The dermatilomania It is a psychopathological disorder characterized by an extreme need to touch, scratch, rub, rub or rub the skin. People who suffer from this disorder are unable to resist performing these behaviors, so they scratch their skin impulsively to mitigate the anxiety of not doing it..
Obviously, suffering this psychological alteration can greatly damage the integrity of the person as well as provide a high level of discomfort and have a significant impact on their day to day.
In this article we will review what is known today about dermatillomania, what characteristics this disease has and how it can be treated.
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Dermatilomania is a psychopathological disorder that was first described by Willson under the name of skin picking..
At its core, this psychological alteration is characterized by the need or urge to touch, scratch, rub, rub, squeeze, bite, or excavate the skin with nails and / or accessory tools such as tweezers or needles..
However, dermatilomania remains today a little-known psychopathological entity and with many questions to answer..
In recent years, there have been many debates about whether this alteration would be part of the obsessive compulsive spectrum or an impulse control disorder.
That is, if dermatilomania consists of an alteration in which the person performs a compulsive action (scratching) to mitigate the anxiety caused by a certain thought, or an alteration in which the person is unable to control their immediate needs to rub your skin.
At present, there seems to be a greater consensus for the second option, thus understanding dermatilomania as a disorder in which, when faced with itching or other skin sensations such as burning or tingling, the person feels an extreme need to scratch, for what ends up doing the action.
However, the relationship between the skin and the nervous system appears to be very complex, so there are multiple associations between psychological disorders and skin disorders.
In fact, the brain and the skin have many associative mechanisms, so that, through its lesions, the skin can account for the emotional and mental state of the person.
More specifically, a review by Gupta revealed that between 25 and 33% of dermatological patients had some associated psychiatric pathology.
Thus, a person who suffers from alterations in the skin and in the mental state, as is the case of individuals who suffer from dermatilomania, must be evaluated as a whole and guide the explanation to the alterations suffered in two aspects.
1. As a dermatological disorder with psychiatric aspects.
2. As a psychiatric disorder with dermatological expression.
Dermatilomania is also known today by other names such as compulsive skin scratching, neurotic excoriation, psychogenic excoriation or excoriated acne.
With these 4 alternative names to dermatilomania, we can already see more clearly what is the main expression of mental alteration.
In fact, the main characteristic is based on the feelings of need and urgency that the person experiences at certain moments of scratching, rubbing or rubbing their skin.
Normally, these sensations of the need to scratch appear in response to the appearance of minimal irregularities or defects in the skin, as well as the presence of acne or other skin formations..
As we have commented previously, scratching is done in a compulsive way, that is, the person cannot avoid scratching the determined area, and it is done through the nails or some utensil.
Obviously, this scratching, either with the nails or with tweezers or needles, usually causes tissue damage of varying severity, as well as skin infections, permanent and disfiguring scars, and significant aesthetic / emotional damage..
Initially, the clinical picture that defines dermatilomania appears in response to itching or other skin sensations such as burning, tingling, heat, dryness, or pain..
When these sensations appear, the person experiences immense needs to scratch that area of skin, which is why they initiate compulsive scratching behaviors.
It should be noted that whether we understand the alteration as an impulse control disorder or an obsessive compulsive disorder, the person cannot resist performing the scratching actions because if he does not do so he will not be able to get rid of the tension that suppose not to.
Thus, the person begins to scratch the skin in a totally impulsive way, without being able to stop to reflect on whether he should do it or not, and obviously, causing marks and wounds in the skin area..
Subsequently, the impulses to scratch do not appear after the detection of itching, acne or other natural elements of the skin, but by the permanent observation of the skin itself.
In this way, the person with dermatillomania begins to obsessively analyze the condition of the skin, a fact that makes controlling or resisting the urge to scratch become a practically impossible task.
During observation the nervousness, tension and restlessness increases, and can only decrease if the action is carried out.
When the person finally performs the action of scratching or rubbing their skin impulsively, they experience high sensations of gratification, pleasure and relief, which some patients describe as a state of trance.
However, as the scratching action progresses, the feelings of gratification diminish while the previous tension also disappears..
Thus, we could understand the functioning pattern of dermatilomania as extreme feelings of tension which are eliminated through the action of rubbing the skin, a behavior that provides a lot of gratification in the beginning, but that disappears when there is no longer so much tension.
As we can see, although we have to bridge many important distances, this pattern of behavior differs little from that of a person addicted to a substance or a certain behavior.
Thus, the smoker who spends many hours without being able to smoke, his state of tension increases, which is released when he manages to light the cigarette, at which time he experiences a lot of pleasure..
However, if this smoker continues to smoke one cigarette after another, when he is smoking the fourth in a row, he will probably not experience any type of tension and most likely the gratification that the nicotine provides will be much less.
Returning to dermatilomania, as the action of scratching the skin progresses, the gratification disappears, and instead feelings of guilt, regret and pain begin to appear, which progressively increase as the action of scratching is prolonged.
Finally, the person suffering from dermatillomania feels shame and self-reproach for the injuries and injuries resulting from their compulsive scratching behaviors, a fact that can cause multiple personal and social problems.
So far we have seen that dermatilomania is an impulse control disorder in which the person is unable to resist scratching certain areas of their skin due to the prior tension caused by self-observation and the detection of certain skin aspects.
However, what areas of the body are often scratched? What sensations does the person with this alteration have? What behaviors do they normally perform?
As mentioned, there is still little knowledge about this psychological disorder today, however, authors such as Bohne, Keuthen, Bloch and Elliot have contributed more than interesting data in their respective studies..
In this way, from a bibliographic review carried out by Doctor Juan Carlo Martínez, we can draw conclusions such as the following.
-The sensations of prior tension described by patients with dermatillomania rise to levels between 79 and 81%.
-The areas where scratches are performed most frequently are pimples and blackheads (93% of cases), followed by insect bites (64%), scabs (57%), infected areas (34%) and healthy skin (7-18%).
-The behaviors most frequently performed by people with dermatillomania are: squeezing the skin (59-85%), scratching (55-77%), biting (32%), rubbing (22%), digging or removing (4-11 %), and puncture (2.6%).
-The instruments most used to perform this action are nails (73-80%), followed by fingers (51-71%), teeth (35%), pins or brooches (5-16%), tweezers ( 9-14%) and scissors (5%).
-The areas of the body most affected by the compulsive behaviors of dermatilomania are the face, arms, legs, back and thorax.
-People with dermatillomania try to cover the wounds caused with cosmetics in 60% of cases, with clothing in 20% and with bandages in 17%.
The epidemiology of dermatillomania has not yet been well established, so the currently existing data are not redundant..
In dermatological consultations, the presence of this psychopathological disorder is found in between 2 and 4% of cases.
However, the prevalence of this problem in the general population is unknown, in which it is understood that it would be lower than that found in dermatology consultations.
Likewise, in a study carried out on 200 psychology students, it was found that the majority, 91.7% acknowledged having pinched their skin during the last week.
However, these figures were much lower (4.6%) if the action of pinching the skin was considered as a response to stress or a behavior that produced functional impairment, and up to 2.3% if said action was considered to have some relationship with any psychiatric pathology.
Today we do not find in the literature a unique and totally effective treatment to intervene this type of psychopathology. However, the methods that are most used among mental health services to treat dermatillomania are the following.
Antidepressant medications such as selective serotonin inhibitors or colomipramine are usually used, as well as opioid antagonists and glumatergic agents..
This therapy focuses on looking for the underlying cause of the disorder, as well as the effects that it can cause.
The patient is helped to develop impulse control skills without damage and to reduce scratching behaviors.
This therapy has obtained very good results for the treatment of obsessive compulsive disorder, for which similar effects are expected in the intervention of dermatilomania.
With this treatment, behavioral techniques are developed that prevent the appearance of impulsive acts, and at the same time obsessive thoughts of scratching are worked on so that these are experienced with lower levels of tension and anxiety..
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