Question 1

What are the first steps to stopping a routine of fixating on the skin?

Matthew Traube · Accepted Answer

First, consciously identify your behavior patterns. So much of how we live is on autopilot. Many people that I speak with will say that the first thing they do in the morning is think about their skin. Then there will be predictable times throughout the day where they gravitate towards focusing on their skin. Here’s the tricky part, when I ask people during sessions when they focus on their skin, most people can tell me without thinking too much about it, but in the moment, many people don’t fully recognize when they are putting so much focus on their skin. I believe it’s hard to change a habit if we do not consciously identify when it’s happening. I generally tell my clients to start by consciously identifying when they are focusing on the skin. Once they get better at identifying the habit, they will then get an opportunity to learn how to make a choice about how to manage it. They can either continue the habit or work on changing the habit.

Question 2

What is psychodermatology?

Matthew Traube · Accepted Answer

Psychodermatology is how the mind influences the skin and how the skin influences the mind. I help people deal with the psychological aspects of skin conditions. Skin conditions can affect self-esteem, relationships and professional development. I help people put the skin problem in perspective so they can better deal with their lives.

Question 3

How do you help build self-esteem that has been lessened due to a history of severe facial acne?  The acne has left some scarring.

Matthew Traube · Accepted Answer

I generally notice that younger people deal with skin issues during important developmental periods. Often building back self-esteem after skin issues can be more challenging. For instance, if you have a history of limiting your social life because of skin issues or convincing yourself that you are not dateable, later on in life, you may experience both physical scarring and emotional scarring. However, your skin does not define you. We want to challenge your notion of why you may feel insecure about your social life.

There are feelings and facts. Feelings are subjective and are constantly changing. Facts do not change. You may think your self-worth is diminished while others think highly of you. There is great power in that dynamic. Just as you learned that you're flawed because of bad skin, you can unlearn it, you can identify when bad feelings happen and question your thoughts. Your thoughts are subjective and can be adjusted to better fit your reality and be made more accurate. Most people gradually learn that they have the power to adjust their thinking. They can become much kinder and more realistic. When they do that, self-worth will often grow.

Question 4

Thoughts on treating skin picking or excoriation disorder

Matthew Traube · Accepted Answer

Skin picking, hair pulling, nail-biting, cheek biting, and other body-focused repetitive behaviors are often used to help regulate emotions. It can be a coping strategy to reduce emotional discomfort, physical discomfort, or both. For many people, skin picking allows temporary relief from stress or anxiety. Picking can occur both consciously and unconsciously. Once it becomes a habit, many people will pick when they are bored or slightly focused on a task, just enough to make it hard for them to be consciously aware that they are picking.

I help people stop skin picking by using a combination of cognitive-behavioral therapy, habit reversal training, mindfulness, and for some, psychodynamic therapy. I want to give people strategies to address the physical act of skin picking and also strategies to address deeper emotional triggers. For example, on a behavioral level, I might advise you to cover your mirrors because mirrors tend to be a big trigger. When seeing skin imperfections, it can be very tempting to try to fix them with skin picking. We also want to identify what deeper psychological function the habit serves. Does it help you get through a challenging work meeting or a boring class? Once we have a better understanding of when the habit occurs and what your triggers are, we can then create interventions to reduce picking in those areas.

Question 5

Can you tell me more about skin picking. Is it anxiety or OCD related. How is it treated? Are medications helpful?

Matthew Traube · Accepted Answer

When treating skin picking, hair pulling or other body-focused repetitive behaviors it’s important to recognize that it can be both a behavioral problem and an emotional one. Both problems need to be treated. Skin picking for example, can be used to relieve emotional discomfort, physical discomfort, or a blend of the two. People tend to pick when they are anxious or stressed, but many people are surprised to learn that people also pick when they are feeling relaxed, watching television or using a computer. Many of my clients often describe being in a trance-like state and not being fully aware of the behavior. They might be working on a stressful project while they are simultaneously picking. They might be watching a stimulating television show and unaware that they are simultaneously picking. It is widely believed that skin picking can be associated with anxiety or OCD. People are often unaware that they are doing it.

Although there is seldom a magic bullet, the key is to figure out when it is happening and what the motivation behind the behavior is. Then find practical tools to change it. For example, on one level I might advise someone to spend less time in the bathroom if looking into the bathroom mirror triggers the urge to pick the skin. If you are vulnerable to picking your scalp while working at the computer, you might wear a hat. It’s common for people to pick more when they are alone, so I might suggest creating a weekly schedule that reduces the time someone is spending alone. Social support is an important tool.

Psychodermatology for Skin Conditions