ADHD & Skin Picking: Are They Connected?

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Skin picking involves repetitive and excessive touching, pulling, picking, or scratching of the skin. It can begin with a simple urge to scratch or pull on something loose, like a nail. 

But over time, it can escalate into something much more challenging to manage. The results can be quite visible, with bruises, scabs, wounds, and even lasting scars. When this picking becomes severe, professionals define this as Skin Picking Disorder (SPD). While there are many potential causes, studies suggest that SPD stems from impulsivity and difficulties with inhibitory control.

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Understanding Skin Picking Disorder 

Let's look at skin-picking disorder to understand this condition better.

You may encounter various terms related to skin picking online, such as Body-Focused Repetitive Behaviors, Dermatillomania, or Excoriation disorder. But what's the difference?

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Skin Picking Disorder is also known as Excoriation Disorder or Dermatillomania. It involves an intense urge to scratch or excessively pick at the skin. This can result in lesions, injuries, or scarring. Often, the desire to pick at healthy or dry skin is due to problems with impulse control. 

Dermatillomania is the preferred scientific term for Skin Picking Disorder. But, some experts also refer to it as chronic skin-picking.

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Body-Focused Repetitive Behaviors (BFRBs) is another term you might see. They describe any repetitive behavior that leads to self-injury, such as biting, hair pulling, hitting, and scraping.

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Here is a list of common BFRBs that affect different body parts:

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• Excessive Skin Picking or Scratching Skin (Dermatillomania)
• Nail Biting (Onychophagia)
• Lip Biting (Morsicatio Labiorum)
• Inside Mouth Biting (Morsicatio Buccarum)
• Tongue Biting (Morsicatio Linguarum)
• Picking Fingernails and the skin around them (Onychotillomania)
• Chewing Skin or Scabs (Dermatophagia)
• Excessive Nose Picking (Rhinotillexomania)
• Skin Biting (Dermatophagy)
• Hair Pulling (Trichotillomania)
• Hair Eating Disorder (Trichophagia)

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As you can see, many behaviors beyond skin picking are associated with BFRBs. 

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How Does Skin Picking Affect Daily Life and Functioning?

Skin Picking Disorder can take a toll on your daily life and well-being. 🙁 The urge to pick at your skin can be so strong that it can interfere with your daily activities and routines. 

The visible damage caused by skin picking can also bring about intense feelings of shame, isolation, and embarrassment. Feeling self-conscious when others notice the wounds or scars is entirely understandable. It can make you want to hide away and avoid social situations.

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What causes skin picking?

Studies show that people with skin-picking disorders report a higher prevalence of an underlying mental health condition.

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According to The Mini ADHD Coach Medical Advisor:

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‘Research suggests that individuals with skin-picking disorders have higher rates of underlying mental health conditions. This includes generalized anxiety disorder (63.4%) and depression (53.1%). Furthermore, approximately 25% of individuals with skin-picking disorders report having panic disorder, PTSD, OCD, and ADHD.’

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While there may not be a direct link, there is a correlation between ADHD and skin picking. The symptoms of ADHD can trigger and subconsciously contribute to repetitive behaviors such as skin picking.

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Skin Picking Disorder and ADHD 

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To understand the connection between ADHD and skin picking, I asked my Instagram followers. The responses I received were eye-opening. Many shared their experiences, suggesting a common link between skin picking and ADHD.This prompted me to dive deeper into the topic, eager to uncover the reasons behind it. During my research, I learned that ADHD symptoms can contribute to the development of skin-picking behaviors in several ways.

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Impulsivity 

We may sometimes find ourselves engaging in behaviors without even realizing them. Skin picking can be one of those impulsive habits that some people with ADHD may struggle with. The inability to control urges makes it hard for people with ADHD to resist the urge to pick at their skin. Unfortunately, this can harm our skin over time and lead to feelings of shame. Despite our best intentions, the compulsion to engage in these activities can be overwhelming, and we may do it without even realizing it. 

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Emotional Triggers

Living with ADHD can bring about heightened levels of stress and anxiety. Many of us with ADHD struggle with emotional regulation, and skin picking may become a coping mechanism. Skin picking itself can also be a way of attempting to manage and alleviate anxiety. 

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I know someone with ADHD who pulls at her hair when struggling to regulate her emotions. It serves as a way for her to divert her attention from emotional pain. Unfortunately, this has led to her developing bald spots in certain areas. But this is her unique way of dealing with stress, and I'm here to try and help her find alternative ways to cope. ❤️

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Inattentive ADHD Behavior

One of the hallmark symptoms of ADHD is inattentiveness, which can lead us to exhibit behaviors without realizing it. 

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I know someone with the inattentive type of ADHD who struggles with Skin Picking Disorder. She has an unintentional habit of picking her skin whenever she's bored. For many people with inattentive ADHD, stopping picking or scratching their skin can be challenging. As they may not be aware that they're doing it, the automatic nature of this behavior can make it difficult to stop.

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The Mini ADHD Coach Medical Advisor says: 

‘ADHD can make it challenging to focus. When combined with impulsive behaviors, inattentive symptoms can increase habits like skin picking. This can lead to injury and is often unintentional. ‘

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Dopamine Rush

Have you ever found yourself engrossed in videos where people pop their pimples? It's a sensation that can be weirdly captivating, right? When we witness these body-focused repetitive behaviors (BFRBs), our brains can experience a dopamine rush. This rush can bring a sense of satisfaction and even a calming effect. 

Individuals with ADHD may also engage in these activities seeking that same dopamine high. Research tells us that the ADHD brain needs more dopamine to thrive, so it's understandable that we find many inventive ways to get that rush!

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The Mini ADHD Coach Medical Advisor says: 

‘Recent studies into Skin Picking Disorder (SPD) have revealed abnormal brain activation in regions associated with the "wanting" process. The key neurotransmitter responsible for this is dopamine. This suggests that skin picking is a form of pathological "wanting" to relieve anxiety, with the perceived reward as a coping mechanism.’

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Managing Skin Picking Disorder and ADHD 

When you find yourself caught in the overwhelming urge to pick at your skin, it can be incredibly challenging to resist. But it's important to remember that alternatives and effective treatment options are available to help you overcome Excoriation Disorder or Body-Focused Repetitive Behaviors (BFRBs).

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The journey to finding the right treatment for you may require some exploration and patience, but the good news is that there are numerous approaches to consider. Everyone is unique, and what works for one individual may not work for another. Therefore, it's essential to remain open-minded and willing to try different strategies until you find the approach that resonates with you and brings about positive change.

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Let's go through a few of the options. 👇

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Treatment Approaches

According to The Mini ADHD Coach Medical Advisor:

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Research suggests that improving attention span and reducing impulsivity could potentially decrease symptoms of Skin Picking Disorder (SPD). Additionally, there are a few treatment options that target SPD. This includes CBT, competing response training, and medication. 

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Cognitive-Behavioral Therapy (CBT) 

Research has found Cognitive Behavioral Therapy (CBT) effective for skin-picking disorders. With the support of a therapist, CBT can help you gain a deeper understanding of your condition and develop coping strategies. Although it requires much initial work, CBT can be effective for compulsive behavior. 

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Habit Reversal Training

Habit Reversal Training (HRT) is a therapeutic approach for treating skin picking and other BFRBs). It helps reduce and manage symptoms by breaking the cycle of picking and teaching new coping strategies. HRT is behaviorally-based and effective for BFRBs like skin picking, hair pulling, and lip biting. It aims to replace the behavior with more desirable alternatives by using competing responses like wearing gloves or keeping hands occupied with fidget toys.

Awareness Training

Awareness training can help individuals with ADHD manage skin-picking behaviors. It involves learning to recognize triggers, interrupt automatic responses, and develop coping strategies using self-awareness and mindfulness. By becoming more conscious of their skin picking urges, they can implement distraction techniques, practice mindfulness, and find healthier ways to manage stress and emotions. By incorporating awareness training into their treatment plan, individuals with ADHD can gain better control over their skin-picking behaviors, reducing the frequency and intensity of episodes.

Acceptance & Commitment Therapy

Acceptance and Commitment Therapy (ACT) can be beneficial in addressing skin picking behaviors in individuals with ADHD. ACT focuses on accepting difficult thoughts and emotions while committing to changing their behavior. By practicing acceptance, individuals with ADHD can acknowledge and make room for the urge to pick their skin without judgment or resistance. 

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They can identify their values and actively engage in behaviors that align with these. ACT teaches emotional regulation and builds resilience, allowing them to be more compassionate and accepting of themselves. ACT is particularly helpful in reducing the shame and isolation that many people feel.

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Medication

While there is no FDA-approved medication for treating skin picking disorder, SSRIs (selective serotonin reuptake inhibitors) are often used 'off-label.' 

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There is also growing research indicating that anticonvulsant medicines like Lamictal (lamotrigine) and supplements such as N-acetyl cysteine can be beneficial in managing skin picking. 

Consulting with a healthcare provider with knowledge of skin picking is crucial. A specialist can assess your needs and recommend strategies tailored to you. 

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Social Support

Don't underestimate how much social support as a treatment approach is. Both skin-picking disorders and ADHD can be isolating. Seek help from non-judgemental people that you trust. Whether this is family, friends, or a therapist, sharing your experiences and receiving support can make things more manageable. And, even better - you have someone to celebrate with when you get on top of your symptoms. 

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Conclusion

Skin picking disorder, dermatillomania, or excoriation disorder, is a genuine mental health disorder. Although it's more common in OCD, there's a significant connection between skin picking and ADHD. ADHD symptoms like impulsivity, emotional triggers, and inattentive behaviors can make many of us vulnerable to skin-picking behaviors and other body-focused repetitive behaviors. 

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The good news is that many treatment options target this behavior. Therapeutic options include cognitive behavioral therapy, habit reversal training, awareness training, and acceptance and commitment therapy. Some research also suggests medication can help; however, we must remember the vital role of social support and reducing loneliness and isolation. 

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As always, it's essential to consult a healthcare provider experienced in treating skin picking disorders to determine the most suitable approach. By addressing the underlying causes, managing symptoms, and seeking support, individuals with ADHD and skin picking disorder can take control of their skin picking, get their skin back to a healthy condition and reduce feelings of shame or isolation. 

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Remember; everyone's journey is different, so you must find what works best for you and stay committed to the chosen treatment plan. With the proper support and strategies, overcoming skin picking disorder and managing ADHD symptoms is possible.

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