Getting to the root of the problem: skin picking disorder and aesthetic procedures
Abstract
Excoriation disorder or skin picking disorder (SPD) is a chronic mental illness. It is defined by recurrent skin picking, scratching, rubbing and digging or urges to do so that goes on for extended periods of time, resulting in skin lesions and behaviour that interferes with functioning in other areas of life. The skin-picked area of the body can be smooth and healthy, and the anomaly invisible to the naked eye. Commonly, individuals with SPD seek aesthetic procedures to address perceived self-defects or to remedy their self-inflicted scarring. It is important for aesthetic practitioners to identify SPD because continuing with aesthetic interventions could worsen the illness for the sufferer. In response to this issue, aesthetic practitioners can identify individuals with SPD by administering a screening questionnaire and appropriately providing referrals to mental health professionals.
Many people have probably squeezed a spot during their adolescence or picked at a scab. An inner voice may have forewarned, ‘do not pick at it, it is going to leave a scar’, but was ignored. Some individuals are born with blemish-free skin and struggle less with urges, while others are not so lucky. This all sounds natural and normal, but when it crosses over into picking, hour after hour without being able to stop, despite wanting to, a mental illness called excoriation—or skin picking—disorder (SPD) may be in motion. Sufferers report a loss of control and significant distress that, in turn, disrupts healthy functioning in other areas of their lives.
SPD is a chronic mental illness that is classified under obsessive–compulsive disorder and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013). Symptoms include recurrent skin picking, scratching, rubbing and digging or urges to do so that go on for extended periods of time (at least 1 hour), resulting in skin lesions and behaviour that interferes with functioning in other domains, such as school, work, social or merely personal grooming. Repeated attempts have been made to decrease or stop skin picking but are unsuccessful.
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