I found these articles on http://www.brainphysics.com/skin-picking.php and thought that I would post them so that maybe some of us could benefit from what they say. I am really interested in this vitamin b inositol, it seems to reduce the urge to pull or pick. I want to find a cure! I want relief! We all need to pull together so we can overcome this awful condition we all have. I hope this helps. So here are the articles. M

What Is Compulsive Skin Picking?

Compulsive Skin Picking (CSP) is a body-focused repetitive behavior that results in the destruction of one's own skin. The face is usually the main target of skin picking, but Compulsive Skin Picking may involve any part of the body. Skin picking is a form of self-mutilation that can be quite serious, as people who suffer from CSP may experience bleeding, bruises, infections, scarring or even permanent damage to the skin.

The behavior is oftten unconscious, and people with this compulsion may have difficulty stopping because they are often unaware of their actions. Compulsive Skin Picking is also called dermatillomania. It is classified by psychiatrists as an impulse control disorder.

What Causes Compulsive Skin Picking?

The cause of Compulsive Skin Picking is probably a combination of biological and environmental factors. Many animals engage in excessive skin picking and scratching, and some have theorized that an out-of-control grooming mechanism in the brain causes these behaviors.

Scientists have developed mice who are missing a certain gene, causing them to engage in compulsive grooming that leads to bald spots and patches of missing fur. These behaviors may increase when under stress.

Compulsive Skin Picking is often observed in people suffering from obsessive-compulsive disorder; in fact, about a quarter of those with OCD also have CSP. About a quarter of those with body dysmorphic disorder also have CSP. The most well-understood form of compulsive self-mutilation is trichotillomania or hair pulling, and this also tends to disproportionately afflict people with OCD. Because it is a repetitive behavior and common in people with obsessive-compulsive disorder, is sometimes considered a related OC spectrum disorder. These disorders tend to run in families.

There are several reasons why people with CSP continue their behaviors.

•Self-Soothing: When stressed, many people feel a need for self-soothing and find they feel better when they pick. Skin picking has a kind of soothing effect on their nervous systems, and reduces levels of stimulation.

•Stimulation: On the other hand, when people are bored or inactive, skin-picking may provide a needed level of stimulation for the nervous system. It may help keep a person alert or awake when they would otherwise become bored or distracted.

•Perfectionism: Skin-pickers may stand for hours in front of mirrors closely examining their faces or other body areas for the tiniest irregularity and then try to fix it, in hopes of achieving a perfect complexion. Paradoxically, the skin-pickers always end up looking much worse in spite of their efforts, as a result of the damage that they do to themselves in pursuit of relentless perfectionism.

Skin-picking can result in a self-perpetuating cycle. Picking may lead to shame and anxiety, which can result in more picking.

The Terminology of Repetitive Self-Mutilation

The most common behaviors performed by people suffering from superficial compulsive self-mutilation are not dangerous but can become extreme. These include hair-pulling, nail-biting, and the picking and scratching of scabs and skin.
•Skin Picking: dermatillomania
•Skin Biting: dermatophagia
•Hair Pulling: trichotillomania
•Nail Biting: onychophagia

These behaviors are probably all different aspects of the same problem.

Treatment for Compulsive Skin Picking

Picking can become a major focus of life and can interfere with relationships, work, and general happiness. Not recognizing the problem as a real disorder, many do not seek treatment. People with CSP may feel crazy and out of control, but not know what to do or where to go for help. Fortunately, CSP responds fairly well to medication and behavioral therapy.

Medication: The medications mainly used to treat picking are the same group as those used for OCD, including antidepressants (SSRIs). Drugs that help skin picking may take several weeks before they start working. They also may not work perfectly. Usually, 65 percent improvement from a medication is considered a good result. Medication should never be considered an end in itself, but a tool to help with therapy.

Psychotherapy: Cognitive-behavior therapy has been studied as a means of treating skin-picking and related disorders. Therapy may involve several different techniques, outlined below:

•Habit Reversal Training (HRT) is a four-step process which teaches the person with how to relax, how to breathe and feel centered, and to perform muscle response exercises. HRT includes self-monitoring and stimulus control (described below) and social support.

•Self-Monitoring is simply making the person with CSP more aware of their behaviors. As the behavior can often be unconscious, awareness can be improved by simply keeping a log of picking behaviors. The very act of recording the behavior can also interrupt the process and reduce the picking.

•Stimulus Control (SC) is a behavioral treatment that helps sufferers identify and eliminate, avoid, or change the environmental factors, moods, or circumstances that trigger picking. The goal is to consciously control these triggers to create new learned connections between the urges and alternative, non-destructive behaviors. For example if picking usually occurs while alone, the person will be encouraged to spend more time with others. If the picking occurs in front of the mirror, then the person may be asked to cover the mirrors in their home.

•Competing Response is a technique designed to give the person an alternative to picking. This can include fidget toys, knitting, beading, or other activities to keep the hands busy.

These techniques are all temporary means of helping the person learn to resist the urge to pick. The more the urge is resisted, over time the weaker the urge becomes. Once the urge fades, these techniques become less necessary. The length of time it takes to extinguish the behavior depends on how long the person has had the problem and how diligent they are in resisting the urges. Although therapy typically lasts from 10-12 weeks, it can take up to 12 months for the urge to pick to finally fade away.

Self Help & Online Resources Even today, when compulsive skin picking is no longer a disorder without a name, it still has scant awareness among both treatment providers and patients. Finding a clinician that has experience in treating skin picking is often difficult. However, thanks to the internet, information about CSP is being spread, and there are a few online resources that might be handy to CSP sufferers. One resource worth mentioning is the Compulsive Skin Picking online center, which provides useful self-help information and an online counseling option to people who have difficulties finding a treatment provider in their area.

Natural Remedies: Some people benefit from the B-vitamin inositol, which seems to reduce the urge to pull or pick. It is broken down by the body into two neurotransmitters that enhance the activity of serotonin in the brain. Serotonin, is a brain transmitter that may be implicated in OCD and related disorders. Inositol needs to be taken in large quantities, but will not build up to toxic levels as it is a water soluble vitamin.

Keep the Hands Busy

Fidget toys to keep the hands busy can be an important aid in treating difficulties like compulsive skin picking. A pocket koosh ball is a good way to occupy the fingers. [More finger toys.]

How to Stop Compulsive Skin Picking and Scratching

A Body-Focused Repetitive Behavior
by Ted A. Grossbart, Ph.D.

Everyone pulls off the odd bit of skin or squeezes a random pimple. But for some people the squeezing, scratching, or picking becomes an absolutely monstrous compulsive behavior that threatens to take over their lives. Concealing what they are doing and its impact, can trigger desperate attempts at camouflage and the avoidance of activities and relationships.

As a practicing skin psychologist for 30 years, I have seen a recent increase in people coming in with skin picking and scratching problems. Some have an underlying skin disease, but the behavior itself may be the whole story. Feeling great shame, people become isolated, rarely talking to friends and neighbors about their problem. This makes it hard for them to connect with others for support. The Internet may become their key source of support and information.
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Picking problems that look the same from the outside can be very different on the inside.
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Pickers and scratchers range from very emotionally troubled, to otherwise quite healthy and successful people. Picking problems that look the same from the outside can be very different on the inside. Treatment needs to be carefully individualized — simple formulas and stock programs are often not enough. The treatment approach must be matched to both what is fueling the picking and the individuals personal psychology.

Many different paths can lead to a picking problem. Any area may be the target, some people use tweezers or nail files and produce deep permanent scars. Many people describe looking for self-soothing, and go into a trance-like daze when they pick. Some people do most of their picking when they are bored, reading, or watching a movie, and little is going on. For others as the stress ratchets up, so does their picking. For yet another group, what starts as a well-intentioned attempt to smooth out or improve an area of skin may quickly turn destructive when it combines with a relentless perfectionism.

Deep guilt and shame can easily compound the problem. Sarah G. told me, "Over the years I have gradually shared all my secrets with my husband except one. Ever since college I have been disappearing into the bathroom to tear at my skin. I don't know if he suspects or not. I feel like a freak, I know I should tell him, but..." For her, 'coming out' was a critical step. Probably no treatment approach would have worked without it.

Not seeing their problem as a serious 'real' disorder, some deny themselves serious treatment. Picking can become a major focus of life and can seriously erode relationships, work, and leisure and really make people feel crazy and out of control. People who are hard on their skin are typically also hard on themselves about it. Fiona O. put it sharply, "I'm doing it to myself, so I deserve what I get."
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When Julia got out her magnifying mirror and bright light she knew trouble was coming.
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When Julia B. got out her magnifying mirror and bright light she knew trouble was coming. Deep scaring, recurrent skin infections and and an overwhelming sense of shame were no match for her compulsion to keep digging deeply at the skin on her arms. At first picking would bring her a blissful, trancelike sense of peace, and then as the blood flowed this would change into revulsion and self-reproach.

Intriguingly, a high percentage of pickers I've work with were picked on by others when they were growing up. They may have been scapegoated at school or the the victim of critical, perfectionistic parents. Being picked on then becomes a pattern that people loyally continue by internalizing the problem and picking on themselves.

Emma L. described her erratic parents and chaotic childhood, "Picking was the one stable thing I could depend on." As she was able to build a more solid identity and sense of herself in therapy, she was able to let go of the picking.

Natalie M.'s focus on her picking as part of a lifelong pattern of obsessions and compulsions let her use medication and behavior therapy very effectively. The very specific prescriptive style worked very well for her. In contrast Brent L. came to think of his picking as an addiction without a substance and adapted parts of the AA 12-step approach. He found he could stop picking if he was able to focus on, and sit with, the emotional pain that it was masking.

For others really pushing to get at the emotions that are lurking when picking starts is key. Picking can be an angry act, as I suggested to Brad K., if he did to someone in the street what he did to himself, they would put him in jail. Anne R. usually picked only in private, but when she got a cell phone call in a crowded car telling her that her boyfriend was also dating someone else, the picking started and her blood started to flow. Her skin took the beating she wished she could have delivered to him. People like Anne and Brad need help to feel their feelings in their hearts instead of in their skins.

Treatment: What Works

I have been most impressed with the effectiveness of three treatment tools:

Medication: Medications including antidepressants (SSRIs) and mood stabilizers have been very helpful for some of my patients, and a disappointment for others. If you want to go this route it is important to be persistent and expect to experiment with different drugs and dosages.

Psychotherapy:

With literally hundreds of different psychotherapeutic approaches, it is hard to be an educated consumer.
Look for good personal chemistry: someone you feel understands you.
Look for a depth of experience working with picking and scratching. Someone can be a great therapist for people with other problems, yet ignorant and ineffective in this area.
Ideally a therapist should be competent to address behavior change, cognitive (thinking) issues, and also the emotional side of the problem. A therapist who is too strictly committed to one approach or technique may have major blind spots.

These two approaches are the most established, best researched and validated treatments. If you are not getting the help you need from them, consider adding another less well-researched resource to your program:
Alternative Treatments: Hypnosis and self-hypnosis are adjunctive techniques best taught by a qualified psychotherapist. These approaches may be useful for people who go into a spacey trance state when they pick. You can learn to turn this inadvertent negative hypnosis into an effective treatment technique.

Compulsive picking and scratching can be among the most stubborn and depressing symptoms, but with persistence and competent help, you can make real progress.