Everyone in the world has a stim to help calm or regulate themselves. These repetitive behaviors are more commonly noticed among people with autism spectrum disorder (ASD). Skin picking in autism is one of the most common ones found in those on the spectrum.
While skin picking may provide needed sensory input for people on the spectrum, it can also be problematic. A skin-picking disorder can lead to scars and emotional distress. So what do you do if your loved one is skin-picking, and how do you convince them to stop?
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Understanding repetitive behaviors
Skin picking is one of many potential repetitive behaviors linked to autism spectrum disorder. Also called excoriation disorder, children on the spectrum may pick their skin as a form of self-regulation or sensory stimulation.
If the person with autism spectrum disorder experiences negative emotions like stress or anxiety, skin picking may help them mitigate those emotions and provide needed stimulation.
Many times this compulsive behavior will be involuntary. The person may not realize they pick their skin which will make it a challenge to help them stop picking. Negative emotions lead them to need a sensory outlet, and repetitive behaviors like skin picking help them find one.
Potential causes of skin picking in autism
While there’s no one set cause for skin-picking behavior, research has uncovered multiple potential triggers for excoriation disorder among the autism community. These include:
Skin-picking disorder can often help calm anxiety disorders or other anxiety caused by mental health issues or obsessive-compulsive disorder. It may also be a lack of impulse control due to OCD.
Beyond the mental causes, skin picking has been linked to neurological conditions like Tourette’s, ADHD, and dementia. It also may have a biological cause, such as a thyroid issue linked to hormone problems.
Risks associated with compulsive skin-picking
Skin-picking disorder is a condition that can have negative impacts on a person. There are both physical and emotional damages caused by compulsive skin picking. Plus, skin picking can also impact the relationship with family and caregivers.
Skin-picking disorder physical damages
Skin picking can lead to self-injury for the person doing the picking. Skin damage, including opening new wounds or reopening older wounds, is possible. Occasional skin picking can lead to bleeding or scarring.
Severe skin picking can cause more serious damage that may require surgery, like skin grafting. Some skin wounds may also become infected and require antibiotics for treatment.Â
Infection can also lead to a more serious condition caused by sepsis which can be life-threatening. While sepsis from skin picking is rare, it’s still a possibility.
Skin-picking disorder emotional damages
The emotional impact of skin picking can cause mental health struggles for people with autism spectrum disorder. Many may become embarrassed or ashamed due to the visible injuries they inflict on themselves.
This shame leads to them constantly trying to cover the injuries and contributes to anxiety, depression, and potentially social isolation.
Skin picking disorder impact on families
Skin picking can also cause issues between the person picking their skin and their family and caregivers. Due to the potential physical and emotional damages, caregivers will see an increase in stress as they work to divert the autistic person’s stims to something other than skin picking.
Plus, if the injuries are serious enough to require a trip to the hospital, it can impact the family dynamic as other family members could experience stress, worry, and frustration.
Interventions for skin picking disorder in autism
If someone is trying to stop picking their skin but having trouble with it, there are interventions that can help them stop.
Behavioral interventions like therapies and environmental changes can assist any efforts to stop picking one’s skin. If further interventions are required, medication may need to be introduced.
Behavioral therapy
A common therapy suggested to help with skin-picking behavior is cognitive behavior therapy or CBT. It is often used to identify what may be triggering skin picking and uses a technique called habit reversal training. This training helps the person picking skin transition to new, less harmful behaviors.
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On top of cognitive behavior therapy, other therapies used to stop skin picking include group therapy, peer support, and acceptance and commitment therapy.
Environmental changes
Environmental factors may play a factor in skin-picking. Making changes to the environment could help reduce skin-picking. Some of the changes include:
- keeping nails short,
- wearing long sleeves and tight-fitting clothing,
- using fidget or stress items to keep their hands busy,
- using lotion and keeping skin clean as a self-care activity.
Medications
If the skin picking becomes so bad the person needs to seek help from a healthcare professional, it’s highly likely medication will be prescribed. Selective serotonin reuptake inhibitors have been shown to help the most with skin picking and are the most often prescribed.
Managing skin-picking disorder at home
While therapies and environmental changes may be necessary, what does a parent or caregiver do to help stop skin picking at home? Some suggestions for the home include:
- identifying when and where skin-picking occurs the most to avoid triggers,
- trying to resist for longer periods of time each time they feel the urge to pick,
- and telling others to help them recognize when they are picking skin.
Many of the home interventions tie into environmental changes that can help stop skin picking. Of course, if the skin picking continues, it may be time to seek professional help.
Patience and understanding
Skin-picking disorder can be tough as it creates the potential for injuries that can turn serious. It’s important to find the triggers and help your loved one overcome them before it causes significant distress to them and their caregivers.
While it can be used as a coping mechanism or emotional regulation, the potential long-term issues make it necessary to help the person find other behaviors that don’t have the potential to lead to negative feelings or struggles with mental or physical health.
It’s important for caregivers to be empathetic and understanding as the person may feel compelled to pick their skin without knowing why. They need to know someone supports them as they go on their journey to change this behavior for the better.
There is no one-size-fits-all approach to helping stop skin-picking. Therapies may work, environmental changes may work, and some combination of the two may work. Still, medication may be necessary. What’s important is your loved one knows you are there to help them as they address their skin-picking behaviors.
FAQs
Q: Is skin picking common in autism?
A: Skin picking, also known as excoriation disorder, can be one of many behavioral symptoms of autism spectrum disorder. It may be connected to sensory regulation, boredom, or anxiety.
Q: Is picking your skin a form of stimming?
A: Picking skin can be a form of stimming called body-focused repetitive behavior. It is often used as a coping mechanism for stress, anxiety, or sensory overload.
Q: Is skin picking a sensory-seeking behavior?
A: Research found skin picking can be a sensory-seeking behavior for autistic people in need of self-regulation or sensory input.
Q: Is dermatophagia common in autism?
A: According to research, a type of skin picking known as dermatophagia is common among people with autism. It’s also connected to other disorders, including Alzheimer’s and intellectual disorders.
Q: How to heal picked skin?
A: If a person has wounds from picking skin, they will need to be cleaned and covered to heal. The person will also need to not pick at their skin again.
References:
Cavalari, R. N. S., DuBard, M., & Luiselli, J. K. (2014). Simplified Habit Reversal and Treatment Fading for Chronic Skin Picking in an Adolescent With Autism. Clinical Case Studies, 13(2), 190-198 https://doi.org/10.1177/1534650113510348
Jafferany, M., Patel, A. Skin-Picking Disorder: A Guide to Diagnosis and Management. CNS Drugs 33, 337–346 (2019). https://doi.org/10.1007/s40263-019-00621-7
Russell Lang, Robert Didden, Wendy Machalicek, Mandy Rispoli, Jeff Sigafoos, Giulio Lancioni, Austin Mulloy, April Regester, Nigel Pierce, Soyeon Kang, Behavioral treatment of chronic skin-picking in individuals with developmental disabilities: A systematic review, Research in Developmental Disabilities, Volume 31, Issue 2, 2010, Pages 304-315, ISSN 0891-4222, https://doi.org/10.1016/j.ridd.2009.10.017.
