Captive of the mirror: ‘I pick at my face all day, every day’
Liberate patients by changing their skin-picking habits and treating their impulsive urges
In a case series, three patients were successfully treated with habit reversal (Table 3) and cognitive-behavioral techniques, consisting of:
- awareness training (using a skin-picking diary)
- competing response techniques (such as making a fist or squeezing a ball)
- emotion regulation skills
- psychoeducation
- cognitive restructuring (such as using Socratic questioning to produce rational alternatives) in situations that elicit the urge to pick.28
In another case series, 22 dermatology patients with skin picking received psychotherapy with insight-oriented and behavioral components. Therapy included attention to developmental issues and active conflicts, cognitive restructuring, and tools to manage aggression and social relations. Although treatment duration varied— the mean was weekly for 14 months—skin lesions healed in 17 patients (77%).29
Related resources
- Obsessive-Compulsive Foundation https://www.ocfoundation.org
- Koran LM. Obsessive-compulsive and related disorders in adults: A comprehensive clinical guide. Cambridge, UK: Cambridge University Press, 1999.
- Phillips KA. The broken mirror: Recognizing and treating body dysmorphic disorder. New York: Oxford University Press, 1996.
Drug brand names
- Citalopram • Celexa
- Clomipramine • Anafranil
- Doxepin • Sinequan
- Fluoxetine • Prozac
- Fluvoxamine • Luvox
- Naltrexone • ReVia
- Olanzapine • Zyprexa
- Pimozide • Orap
- Sertraline • Zoloft
Disclosure
Dr. Grant reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
Dr. Phillips receives research support from Eli Lilly and Co., Forest Pharmaceuticals, and Gate Pharmaceuticals; she is a speaker for or consultant to Eli Lilly and Co., Forest Pharmaceuticals, and UCB Pharma.
