Dermatophagia: symptoms, causes and treatment

This disorder leads the person to bite his or her skin, and shares characteristics with OCD.

Dermatophagia is a psychological disorder that involves biting the skin.. Normally, what is bitten by the person with dermatophagia is the skin around the fingernails (around the fingertips), although there are also cases in which the person bites the lips and the inside of the mouth.

These small lesions caused by the bites end up causing reddening of the skin, which may bleed, and the appearance of wounds. In this article we will know the symptoms of dermatophagia, the consequences, causes and treatments.

What is dermatophagia?

Dermatophagia is usually associated with people with a rather nervous and/or anxious temperament; it is also related to states or moments of tension and stress. It is also associated with states or moments of tension and stress, it presents characteristics of the obsessive-compulsive spectrum and impulse control disorders..

That is, it is a disorder with three types of symptoms or components: those related to impulse control, anxious and obsessive-compulsive.

Symptoms

These are the main symptoms and signs of dermatophagia.

Impulse control: impulsivity

Dermatophagia is related to impulsivity and impulse control. An impulsive act involves not being able to resist the temptation to perform a certain action, as well as its consequentand its consequent relief and the feeling of pleasure experienced by the person.

Impulsive behaviors are also related to the fact of not thinking about the consequences of our own actions; that is, it would be something like "acting without thinking". Thus, impulsivity involves losing controland can cause us to make mistakes on a larger scale, even to the extreme case of hurting someone.

In the case of dermatogafia, the direct consequences of biting behaviors affect the subject suffering from the disorder himself.

2. Anxiety

Anxiety is also very characteristic of people with dermatophagia. Isolated episodes of anxiety (as triggers for impulsive skin biting behaviors) may occur, or the biting behaviors may occur as part of a more global anxiety disorder (e.g., Anxiety Disorder (e.g. Generalized Anxiety Disorder, social phobia, separation anxiety disorder, etc.).

Thus, when the person feels that internal restlessness, together with nervousness and physiological symptoms typical of anxiety, he/she will seek to alleviate that state through impulsive action, will seek to alleviate this state by means of an impulsive action (or compulsive, as we will see later), biting the skin. (or compulsive, as we will see later), by biting the skin. That is to say, it would be a kind of maladaptive coping mechanism, since the subject ends up hurting himself.

3. Obsessions and compulsions

Dermatophagia has also been related to Obsessive-Compulsive Disorders (OCD) and related disorders (a newly created group of disorders in the DSM-5). However, it does not really belong to this category within the manual, although we could perhaps place it in the subcategory of "Other specified/unspecified OCD and related" (where disorders that do not meet all the guidelines or criteria for an OCD diagnosis are grouped).

It does appear in the DSM-5, however, excoriation disorder, a similar disorder but not to be confused with dermatophagia, in which the person scratches (not bites) the skin.In dermatophagia, the person scratches (not bites) his or her skin.

Thus, following the spectrum of OCD, it is true that we can find obsessive behaviors in dermatophagia; for example, it is possible that the person has certain recurrent "negative" images or thoughts in the mind (obsessions) that cause a state of anxiety, and that leads to the behavior of biting the skin.

In this case, such behavior would be similar to a compulsion, or at least it would perform its function, that of reducing the state of anxiety of the person).

Causes

Generally, dermatophagia is originated as a consequence of stressful moments and the need to cope with such moments, coupled with a lack of skills and abilities to deal with them.coupled with a lack of adaptive coping skills.

Thus, a person who in moments of nervousness, uncertainty, discomfort, stress, etc., chooses to bite the skin around the nails (or other areas of the body such as the mouth), and does so systematically during moments of stress, may end up "learning" to respond in this way (according to behavioral theories).

But how is such behavior learned? Through reinforcement; that is to say, these behaviors of dermatophagia would be reinforced by the pleasure that the person feels when "unloading" the tension through the action of biting..

Thus, the succession of actions/states would become the following vicious circle: stress situation → biting the skin → feeling pleasure → reinforcement of the action (and back to the beginning).

However, sometimes the person does not seek to feel this "pleasure", but rather the opposite; to feel pain. Thus, another possible cause of dermatophagia is related to an emotional Pain that the person is feeling; to combat it, he/she would choose to bite his/her skin and physical pain that would allow him/her to decentralize from the emotional pain.. It would be a kind of self-injurious behavior, although not with the real purpose of hurting oneself, but rather to "distract" from the pain or emotional discomfort.

Consequences

If these behaviors are perpetuated over time, the lesions on the skin, mouth and fingers may become more and more important.

In addition, if dermatophagia is not stopped, the person runs the risk of assuming this coping strategy to stress as the predominant coping strategyThis would prevent him/her from developing truly adaptive and functional strategies (such as using breathing techniques to calm down, relaxation exercises, practicing sports, etc.).

Treatment

Psychological treatment of dermatophagia will focus on finding alternative behaviors that are incompatible with skin biting. A behavioral treatment may be useful in cases of dermatophagia; i.e, behavior modification techniques that allow the elimination of the inappropriate action and the establishment of an appropriate behavior. and the establishment of an appropriate behavior.

Incompatible behaviors

In order to apply a technique that seeks to establish an incompatible behavior, it is important to first detect when, how and against what background the skin biting behavior develops. Once the analysis of the applied behavior has been carried out, we will be able to know the antecedents prior to the appearance of the undesired behavior (for example, when the parent scolds the child and the child feels tense, or when one feels anxious about another specific situation).

Knowing the antecedents will allow us to prevent the behavior.. If it cannot be prevented or if there are difficulties to do so, an incompatible and alternative behavior will be chosen, as we said (for example, using the hands to perform another action, or the mouth, avoiding biting).

It often happens, especially in children, that it is difficult to eliminate a behavior if another one is not established in its place. Let us think for example of people who smoke; very often these people choose to chew gum, eat candies, smoke electric cigarettes, etc. (these are alternative and incompatible behaviors).

2. Psychoeducation

In addition to all of the above, the following will also be indicated to treat dermatophagia educating the patient in alternative and functional coping strategies (psychoeducation) (psychoeducation), to be applied in times of stress.

As we mentioned before, some of them can be: breathing techniques, relaxation techniques, practicing sports, doing yoga, leaving the stressful situation and looking for a quiet place, etc.

3. Psychopharmaceuticals

Finally, you can opt for the use of anxiolytic drugs (or antidepressants, in the case of comorbid depression) to alleviate anxious or depressive symptoms, but pharmacological treatment should always be considered as a rather punctual alternative, and always complementary to psychotherapeutic intervention.

In the end, the important thing will be to resolve the situation in the long term and producing deep and lasting changes, and this can only be achieved through appropriate psychological therapy.

Bibliographical references:

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 5th ed. Arlington, VA: APA. (transl. cast.: Madrid: Editorial Médica Panamericana, 2014).
• Belloch, A.; Sandín, B. and Ramos, F. (2010). Manual de Psicopatología. Volume I and II. Madrid: McGraw-Hill.