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If you work in childcare, teaching, or child protective services, having a clear understanding of the potential mental disorders children may suffer from is crucial.

Understanding the complexities of these disorders, the potential signs, and the appropriate people to contact for help is an imperative part of your duties. You must be as educated as possible on the potential complications affecting a child’s development, including a condition like excoriation disorder. That’s why, in this article, we will be looking directly into excoriation disorder and providing useful information regarding what it is, the signs to look for and how you can help.

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What is excoriation disorder?

Excoriation disorder is a mental health condition also known as skin-picking – as the name suggests, it’s when children pick their skin constantly to the point of pain and harm. It’s often compulsive, which means they can’t stop even if they want to. It can cause serious damage to the spots they pick and have major health implications.

Skin picking can cause scabs, scars, bleeding, and infection. It can also lead to embarrassment and shame should other people notice and leave children insecure about their skin. Some children will pick at their skin as it makes them feel good initially, and it’s most prominently triggered by stress and/or anxiety.

The symptoms to look for

Recognizing and getting the disorder diagnosed quickly is crucial. This will avoid permanent damage to the child’s skin and ensure they get the mental health support they need. This is why it’s important to be aware of all of the potential signs and symptoms of excoriation disorder so the appropriate people can be alerted immediately and the child can receive the help they require. Below is a list of some of the symptoms you should look out for:

  • Scabs or marks on their body – common areas include the face, arms, legs, back, gums, lips, shoulders, scalp, stomach, chest, fingernails, toenails, and cuticles.
  • Signs of bleeding or infection
  • Visible scars
  • Constantly scratching, squeezing, or rubbing their skin
  • Most children use their fingernails, but some use tweezers or other tools. If you see them carrying these around or hiding them, this could suggest they have excoriation disorder but remember not to assume until you have all the details.

Some children will pick at the same spot repeatedly, whereas others will pick at areas all over their bodies. That’s why it’s important to remember not all signs of skin picking will look the same on each child that suffers from it. Some children may have many of these spots or scabs, whereas some may have fewer but with much deeper marks.

What are the causes of excoriation disorder?

There are many reasons a person can develop excoriation disorder, including:

  • An infection, rash, or injury that creates a scab can typically lead to an unfortunate habit developing due to a variational form of trauma. If a person is injured in any way that leaves a mark on their body, the irritability of a scab often makes them want to pick at it. This urge to pick and scratch it away can manifest into this cycle, with unhealthy behavioral patterns and habits becoming hard to break.
  • Stress or mental health conditions – this means that during times of stress or high anxiety, it’s common for people to react to this feeling by disrupting their body and manipulating it in some way. Common examples of this are skin picking, fingernail biting, or hair pulling to relieve it. It can also be a form of self-grooming done to try and correct the imperfections of a person’s skin due to body image and insecurity issues.

Excoriation disorder can also develop alongside or because of other mental health conditions. Some of these are listed below:

  • OCD is the most common mental health condition that develops alongside excoriation disorder due to the similarities between the two with compulsivity. Unwanted repetitive thoughts characterize OCD.
  • Trichotillomania – another compulsive condition related to OCD. This leads to hair-pulling, nail-biting, and teeth-grinding.
  • ADHD – a neurodevelopmental condition that interferes with a person’s ability to focus and control impulsive behaviors and thoughts. A child with ADHD may develop excoriation disorder due to hyperactivity or low impulse control.
  • Autism spectrum disorder – a neurodevelopmental condition that affects behavior and communication. This can manifest as repetitive behaviors such as skin picking.

How excoriation disorder is diagnosed

If you have recognized any of these symptoms in a child you know, it’s important to alert the appropriate people. This may be the parent, caregiver, CPS, or pediatrician. They will then be advised to seek medical advice. For a child to be diagnosed with excoriation disorder, the professional must see three things happen. These are:

  • They pick at their skin so much and for so long that it causes wounds.
  • They have tried and failed to stop on their own.
  • The picking makes them upset or causes problems in their daily activities.

Excoriation disorder treatment

Diagnosis, as early as possible, is incredibly important because it will make sure that the child can then go on to get all of the appropriate help and support that they need. There are several evidence-based treatment options available for children suffering from excoriation disorders. These are all therapeutic approaches designed to help manage and control the compulsive behavior of a sufferer while also exploring what is causing them to pick their skin excessively. Some of these treatment plans include:

  • Cognitive Behavioral Therapy is the most common treatment and is designed to help the child become aware of the reasons why they pick, giving them alternative ways to handle these. Anti-depressants may also be prescribed besides this, but not always.
  • Habit Reversal Training – similar to CBT, this highlights alternative ways to handle their relative feelings. It also begins with awareness of the need for treatment, which those in denial will benefit from.
  • Acceptance and Commitment Therapy uses mindfulness techniques to teach acceptance of negative thoughts and emotions while combining behavior change techniques.
  • Pharmacotherapy – this treatment uses medication in conjunction with counseling. This is not as commonly used in children, however.
    Mental health conditions can arise at any age, with excoriation disorder most common in teens. This is why it’s important to be aware of the signs and what may be causing them to pick at their skin, so you can get children the help they need quickly.