Also known as dermatillomania, excoriation is a mental health condition closely related to obsessive-compulsive disorder. Patients who have excoriation repeatedly pick their skin, and the condition can cause significant disruption to daily life. Patients pick at healthy skin and also at scabs, lesions, pimples, calluses, and other skin irregularities. Some patients may spend several hours each day picking at their skin, and the condition frequently comes and goes, alternating between symptom-free periods and periods of high intensity. Women are diagnosed with excoriation more often than men, and the disorder affects a little over one percent of the population. Most patients develop this condition near puberty, and it is also common in adults under forty-five years old. The treatment recommendations outlined below are often beneficial in patients with excoriation.
Habit Reversal Training
Habit reversal training is a behavior-based approach to the treatment of excoriation and other repetitive behaviors such as hair pulling. The training regimen was originally developed in the 1970s and operates on the premise that patients who engage in the repetitive behaviors are unaware they are doing so. Practitioners believe the repetitive behaviors occur because patients are experiencing underlying discomfort or urges trapped within their subconscious. The goal of habit reversal training is to make patients aware of their repetitive behaviors and replace these with behaviors that are less disruptive for the patient. Patients monitor themselves for repetitive behavior and keep a behavior diary to record incidents of this behavior. After several weeks of learning to recognize their behavior, patients focus on developing a competing response. The competing response varies according to the patient’s situation, and it is ideally held for at least one minute. Therapists try to help patients develop competing responses that make it impossible to engage in the previous unwanted behavior. For example, patients who pick their skin with their right hand may be encouraged to sit on that hand or make a fist with it to prevent skin picking. In patients with milder forms of excoriation, habit reversal may be the only line of treatment necessary.
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