Q. I am a 53-year-old woman that has a disorder I think is related to Trichotillomania. I have an obsession with picking my skin. The slightest bump or abnormality causes me to pick at things until they bleed. I recently saw a segment on 20/20 about Trichotillomania and the piece mentioned that other types of this disorder were picking.

I've always thought it was some sort of compulsive obsessive disorder but never heard anything until this program aired. My grandfather used to pull his hair out. Everyone in the family always said he was crazy. The program mentioned an excess of a grooming gene. What can you tell me about my problem and where and how do I go about seeking help?

A. The syndrome sometimes called compulsive skin picking (CSP) may, indeed, be related to both trichotillomania (compulsive hair-pulling) and to the obsessive-compulsive spectrum of disorders in general. Some data suggest that skin picking exists on a continuum of severity, with as many as 4% of students reporting significant impairment from severe CSP (Bohne et al,
Behav Modif 2002;26:320-39).

There is no firm link between CSP per se and any sort of psychotic condition that would render CSP sufferers crazy. You may be best off consulting a psychiatrist with expertise in OCD-type conditions; he or she would be in the best position to consider both pharmacological and psychological treatments with you.

Indeed, some studies find that SSRI type medications (Prozac, Zoloft, Paxil, Luvox, etc.) may be helpful in CSP, though data are preliminary and there are two cases in which SSRIs appear to have worsened CSP. Cognitive-behavioral therapy (CBT) may also be helpful for CSP, and this could be provided either by a psychiatrist or a clinical psychologist with special training in CBT.

You may also find useful information at the Trichotillomania Learning Center (call 831-457-1004; or write to 1215 Mission St. Ste 2, Santa Cruz CA 95060). I hope you get help soon.

September 2003

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