The Compulsive bruising disorder (DEC)also said “Skin Picking” in English and “Dermatillomania” In Italian, it is a clinical condition characterized by a constant tease of the skin that causes skin lesions, and by repeated attempts to curb this behavior, according to the APA (American Psychiatric Association) lines of 2013.
Although this disorder appeared in the history of psychiatry already at the end of the 1800s, it found a definition precisely recently recently, when according to the DSM-5 manual, always in 2013, it was included among the Obsessive-compulsive spectrum disorders.
The Dec is a very disabling psychological disorder: those who suffer, in fact, torments their skin in various ways: pinching, rubbing, scratching, often tearing in an attempt to eliminate real or rather imaginary skin imperfections present on its skin (e.g. in, pimples, blackheads, crusts, etc.), with the consequence of causing wounds and even serious escorts. They can lead to infections and scars.
The subjects scratch with their nails, but are capable of tormenting their skin even with tweezers, scissors, needles, or even with the teeth. The part affected is normally the face, but the arms, chest, shoulders, hands, lips and chapel leather can also be prey to attack.
The discomfort can debut at all ages, from pre -adolescence to old age, with a prevalence for the female sex.
The person who suffers from it takes a lot of hours of his day to inspect his skin, with or without the mirror, and obviously leaves out daily appointments such as study, work and social contacts.
These individuals then seek in every way to disguise with tricks and clothes the signs left by their “torture”, as the feeling that accompanies them is always that of shame, embarrassment, guilt; Thus, they will avoid public places such as swimming pools, beaches, gyms where they should necessarily undress and make their bruises public.
The difference with what can be considered common behavior is the inability to control the impulse of torment the skin and not to be able to stop.
This practice, in fact, becomes pathological when it assumes the character of a compulsion, that is, when the subject cannot exempt himself from implementing the behavior, when it is repeated over time, with an increasing intensity and, therefore, begins to cause evident and/or permanent skin changes. In these cases the dermatillomania It also has obvious social, relational, working consequences.
Usually this disorder is put into practice after having lived very stressful and anxious situations: the most common debut is following stressful life events, is unexpected such as mourning, layoffs, separations, or even planned, e.g. births, wedding, removals, etc.
The precise causes are still unknown, however multiple hypotheses have been formulated, supported by first scientific confirmations, ranging from genetic, hereditary factors to neurological ones and unexpressed anger.
It has characteristics similar to obsessive-compulsive disorder (DOC), to body dysmorphism disorder and tricotillomania, often it is found in comorbilities with these disorders. Some American research also sought possible correlations with fluctuations in the hormonal cycle, but with controversial results.
The emotions that precede this behavior are usually anxiety, boredom, excitement, fear, and we notice how the episodes are characterized by an increase in emotional tension. Often this behavior is implemented by the subject in a “trance” state and also has a calming effect.
So, they can be assumed Two main functions Del dec: the function of regularization of emotions (like other self -injurious behaviors, makes the negative ones vanish) or as a sort of “reward”, as it relaxes and is extra -year, similarly to other disorders of the behavior control deficit, e.g. gambling, internet addiction, binge eating, etc.
The question of genetic predisposition is however controversial, some studies have highlighted the presence of dermatillomania (between 19 and 45%) Between first degree relatives of patients with disorder, others have found, as already mentioned, family comorbilities with Obsessive-compulsive spectrum disorders.
The treatment of election is the Cognitive behavioral therapy. The primary objective is the modification of behavior, to interrupt skin lesions as soon as possible.
The pinched the skin is considered a learned response, conditioned by a specific situation. The person is almost always unaware of the triggering cause and does not realize that some events cause this impulse. The program consists, in the Make it aware of these uncomfortable situations that trigger the answer and, therefore, learn to implement alternative behaviors and face emotions. Self -control and stress management skills are taught, together with adequate cognitive renovation of negative thoughts.
The model to explain how the disorder works and is maintained, takes into consideration some elements, such as:
– conditioned stimuliboth internal and external to the subject, who have the ability to activate the implementation of the behavior; They vary from individual to individual: example particular emotional states (anxiety, anger, tension, boredom, solitude, etc.), negative thoughts/beliefs (“I have to have perfect skin”, “if I have pimples everyone will make fun of me”, etc.), find themselves in particular environments/contexts (bedroom, bathroom, in front of the mirror, etc.), carry out certain sedentary activities (read, to study, Particular moments of the day, find themselves alone in the house, have submissive certain tools (tweezers, scissors, etc.), visual and/or tactile stimuli (pimples, freckles, crusts, skin reliefs, etc.);
– preparatory behavioras many subjects develop a particular routine to carry out this activity (they can concern the going to a private place, prepare the tools, choose a particular area of the body to be pinned, visually or tactilely looking for their own picking goals, etc.);
– the actual behaviors of decmay vary depending on what is concretely done on the lens (taping, scratching, squeezing, digging, etc.), to what result you try to reach (remove a crust, eliminate the pus, bring out a black point, etc.), the overall duration of the episode (from a few seconds to many hours). What is made of cuticles, crusts, leather flaps etc. It is very complex and particular, also depending on the severity of the disorder (if, perhaps, it is in comorbidity with other psychiatric pathologies): some patients throw them away simply, others observe them, study them, pass them through their fingers and sometimes they come to preserve them and collect them;
– the consequences of behavior (they can be reinforcing or opposing), the immediate feeling that is often felt is of pleasure, therefore a pleasant emotional consequence, as a true psychic gratification, which acts as a positive reinforcement on the disorder and contributes to its maintenance, going to develop a real dependence. Other times, it may have a distracting effect, which causes relief from stress, boredom, unwanted emotions and thoughts (e.g. “I go to trance and forget my problems for a while”). Some subjects explain it as a sort of mental “enchantment”. In some cases, it is moved by the search for perfection (e.g. reaching symmetry between the eyebrows or obtaining smooth skin, etc.), in fact one of the motivations that maintain the DEC is precisely perfectionism: these patients can remain in front of the mirror to examine their face closely in search of imperfections, in an attempt to eliminate them and reach the much -coveted perfection. Paradoxically, after a “treatment” of this kind, it appears aesthetically worse than before; All this intensifies negative emotions such as guilt, shame or anxiety, which can, in turn, trigger subsequent episodes, creating a vicious circle.
There cognitive-behavioral therapy In essence, he tries to modify thoughts, emotions and behaviors that precede the “picking”, to go to act, subsequently, also on the consequences that maintain and perpetuate this disorder.
In particular, theHabit Reversal Training It is very useful in cases of dec. It consists of 3 phases: implementation of awareness, implementation of the competitive response and social support.
The first predicts that the patient learns to monitor and describe the behaviors of Skin Picking, also recognizing previous thoughts, emotions and situations (e.g. alarm bells) and consequent. Often, in fact, the action takes place unconsciously, without the full knowledge of the chain of events that eventually produces the damage.
The second phase consists in learning to implement a different behavior, which prevents the usual and harmful one. This behavior, called “competitive response”, is emitted for a minute, as soon as he realizes that the skin is being tormented or warns the first alarm bell. Common example is to make the patient bend his arms or let him spread his arms along his sides, slightly tightening the fists. Whatever you decide to do, it is important that the action is: physically incompatible with harmful behavior, practicable in almost all situations, imperceptible to others and acceptable for the subject.
The final phase provides for the engagement of a person for social support: it may be a friend, a family member, the partner, etc. To which he is asked to point out his behavior, with the aim of helping him to be more aware and kindly remind him to put the competitive response into practice.
