Skin picking and hair pulling are NOT compulsions

People often think skin picking or hair pulling are OCD compulsions. They aren’t. They are BFRBs (Body Focused Repetitive Behaviors) and the urge to pick or pull is vastly different than an OCD compulsion.

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[gsammyyy]

So can it be a combination of both- out of compulsion and feel-good thing?

[christianbaughn]

"A compulsion is something we do when we have OCD to reduce the discomfort that the intrusive thoughts our feelings are giving us".

You say that dermatillomania isn't a compulsion, because it isn't done to reduce the discomfort of intrusive thoughts/negative feelings. You are wrong. Many people do if for exactly that reason. And as for there being "nothing bad about" the act of picking, again, you are very wrong. I've encountered many others with dermatillomania, and what they describe feeling whilst the picking is taking place is a million miles from the "satisfying" that you describe it to be. Also, in regards to OCD/compulsions and them not being satisfying, surely it is somewhat satisfying, in the form of relief/respite, to feel a reduction in discomfort from intrusive thoughts/negative feelings that picking brings.

[-SteampunkTraveler-]

i pick because of the anxiety and I feel awful and it doesnt feel satisfying at all just soothing and I know it's bad.

[RoxanneKress-lgmp]

Well I was diagnosed with OCD when I was a teen, I’m 25 so that was like 5-10 years ago but it’s both for me I hate it and love it

[christianbaughn]

Some of what you say about picking and pulling in this video doesn't match up with info posted in the FAQs on bfrbdotorg (typed this way as YouTube doesn't like links in comments). The following are your words:

"It's satisfying to pick or pull. It feels good. There's nothing bad about it except the ramifications that happen afterwards, the damage or the lack of hair, those things. But it is a drive and impulse because it feels good".

This seems to contrast greatly with what bfrbdotorg says about what skin picking or excoriation is:

Skin picking (excoriation), is characterized by the repetitive picking of one’s own skin. Individuals who struggle with this disorder touch, rub, scratch, pick at, or dig into their skin in an attempt to improve perceived imperfections, remove rough patches/scabs, smooth areas, or accomplish some goal. Skin picking often results in tissue damage, discoloration, or scarring.

Occasional picking at cuticles, acne, scabs, calluses, or other skin irregularities is a very common human behavior; however, research indicates that approximately 2%- 5% of the population picks their skin to the extent that it causes noticeable tissue damage and marked distress or impairment in daily functioning. An estimated 75% of people experiencing skin picking disorder are female. The behavior typically begins in early adolescence, although skin picking disorder can begin at any age. Without treatment, skin picking disorder tends to be a chronic condition that may wax and wane over time. 

Signs and Symptoms

Skin picking disorder is currently classified as Obsessive-Compulsive and Related Disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

‍The DSM-5 diagnostic criteria include:

Recurrent skin picking that results in skin lesions

Repeated attempts to stop the behavior

The symptoms cause clinically significant distress or impairment

The symptoms are not caused by a substance or medical or dermatological condition

The symptoms are not better explained by another psychiatric disorder

Those who engage in skin picking tend to pick from multiple body sites, for extended periods of time, targeting both healthy and previously damaged skin. Targeted areas of the body may change over time. Commonly reported experiences that lead to picking include: an urge or physical tension prior to picking, unpleasant emotions, cognitions (permission-giving thoughts, beliefs about how the skin should look or feel), sensations (a bump, sore spot), and/or a displeasing aspect of one’s own appearance (visible blemish). Commonly reported experiences following picking behavior include: urge reduction, sense of relief or pleasure, psychosocial difficulties or embarrassment, avoidance, reduced productivity, emotional sequelae such as anxiety or depression, skin infections, scars, lesions, and/or disfigurement.

Although the severity of skin picking disorder varies greatly, many people who struggle with skin picking exhibit noticeable skin damage, which they attempt to camouflage with makeup, clothing, or other means of concealing affected areas. Due to shame and embarrassment, individuals may also engage in avoidance behaviors, including the avoidance of certain situations that may lead them to feel vulnerable to being “discovered” (e.g., wearing shorts, being seen by others without makeup, or intimacy).

Due to the nature of skin picking, it is important to consider whether the behavior is characteristic of excoriation disorder or whether it is better accounted for by another psychiatric disorder which warrants treatment. For example, skin picking may be a symptom of a dermatological disorder, an autoimmune disorder, body dysmorphic disorder, obsessive-compulsive disorder, substance abuse disorder (e.g., opiate withdrawal), developmental disorder (e.g., autism spectrum disorder), or psychosis. Comprehensive evaluation and accurate diagnosis is important in determining an appropriate treatment plan.



Thank you for recommending bfrbdotorg. I'm glad I went there for further information on dermatillomania.