ADHD & Skin Picking: Knowing More About This Comorbidity

ADHD & Skin Picking: The Irresistible Urge to Peel It Off

An ADHD person can struggle with many things that neurotypical people sometimes think goes the same for everyone. Being forgetful, for instance, is a common trait among busy people whether or not they have a neurodivergent condition. Everyone can also become inattentive and impulsive. 

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However, neurotypical individuals seem to forget that having ADHD symptoms often mean the struggles are more intense and persisting. ADHD-related forgetfulness, for example, can happen more frequently than the “ordinary” forgetfulness that most adults deal with. ADHD impulsivity can also result in risky behaviors and impulsive purchases. 😔 

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Another example of a more intense, persisting struggle we - as people with ADHD - often get caught up with is skin picking disorder or dermatillomania. Do you usually take off excess skin on your body or have that bad habit of picking the skin around your nails? Or perhaps you often scratch your skin and pull on them? Well, that might be skin picking. It might sound like a minor, harmless thing to you, but it can be pretty challenging for some people to resist the urge to do so. 😭

The excessive urge to pick on your excess skin isn't normal nor is it just a bad habit. Sometimes, an ADHD diagnosis can be linked to these events. While we are not saying that if you experience this, you automatically have ADHD-related dermatillomania, these instances can still affect how you function in your daily life. 

The repetitive behavior or unintentional skin-picking habit can be a sign of something more severe that you need to understand and consider. Sometimes, people do skin picking to the point that it can cause harm to their skin. It can also be a way of dealing with stress or anxiousness 😵. If you often find yourself doing this, it might be time to talk to your doctor about it.

‍What Is Skin Picking?

Skin Picking is the repetitive or excessive touching, pulling, picking, or scratching of one's skin. This can often result in bruises, scabs, wounds, and even scars. It usually starts as just a normal urge to scratch but eventually turns into something bigger you cannot control. When the repetitive picking of skin results in a more serious concern, it can become a Skin Picking Disorder or a symptom of a deeper problem. In this regard, according to a study, SPD can be defined as a repetitive behavior disorder due to impulsivity and inhibitory control deficits.

Skin Picking Disorder may impact a person's overall health, especially the way the skin receives sensory stimuli. It can cause functional impairment to your life because the urge to pick can be so strong that it can disrupt daily activities and routines. 🥺 In the same manner, Skin Picking can also result in a substantial distress involving feelings of shame, isolation, and embarrassment when the tissue damage is evident.

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Before we go to the connection between ADHD and Skin Picking, let's learn more about this excessive urge and repetitive behaviors that we tend to do when we are in significant distress or experience a lack of impulse control over our actions.

More About Skin Picking Disorder

You may come across different terms that seem to pertain to the said condition. Along with Skin Picking Disorder, you may also come across terms like Body-Focused Repetitive Behaviors, Dermatillomania, or Excoriation disorder. Are they one and the same? 

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Skin Picking Disorder, which is also called Excoriation Disorder or Dermatillomania, refers to the intense urge to scratch or excessive picking of your skin to the point that it causes lesions, injuries, or scarring. It is limited only to the desire to pick healthy skin or dry skin due to poor impulse control or uncontrolled behavior. Dermatillomania is the scientific term for Skin Picking Disorder which is now the preferred term. Other experts also call it chronic skin-picking. 

Meanwhile, Body-Focused Repetitive Behaviors (BFRBs) refer to all the repetitive ways a person can harm their body. It is not only limited to picking and scratching the skin, but also include nail biting, hair pulling, hitting, and scraping. It can be any repetitive behavior that results in injuring oneself. Here’s a list of the common BFRBs affecting different body parts:

• Excessive Skin Picking or Scratching Skin (Dermatillomania)
• Nail biting (Onychophagia)
• Lip Biting (Morsicatio Labiorum), Inside Mouth Biting (Morsicatio Buccarum) and Tongue Biting (Morsicatio Linguarum)
• Picking Fingernails and 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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For Body-Focused Repetitive Behaviors like the ones mentioned above, their causes point in different directions. These bad habits seem to run with other family members, suggesting they can be hereditary. There are also environmental and psychological factors that might contribute to the development of these disorders. It can also be caused by traumatic brain injury. But how is it related to people with ADHD? 🤔

Adult ADHD Struggle With Skin Picking

When I released a survey about the experience of other people with ADHD on my Instagram account, many of them answered that they, too, are struggling with the same skin-picking behavior. Some people also asked me about these certain conditions and how they connect with Attention Deficit Hyperactivity Disorder.

So, I researched a bit about Skin Picking and found out that it is more likely related to Obsessive-Compulsive Disorder, another mental health condition. A case report suggests that BFRBs, which include Dermatillomania, are commonly comorbid with OCD and other related disorders. The most frequent comorbid psychiatric conditions are depression, anxiety, and Substance Use Disorder. But, generally, it is leaning toward being a part of OCD symptoms.

The Mini ADHD Coach Medical Advisor says: According to studies, people with skin picking disorders reported extremely high rates of underlying mental health comorbidities such as generalized anxiety disorder (63.4%) and/or depression (53.1%) (Grant et. al, 2020) and around 25% reported having panic disorder, PTSD, OCD and ADHD.

Though there might not be a direct link between BFRBs, specifically Skin Picking, and ADHD, we can still see a connection between the two. There are ADHD symptoms that can influence a person's skin-picking habits and cause repetitive behaviors without noticing them.

ADHD Symptoms Linked with Body-Focused Repetitive Behaviors

Specific ADHD traits may result in a person having to deal with other disorders such as anxiety, depression, Obsessive-Compulsive Disorder, or even Body-Focused Repetitive Behaviors. These ADHD traits can make us do BFRBs like nail-biting, hair pulling, or skin picking because we might have that unwanted urge to keep our hands occupied or do something.😅 

Impulsivity Symptoms

Sometimes, we do things and don't understand why we are doing them. There can be moments when there are no logical reasons for the things we do. Skin Picking can also be one of those activities that we do impulsively. It may be hard for some people with ADHD to control their urges. And because of that, we can't help but engage in these activities that can eventually ruin our skin health.

Emotional Triggers

An ADHD brain might struggle a lot with stress and anxiety 😔 . Sometimes, we cannot deal with difficult situations in our lives, and skin picking can be a way to cope with them. The most prevalent mental health disorders associated with SPD all have one thing in common- anxiety. And skin picking can result from coping with severe anxiety. I know someone with ADHD who, when life's giving her a hard time, does hair pulling until bald spots develop. It can be her way of distracting herself from feeling any emotional pain. Our other friends frequently complained about her behavior, but all I have for her is my support and understanding of how she deals with stress. ❤️

Inattentive ADHD Behavior

Inattentiveness is one of the most common symptoms of ADHD. It can make us do things without noticing what we are doing. I know an inattentive type person who deals a lot with Skin Picking Disorder because she has an unintentional habit of picking her skin whenever she's bored. It can be hard for people with inattentive ADHD to stop picking or scratching their skin because they are not aware that they are already doing it.

The Mini ADHD Coach Medical Advisor says: Symptoms of inattention can make it hard for people with ADHD to focus on tasks and pay attention to details; together with impulsive behaviors, inattention can predispose them to unintentional injuries to themselves or even unintentional habits such as skin picking.

Dopamine Rush

Do you enjoy watching Tiktok videos of someone popping their pimples or blackheads? 😨 I used to be that person, too. And I realized that we feel a dopamine rush whenever we see someone doing BFRBs. It can be satisfying and calming for us. Some people with ADHD might also engage in these activities to get the same dopamine-high feeling. Though watching these clips are time-consuming, my ADHD brain seems to enjoy it because of the feeling it gives me.

The Mini ADHD Coach Medical Advisor says: In the case of skin picking, recent research on brain activity of people who have SPD show abnormal activation in areas of the brain implicated in “wanting” processes which involve the “happy hormone” dopamine. This means that skin-picking can be a form of pathological “wanting” which aims for a means to cope with anxiety – the deemed reward for the behavior.

Managing Skin Picking Disorder and ADHD

When faced with the struggle of resisting the impulsive urge to pick on your skin to get that dopamine rush, finding other coping mechanisms to help you deal with your symptoms is essential. There are plenty of treatment options dedicated to Excoriation Disorder or BFRBs. You can try different approaches and see what works best for you.

The Mini ADHD Coach Medical Advisor says: I have stumbled upon a case report that suggests increased attention span and decreased impulsivity could be mechanisms that, when achieved jointly, could decrease skin picking disorder (SPD) symptoms. The following therapies target various signs and symptoms of SPD.

Cognitive-Behavioral Therapy (CBT) is a type of therapy that can help you challenge your negative thoughts and stop picking on your skin. It might not be easy at first, but with a therapist's help, you will be more knowledgeable about your condition and develop healthy coping mechanisms.

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Awareness training can also help you be more mindful of your surroundings and resist the urge to pick your skin. Competing Response Training, on the other hand, can help you find substitute solutions for handling your BFRBs. Other ways to cope with your skin picking disorder symptoms include keeping your nails short, wearing gloves, or using a fidget toy.

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Medication treatment 💊 can also help you manage your symptoms and make it easier for you to focus on other things. Selective Serotonin Reuptake Inhibitors, for example, can help you manage symptoms of ADHD and, at the same time, improve your Skin Picking Disorder on clinically significant levels. Note that any drug treatment should be discussed with your mental health professional to see if it's the right one for you.

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ADHD treatment involving Skin Picking Disorder should be a multimodal approach. It is essential to find what works best for you and to stick with it. It is equally important to observe the different effects of your treatment with your mental health doctor 👩‍⚕️  to ensure your plan is working well.

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More importantly, ask for help and talk it out with someone you trust. It can be a family member, friend, therapist, or anyone who will understand and be there for you. Having the right support system for your ADHD journey will not easily make your ride smooth, but it can make the trip worthwhile. 💏