Psychogenic Excoriation Disorder:

“No, with her fingernails. Her arm was itching. Real bad, apparently, ‘cause she just kept scratching and scratching. Until she broke skin. And then she started bleeding. She was bleeding all over her desk and dripping blood on the floor and the teacher didn’t even notice. Nobody noticed but me.”

 

Why would a girl scratch herself badly enough that she reached bone and had to be sent to the school nurse? This is due to psychogenic excoriation disorder, also known as: neurotic excoriation, acne excoriee, pathological  compulsive skin picking and dermatillomania. The condition causes people to scratch or pick at skin repeatedly often without them even realizing it. Sometimes there may be a minor skin pathology, like bug bites, or acne, to start the scratching, however the skin can also be perfectly normal with no pathologies. The condition is considered to be a mental health issue and often linked to mood and anxiety disorders, as well as disorders in the compulsivity-impulsivity spectrum such as obsessive-compulsive disorder, body dysmorphic disorder, eating disorders and so on.

Some studies indicate that serotonin, doxepin, clomipramine, naltrexone, pimozide and olanzapine can help in the treatment of psychogenic excoriation disorder. There is research into possible behavioral treatments as well, but it has currently not been shown to be a surefire solution since there are no proven studies. Nevertheless, there are claims to a technique called ‘habit reversal,’ where a patient is self-monitored, recording instances of scratching and eventually creating alternative responses to scratching.  

 

Sources:

Arnold, L. M., M. B. Auchenbach, and S. L. McElroy. “Psychogenic excoriation. Clinical features, proposed diagnostic criteria, epidemiology and approaches to treatment.” CNS Drugs. https://www.ncbi.nlm.nih.gov/pubmed/11475941.

Scheinfeld, Noah S. “Excoriation Disorder.” Practice Essentials, Background, Pathophysiology and Etiology. May 03, 2017. Accessed June 23, 2017. http://emedicine.medscape.com/article/1122042-overview#a1.