in skin picking without much forethought, or they might resort to such behaviors as a tactile form of stimulation when feeling under-stimulated or restless.
The Connection Between Skin Picking and ADHD
The intricate dance between ADHD and BFRBs isn't merely behavioral – it has profound neurological roots. The brain's chemistry, especially in individuals with ADHD, plays a crucial role in predisposing them to these repetitive behaviors.
Dopamine, a neurotransmitter responsible for regulating pleasure, attention, and motor functions, is often imbalanced in those with ADHD. A dopamine deficiency can contribute to feelings of restlessness, impulsivity, and the incessant need for sensory stimulation.
When dopamine levels are lower than typical, individuals might unconsciously seek activities that provide a temporary dopamine surge, hence resorting to self-soothing behaviors like skin picking.
Moreover, the prefrontal cortex – the brain region associated with executive functions like decision-making, impulse control, and attention regulation – often functions differently in those with ADHD. This neural distinction means that not only are these individuals more predisposed to BFRBs, but they might also have a harder time controlling these body-focused repetitive behaviors once they've begun.
It's essential to understand that ADHD doesn't just manifest as hyperactivity or inattention. Its tendrils reach far deeper, affecting various aspects of an individual's behavior, including exacerbating compulsions like skin picking.
However, Skin picking & ADHD are not always being tied together and every case is different. As always, consult your physician.
Strategies to Stop Skin Picking
While there is no medication that is proven to stop skin-picking, we know that ADHD and its associated behaviors are heavily influenced by brain chemistry. Some medications, especially those tailored for ADHD, can help address imbalances in neurotransmitters.
Stimulants like Adderall or Ritalin, for instance, are known to enhance dopamine and norepinephrine levels, which can indirectly decrease impulsivity and the urge to engage in skin picking. However, reactions to medications are individualized, and not everyone may benefit equally. It's essential to work closely with a psychiatrist or primary care provider to find the most appropriate and effective medication regimen.
Cognitive Behavior Therapy (CBT)
At its core, CBT is about understanding and changing patterns of behavior. It begins with identifying triggers that precipitate skin picking. Once recognized, the therapy works on introducing coping mechanisms to divert or suppress the urge. Over time, with consistent practice, the brain learns to resort to these healthier coping mechanisms rather than yielding to the compulsion.
Habit Reversal Training (HRT)
HRT is a subset of CBT specifically designed for compulsive behaviors. It's a three-step process: awareness training (recognizing when and why you pick), competing response training (learning a physical action to do instead of picking), and building motivation. The goal is to create a new, healthier habit that eventually replaces the unwanted one. The HabitAware focuses on utilizing Habit Reversal Training to help you stop skin picking.
- Awareness - The- Keen2 awareness bracelet helps you recognize unwanted habits and gently reminds you when you perform them
- Competing Response - HabitAware’s online course can teach you how to develop a competing response
- Building Motivation - Our helpful online community, The BFRB Change Collective builds you up and supports you every step of the way
Mindfulness and Meditation
The essence of mindfulness is living in the present moment (e.g. “keen” awareness) without judgment. By practicing mindfulness, individuals can become more attuned to their triggers and the early signs of an impending skin picking episode. Guided meditation sessions, in particular, can be useful to develop a greater sense of self awareness. These sessions focus on grounding exercises that engage the senses, diverting attention from the urge to pick and cultivating an environment of inner peace.
Sometimes, the simplest interventions can offer temporary relief.be helpful. Wearing gloves, for instance, can act as a physical deterrent to picking. Bandages or breathable tapes can protect vulnerable skin areas. For those who pick as a means of tactile stimulation, fidget toys, stress balls, or even textured fabrics can offer an alternative sensory experience.
The journey to curbing skin picking can be daunting, often filled with relapses and moments of self-doubt. Joining a support group can be a lifeline. The Picking Me Foundation is the only non-profit dedicated to supporting the dermatillomania community and offers a platform where individuals can share their experiences, learn from others, and realize they're not alone in this battle. Sharing stories and coping mechanisms can provide fresh perspectives and renewed hope.
Juxtaposing ADHD and skin picking underscores the intricate tapestry of human behavior and neurology. However, with patience, professional guidance, and personal resilience, it's entirely possible to overcome the challenges posed by this dual conundrum.