Excoriation

Like many diagnosed with autism, our boys have comorbid diagnoses. One that is on our radar currently is excoriation, a skin picking disorder.

Psychology Today defines it this way:

Also known as excoriation disorder, or compulsive skin picking, dermatillomania is a psychological condition that manifests in the form of repetitive touching, scratching, picking, and digging at one’s own skin. It is an impulse-control disorder and one of several body-focused repetitive behaviors (BFRB) currently classified in the DSM-5 as Obsessive Compulsive and Related Disorders. Dermatillomania affects up to 5 percent of the population and approximately 75% of those are female. The difference between dermatillomania and normal picking at skin imperfections and irregularities, is that the behavior is chronic, results in tissue damage, and causes the individual marked distress and dysfunction.

Repetitive skin picking extends to pulling, scraping, and even biting both healthy and damaged skin from various parts of the body, though most often on the face, hands, fingers, arms, and legs. This behavior, which commonly begins in adolescence but can occur at any age, often results in visible skin damage and disfigurement from lesions, discoloration, open wounds, scars, and infections.

…skin picking can also occur with dermatological conditions, autoimmune disorders, opiate withdrawal, and developmental disorders such as autism.

Unfortunately, E is a skin picker. The sad part is that he is aware he has this issue, hates the fact that he picks, and yet is completely unaware of the action when doing it.

At first, we didn’t think much of it. He had a red spot on his arm here or there, but more recently it is becoming more and more of a visible issue. His arms and, to a lesser extent, his face, are covered in red marks, scratches and scabs. E, thankfully, is not yet self-conscious about his appearance so isn’t worried about how it looks. However, people of the general public see the marks, and doctors unfamiliar with his issues have expressed their concern. Honestly, it looks like he has chicken pox scabs.

Over the years, I’ve learned to ignore strangers’ looks and judgement. What bothers me is that it causes them to worry about him spreading something infectious. I guess it shouldn’t matter, but it does. If I were a parent on the outside, and I walked past a kid, playing at the park or wherever, and saw all those red spots and scabs, I’d wonder if he was sick; if he was contagious. I wish I could just carry a sign wherever he goes that says, “He’s not sick. He’s not abused. He just picks his skin.” Do I need to make him cover his arms even in warm weather to prevent the looks and curiosity? Probably not, but the worry will hover in my mind, especially when I see the judgmental looks.

I worry (and I know he does too) about the potential issues as a result of picking. Abscesses, infection, the needing of a skin graft, or even suicidal thoughts when he gets older. We are working with a psychologist and psychiatrist to help control the picking. On one hand, if it’s a stim, I hate to stifle that, but on the other hand, his health could be at risk. It would be better to adjust his stim to another activity.

One of the ideas we tried was having him wear gloves. That lasted maybe half a day. The gloves bothered him by making his hands too hot; he felt like he couldn’t play on his tablet or hold a pencil properly; all huge issues in an autism household. So, for now, the idea is abandoned, but maybe one day I’ll find just the right pair of gloves. In the meantime, E, his dad and myself all need to be vigilant and redirect him when we see him picking.