‘Excoriation disorder’ is the medical term used to diagnose compulsive skin picking. People with this condition pick at the skin on their arms, legs, face, hands, torso and/or scalp. Approximately 5% of the population have excoriation disorder. A sizable proportion will be picking at the scalp.
Scalp picking is a maladaptive behavior that provides a temporary sense of relief. Whereas some people pick their scalp to ‘deal’ with the itchiness of eczema, others pick their scalp to distract themselves from obsessive, compulsive thoughts or anxiety.
However, what starts as a temporary activity can quickly become a compulsive behavior. This is a problem because it can cause pain, skin damage, hair loss, infection and isolation
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There are several ways to treat scalp picking. While some treatments focus on modifying behavior, others focusing on tackling the underlying causes. It’s also important to treat damage that has been caused to the scalp to prevent a secondary infection from developing.
An effective treatment plan is likely to involve a combination of the following interventions:
Almost everyone picks their scalp from time to time. However, if you’ve been picking your scalp on a regular basis, and it’s begun to impact on the quality of your life, it can be considered a compulsive behavior.
Identifying compulsive behavior can be notoriously difficult for the person suffering because they do not always consciously realize they are carrying out the behavior. In addition, if the behavior is masking difficult thoughts or feelings, tackling the behavior could be challenging as it would mean facing up to uncomfortable feelings.
Indicators that you pick your scalp compulsively:
If you can relate, it’s likely you are suffering from a compulsive scalp picking disorder. Many sufferers delay seeking treatment because they believe there are no effective treatment options. However, evidence tells us that this is not true.
There are a variety of interventions available to control, reduce and even cure excoriation disorder.
Compulsive skin picking – or ‘dermatillomania’- is a maladaptive behavior. It’s an ‘adaptive’ behavior because it’s employed as a coping strategy to help individuals deal with their problems. However, it’s maladaptive because ultimately, the response has a negative impact on long-term health and well-being.
Females are more likely to develop this compulsive disorder than males. In addition, those who have suffered from skin disorders such as acne or eczema of the scalp or more likely to develop a skin or scalp picking disorder.
Seen as these conditions can cause itchiness or discomfort, skin picking may be a habit they’ve learned. However, psychologists suggest the link between skin conditions and compulsive skin picking is more likely due to the poor body image caused by these conditions – we’ll continue to explore this idea later.
There’s not one specific cause of this disorder. In a small number of cases, patients or doctors find it difficult to pinpoint a cause at all. Nonetheless, it can usually be explained by one (or more) of the following factors:
Often, it is caused by an interaction of these factors. For example, someone who experiences severe acne and eczema as a teenager may develop poor body image and low self-esteem. This may trigger a myriad of stress responses and hormone imbalances which leads them to choose scalp picking as a coping strategy.
Sufferers of excoriation disorder pick at many parts of the body – including the face, hands, and feet. However, many sufferers will focus specifically on the scalp. Some psychologists predict that sufferers pick at the scalp because it’s an area of the body disguised by the hair. As such, the sufferer can easily hide the damage– from others and from themselves.
Furthermore, the decision to choose the scalp may infer something about the cause of this condition. It may suggest that anxiety or ruminating thoughts are the culprits, and the sufferer is trying to ‘scratch away’ intrusive thoughts.
The following interventions will be useful in the battle against compulsive scalp picking. While they’re intended for scalp picking, they are likely to be useful for the treatment of all forms of excoriation disorder.
This recommendation features first because a physical cause for scalp picking should always be ruled out first. Physical causes are the culprit in around 10% of cases. Various skin disorders can make the scalp feel itchy, tight and inflamed. Scalp picking can offer sufferers with a degree of relief. However, often their picking behavior exacerbates the original condition – making it more difficult to detect and treat.
The following scalp conditions have been known to cause compulsive scalp itching and scalp picking:
If one of these physical conditions has been causing compulsive scalp picking, it’s likely that treating the condition will eliminate the scalp picking behavior. However, if the original condition has persisted for a long time, scalp picking may have become an entrenched habit that is difficult to shake. If that is the case, there are several ways sufferers can modify their behavior to form new, healthy habits.
It’s important to rule out any physiological causes. One of the hormone conditions known to impact scalp health is Hypothyroidism. Hypothyroidism (or an underactive thyroid) can cause dry itchy skin, a sensitive scalp and hair loss.
Other symptoms of this condition include fatigue, weight gain, constipation, and depression. This condition can flare-up at any time of the lifespan. As such, it is something you’ve developed recently, and you’ve noticed any of the symptoms listed here, it’s worth visiting a doctor to rule out any hormone conditions.
When trying to change any compulsive behavior, psychologists recommend keeping a ‘trigger diary’ for at least a week. A trigger diary involves noting down the time, location and duration of your scalp picking behavior. It’s important to consider how you were feeling during these times too – to understand the psychological triggers.
For those unable to keep a manual ‘trigger diary’ there are wristbands available which electronically track your scalp picking behavior. These are an excellent tool for people trying to track patterns in their compulsive behavior.
Stress is probably one of the leading triggers of compulsive behavior. During times of stress, it’s particularly important to place yourself in the company of others or find alternative ways of dealing with the stress. Various recommendations for relieving stress will follow later!
Being alone may also be a trigger for excoriation disorder. Studies have shown that people tend to partake in compulsive behavior in private. This may be because they are ashamed of the behavior or they want to avoid loved ones from interfering.
If you find yourself scalp picking in the evening, when you’re alone in your bedroom or bathroom – this is a red flag for compulsive behavior. As far as possible, try to limit the time spent alone at times of the day you would usually be compelled to pick your scalp.
Identifying your unique triggers will give you the best possible chance of preventing compulsive scalp picking.
Studies on behavior change show that defining your goals is key to success. To be specific, you should define the reasons you want to stop scalp picking and visualize the results you expect from this positive behavior change.
For example, you might visualize gaining a healthy scalp and renewed hair growth. Alternatively, you may focus on the sense of control you’ll gain over your compulsive behavior – or the reduced sense of isolation you’ll feel after dealing with this behavior.
Goals are useful because they can help you monitor your progress. You’ll be able to measure your scalp improving and your hair growth returning to normal. It’s important to congratulate yourself on these achievements to solidify progression and prevent relapse.
Perhaps you’re not in a position to tackle the cause of your compulsive scalp disorder. Maybe you’re at a loss as to what is causing the condition, or your current treatment plan is not working. In this case, it’s advisable to at least take steps towards limiting the damage caused to your scalp. There are some simple steps you can take to reduce the amount of damage you cause.
Firstly, it’s advisable to cut fingernails short and buff them with a nail brush, so they are not sharp or abrasive. Secondly, you should reduce your access to sharp implements such as tweezers and scissors. Consider locking these away or asking a family member to look after them.
If you’re prone to scalp picking at night, consider wearing some silk or cotton gloves to bed to prevent any damage caused in your sleep.
While these changes won’t cure the problem, they are a short-term solution for limiting damage to the scalp.
For some people, scalp picking disorder can be considered a ‘bad habit.’ Unhealthy habits are malleable and can be changed with a bit of effort and consistency. According to psychologists, it takes 30 days to form a new habit. This suggests that, if some sufferers replaced their scalp picking habit with alternative habits for at least a month, they’d be able to solidify new habits.
The following replacement ‘habits’ may be helpful for some people:
A study published on Wiley Online found that adolescents were able to break the habit of scalp picking if they engaged in habit-changing behaviors for at least 30 days.
However, this study didn’t involve participants who demonstrated pathological scalp picking behaviors. This suggests that changing habits may be useful for people who engage in light scalp picking. More deep-seated compulsive behavior is likely to require more specialist treatment – as we’ll explore.
It goes without saying – if you feel you are suffering from a compulsive skin-picking disorder, you should consult a medical professional for a diagnosis. They will be able to work with you to provide a suitable treatment plan. Moreover, the social support gained from speaking to someone else will be invaluable towards your recovery.
According to specialists, the psychological disorders most commonly related to compulsive scalp picking are Obsessive Compulsive Disorder (OCD), Body Dysmorphic Disorder (BDD), Anxiety, Post Traumatic Stress Disorder (PTSD) and Borderline Personality Disorder (BPD). That’s not to say that everyone suffering from one of these conditions will pick their scalp, but it does predispose them to compulsivity.
In many cases, a health professional will prescribe ‘talking therapies’ as a treatment. This will help the individual work through the underlying issues. Doctors may also prescribe medication such as SSRI’s. These may work by improving an individual’s overall mood.
According to research published in Sage Journals, Cognitive Behavior Therapy (CBT) is currently the most effective treatment. This therapy works by challenging the negative cognitions (thoughts) that lead someone to want to pick at their skin.
Also, the treatment focuses on modifying the behaviors that sustain this condition (i.e., skin picking). A therapist will focus their attention on helping the sufferer break the current cycle of cognitions and behaviors to provide healthy alternatives.
As such, there’s a suite of treatment options available to those suffering from excoriation disorder.
Adequate social support will increase your chances of recovering from a scalp picking disorder. Telling someone you trust about your condition will ease some of the emotional burdens. Furthermore, having someone else look out for you will help to motivate you towards positive change.
Indeed, studies have shown that having a strong social network prevents compulsive behavior such as binge drinking and excessive gambling. It follows that the same may be true for compulsive disorders such as scalp picking.
Scalp picking can cause loneliness. This is because sufferers will often go to extreme lengths to hide their behavior. Studies have shown that loneliness has a negative impact on health and wellbeing. As such, by isolating themselves, sufferers make a recovery even more difficult.
Social support is likely to be your most valuable tool in the fight against compulsive scalp picking.
Studies have shown that self-injurious behavior is nearly always linked to poor body image and poor self-esteem.
As mentioned, sufferers of Body Dysmorphic Disorder are predisposed towards developing compulsive behavior. A study published on Psych Net found that BDD patients frequently suffer from scalp or skin picking disorder and that it should be treated psychologically rather than dermatologically.
Sufferers of BDD have delusional thoughts about their own body. Small imperfections on their body are often exaggerated, and they display a degree of self-hate. While self-esteem is exceptionally negative in BDD sufferers, it’s possible for others without a psychological diagnosis to display poor self-image.
For example, a teenager with acne or a scalp disorder may become obsessed with the different textures and perceived imperfections on their skin. They may recognize their difference to others, and perhaps experience bullying because of their condition. This can lead to poor body image and low self-esteem, which – in turn – sparks a skin picking disorder.
Whether the skin picking is compulsive or occasional, it’s important to try to improve levels of self-esteem to protect against further damage.
Psychologists recommend the following interventions for improving self-esteem:
Studies have shown that individuals who suffer from an anxiety disorder, or obsessive-compulsive disorder, are more likely to develop a skin or scalp picking disorder. Although medication is often required for these conditions, there are several ‘stress-relief strategies’ that can be employed to help keep anxiety under control.
Also, stress relief can be used as a ‘tool’ to help sufferers cope with their problems – so they’ll be less likely to turn to scalp picking as a form of stress relief. This is important because it prevents relapses from occurring.
Some popular forms of stress relief include:
Treating the damage is extremely important. Not only will it prevent infection and reduce pain, but it will also prevent relapse. It will prevent a relapse because it will help remind you that you’re worthy of treatment.
According to studies, many sufferers choose to delay scalp treatment until they have combated their behavior. This may be because they feel that it’s futile to try and treat the scalp when they know they’ll pick at it again and cause more wounds. However, studies have shown that treating the scalp drastically reduces the chances of repeating behaviors.
Treating the scalp may involve washing the area with a sterile solution and applying bandages to any wounds. Covering wounds with bandages will help reduce the temptation to pick at scabs. In some cases, professional assistance may be required to ensure the wounds have been treated effectively.
The treatments described here will be helpful interventions for scalp picking in most cases. As mentioned, the type of treatment is likely to depend on the severity of the condition. If your scalp picking is compulsive, and negatively impacting your life, it’s crucial you visit a medical professional to access treatment.
If your scalp picking behavior is sporadic, it may be possible to change this habit on your own, by adopting some of the tips mentioned here. Finally, although scalp picking is often brought on by psychological causes, it’s essential to eliminate any physical or physiological causes in the first instance.
If left untreated for a prolonged period, compulsive scalp picking can cause some adverse health outcomes. These are explored below.
Depending on the severity of the condition, it can cause permanent scarring and disfigurement. Using sharp implements to pick at the skin can have a particularly adverse effect on the long-term health of the scalp. However, if interventions are offered at an early stage, it’s possible for the skin to heal.
Yes – skin picking can cause a variety of secondary skin infections. Bacteria enter the open wounds and can sometimes cause severe infections. In many cases, sufferers will need to be prescribed a course of antibiotics to treat the infection. In a small number of cases, the secondary infections can become life-threatening.
In a case study published on NCBI, researchers discuss a patient with enduring Bactermia – the presence of bacteria in the blood. It takes researchers months of testing to discover that the Bactermia has been caused by the secondary infection of a scalp picking disorder.
This finding was worrying to researchers because Bactermia causes a severe immune response in the body. It can cause fever, chills, hypotension, shock and even death in some cases.
Some people have claimed that skin picking can lead to the development of skin cancer. There is no clinical evidence to support this finding. However, there is ample clinical evidence to support the fact that skin picking often leads to skin infections.
It’s important to intervene as soon as possible to stop scalp picking behavior. In cases where the behavior cannot be stopped completely, wound cleaning and bandaging should be prioritized to control infection.
Yes and no. If scalp picking is intermittent or treated very quickly – hair health and hair growth are unlikely to be affected. However – if carried out over several months – it is likely to cause hair loss.
It can cause hair loss in two ways; it can cause damage to existing hair, and it can impede the growth of new hair.
It can impede hair growth because it often causes damage to the hair follicle. The constant process of picking causes open wounds and scabs to develop. The associated scar tissue can cause deep-level damage to hair follicles. Permanent damage caused to hair follicles through scar tissue is known as Scarring Alopecia. Follicles tend to become damaged in patches, so hair loss may be gradual and patchy.
Also, it can cause damage to existing hair by promoting tangles and weakening the strands. Scalp picking is often confused with the ‘hair pulling’ disorder trichotillomania. Scalp pickers focus on picking at the scalp rather than pulling out hairs. However, often some hairs do become shed in the process, due to the mechanical damage caused in the process of picking at the scalp.
Although skin picking can cause a lot of damage to the skin, scalp, and hair – the body is wonderfully resilient. If interventions are employed early, this will give the body its best possible chance of recovery.
Intervention should be employed as early as possible – and it should be as targeted as possible. The severity of your symptoms will dictate whether you opt for professional help, or whether you’ll try out your own intervention first.
In any case, social support is vital in the fight any compulsive behaviors. Start treatment today by confiding in a loved one about your scalp picking disorder.
Copyright 2018 by DryScalpGone.