skin picking

[amy g.]

My 15 year old has picked her arms and hands until they are covered in scars and scabs.

 

The first time her neurologist saw it, he said there was medicine that would help, but he did not want her more medicated. I agreed with that.

 

It has gotten worse, so I asked him about it at her last appointment. He just said it was not a side effect of her medication, and he will see her again in a year.

 

I remind her not to pick, and she stops, but starts again 2 seconds later. I do not want to punish or nag her, because it is a compulsion, and she can't help it.

 

I'm no clean freak, but I am starting to worry that it will lead to a system wide infection. It is almost bug season here again, and they love to bite her. She will scratch and pick those until her whole body is covered in scabs.

 

Is there anything that will really work to reduce how many bugs bites she gets or to help weaken the compulsion to pick?

[Guest kartinkent]

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.

Treatment: What Works

 

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

 

1.) MEDICATION: Antidepressants (SSRI’s) 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.

 

2.) PSYCHOTHERAPY: With literally hundreds of different approaches, it is hard to be an educated consumer. Look for good personal chemistry: someone you feel ‘gets’ 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.

 

3.) HYPNOSIS and SELF-HYPNOSIS: These adjunctive techniques are best taught by a qualified psychotherapist. With an impressive record of success for habit control, these approaches are especially 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

[amy g.]

Thanks. "Spacey trance" is a pretty accurate description.

[Orthodox6]

"Picking" signals severe anxiety, and often appears in people with obsessive-compulsive disorder (OCD). Cognitive-behavioural therapy can help this, as can the correct medication. Saying this with sincere goodwill, I would schedule a discussion appointment with an adolescent psychiatrist as soon as possible. You and dd need to discover what underlies this.

[amy g.]

Thanks. I did get a recommendation for a psychiatrist who specializes in anxiety. I'll see if I can get an appointment.

[KidsHappen]

I have two dd who have done this. One just has a combination of dry itchy skin and a mild anxiety problem that causes her to continue scratching at a spot until there is not skin left and then picking the scabs off until the whole thing spreads and covers fairly large areas. It takes forever for this things to heal and she has several fairly large scars because of it.

 

The other child has OCD and her problem was so severe that at times she looked like she had hundreds of cigarette burns all over her body. You can bet you butt I had ever evaluated and had this documented by both her regular dr. and pdoc. She is also bi-polar so treatment was complicated. The first go to drug in a case like this is an SSRI which can be a serious problem for a bi-polar person not already stablized. Since her problem was so severe we simutaneously started her on Zoloft, Seroquel & Trileptal. Within six weeks the behavior started to decrease and was well under control by six months. She has been on this combination of meds for about 5 years now without any problems and has remained well balanced the entire time. If she get a bug bite of something like that, she does have a tendency to pick at it but she does not just randomly pick at her skin anymore. Unfortunately, she has scars that will probably never go away. They look much like the old small pox vaccine marks but are all over her body. She is very fair skinned so they don't really stand out so much. She was lucky in that none of the sores ever got infected.

 

In this day and age with things like MSRA, I would be very concerned about having open sores all the time. Considering that you guys have horses, make sure she is up to date on her tetnus shots. I think I would be covering her in hydrocortisone and maybe even considering a stronger cortisoid to help them heal. Also, an anti-histimine because once sore start to heal, they itch which cause you to want to scratch and pick at them even more. She needs a systemic medication to deal with the root cause of the behavior because she can do some serious damage to herself taking a slower approach. Good luck with this honey. I know it is so very hard. :grouphug:

[Cera]

Is it an issue for her? If it is would she be willing to wear gloves (those thin, stretchy, cotton ones) during the times she is most likely to pick?

 

My daughter is much younger but was picking out of habit (boredom) and we have stopped it by filing her nails to absolutely nothing each morning when she wakes up and having her wear stretchy gloves during the times she is most likely to pick without thinking.

[kewb]

My son has trichotillomania (hair pulling) and skin picking is a related syndrome. Most likely the picking is related to stress/anxiety/boredom. Telling her to stop will not do anything because, as you said, it is a compulsion.

 

For trich my son had to keep a log. Every time he noticed himself pulling he had to write when, how many hairs, and what he was feeling so we could find the pattern. He also take the following supplements that seem to help him manage the urge. He takes 5 HTP 2x a day and a teaspoon of Inositol powder dissolved in juice 1x a day (sometimes 2x if he is feeling very stressed). The Inositol needs to be the powder not the capsules. He also used to carry around a small koosh ball to keep his hands busy.