picking on herself

Karen,

This could be obsessive compulsive disorder. I knew a child who used to pull out her hair in a similar matter. The problem stopped when she received appropriate medication for her OCD.

Andrea

Karen,

Does your daughter get a lot of dry patches on her skin? If so both the behaviour and the dry skin could be related to her diet.

You might want to see a nutritionest or an M.D. who knows a few things about diet. FYI most doctors get very little training on nutrition and rarely address issues related to diet.

My ds’s skin began itching when the dosage of a medication he took was increased. He scratched so hard he broke the skin, causing scabs that he then repeatedly picked at. This went on for months. I decided we needed to break the cycle. We got the doctor to (reluctantly—he thought the itching complaint was psychosomatic) taper him off the medication, but the problem remained—and, yes, it looks really awful. I hoped if we could heal the scabs he had, then, with the itching removed, perhaps the cycle could be broken.

It so happened we had a trip scheduled to the Middle East (probably not in the cards for most anyone at present) so I arranged for a two day stay at the Dead Sea. Ds had to swim at least three times a day in DS, which is chockful of minerals. (Swimming can also be quite tortuous if the water gets in your eyes or mouth.) Three times a day application of DS mud also and all the rest of the time in the pool. Europeans believe skin treatments at DS are particularly beneficial because, in addition to the mineral rich water and mud, it is the lowest point on earth so the air has extra oxygen and fewer UV waves hit the earth. (I reserve judgement on Euro view but will note that some of their insurance schemes actually pay for all costs associated with treatments at the DS.) This regimen was followed up with daily swimming in a regular pool for two weeks. All the mineral, sunlight, and chlorine put his skin on the road to recovery and the cycle was broken.

What I would do if he had this problem again: make him swim daily in the most chlorinated pool I could find and follow with daily application of mineral salt/oil skin conditioner combination. (The Bath and Body shop here sells scented versions. You might find similar Dead Sea products at the Whole Foods store or the like.) This winter he has had very dry skin and I use a mineral salt/oil conditioner, followed by Burt’s Bee Balm. The combination has proved very effacacious.

If this didn’t work to start the healing process within a few weeks, I would go the therapy route—specifically cognitive behavior therapy—I definitely would not bother with anything else—ordinary psychotherapy, for example, would be useless. Skin picking is a variant of OCD, and CBT can be very effective for that, although it is often unpleasant and time-consuming. (For more information, put skinpicking +ocd into google and you will get further information.) Medication is often recommended in conjunction with CBT, at least at first, to make CBT more endurable as an initial matter.

Of course, you could always go to a dermatologist and see what he or she recommends. When this happened with my son, I was at a point where I absolutely could not bear the thought of fitting yet another doctor into my ds’s or my life. And actually, I think it’s better we were able to cure it on our own—he was beginning to feel quite beaten down by all the other various specialists he had to see.

Good luck.

Thank you all for taking the time to respond.

She does say it itches, and I have bought every cream I could get my hands on. But I really don’t think it is the medication. This behavior happens in the summer when she is not on any medication.

I was also leading to the OCD, but all the specialists I have seen seems to believe that it is just a bad habit. This is worse than a habit.

What is the best route to take? A Psychologist, Psychiatrist, I don’t know the difference, except one can prescribe medication.

And is it safe to take Ritalin with different types of medication? This is my big worry.

Thanks again

Karen,
You are right. This is more than just a bad habit. If you feel you’ve done everything to try to break the cycle yourself, you want to see a psychologist (not a psychiatrist, who is the MD who can prescribe medication) who does cognitive behavior therapy. Medication is not strictly necessary, just often recommended. Many people take ritalin in conjunction with the SSRIs usually used for OCD (prozac, paxil, zoloft, etc.). Another medication that is used is tenex, which lowers blood pressure. This also can be used with ritalin. Someone who knows what he or she is doing (e.g., not an ordinary perdiatrician) needs to really know how to manage the medications if the child is taking more than one, particularly SSRIs, because there can be rare adverse interactions resulting in something like serotonin syndrome. A good CBT psychologist should be able to point you to a good doctor he or she has worked with for medications. Usually the doctor would be a neurologist or psychopharmacologist (psychiatrist specializing in drugs). (Often, the psychologist, who spends far more time with OCD people, also has a view on which medications have been the most helpful. A forewarning: the CBT person we worked with for other things definitely did not like ritalin as he’s seen it associated with a lot of negative symptoms. My ds was taking adderall, though, and he was willing to work with that.)

It is also my view that a good CBT psychologist would be willing to give treatment a try without medication, if that is the route you prefer. (This would be my preference. Sometimes managing the side-effects of drugs has been worse than dealing with the underlying problem it’s supposed to treat. Also SSRIs are not immediately effective—you have to gradually step up the dosage and if you find the type you were prescribed is ineffective or has bad side effects, you have to step down the dosage and then try another kind, going through the whole long step-up, step-down process all over again.) If the CBT therapy was proving difficult without medication, only then would I consider it.

Some doctors do treat OCD without therapy by just giving SSRIs. While I have not done extensive research on this, almost all the studies I have seen show that CBT combined with SSRIs is far more effective than medication alone and most knowledgable people would recommend CBT as the first line of attack.

You may be able to get referrals for a CBT psychologist by going to the ocfoundation.org and seeing if they have an affiliate in your area. You might also ask at a local Tourette Syndrome Association because this often occurs with OCD. When I did a brief search just now, I found a Florida outfit that will even do CBT over the phone—which they point out is not preferred, but a second best for those who may not have a CBT psychologist in their locale.

Hi Marie,
I am in Germany, you can buy dead sea products at just about any drugstore. They come in bath oil, salts, shampoo, soap you name it. You could probably find some online. Under the title Totes Meer Salz My dermatologist here recommended using the bath salts to me for one of my outbreaks of excema. I have also used aveeno oatmeal powder, amazing what it did for a very severe outbreak on my face.
Oh, they also have indoor/outdoor pools in just about every town, almost all have a salt/mineral pool. They are great. I find with chlorine pools though, it really dries my skin out and makes it itchy and irritated.
Hope this helps some.
Amy

Agree—chlorine is a poor second place to salt and mineral water, but it does seem to help quicken wound healing when a salt water bathing place isn’t available. (Plus it makes my eyes terribly itchy.) When I went to the Dead Sea there were loads of Germans, Italians, Scandanavians, Swiss and Eastern Europeans.

Hi — You’ve gotten lots of good advice here. You ought to be able to find a psychologist or psychiatrist who is knowledgeable and experienced with OCD and with OCD in kids. Advantage of a psychiatrist is you can do med checks and therapy all with the same person. Just ask LOTS of questions before you take your kid in — you ought to be able to interview a few docs on the phone, and this will give you a sense of their approach.

Medication for the underlying anxiety which is provoking the OCD behaviors can be very helpful. I agree that combo with therapy is best — I wouldn’t take my kid to a doc who only did meds, the therapy is too important.

There are also docs/psychologists who specialize in OCD and “substitute” behaviors, there’s even a book on it (that I’m blanking on title of at the moment). Where are you located, I’m in DC and could give you a ref for this area (my daughter has gone through the skin chewing, picking, shredding clothes etc. etc.).

One of the side effects of Ritalin is tics or OCD-like behavior. Actually side-effect may not be the right term because Ritalin can “bring them out” and they will continue even after meds. are discontinued. This is something you may want to ask your doctor about.

As to who you used. I’m in DC too and used Charles Mansueto’s Behavioral Therapy Center in Silver Spring. I was very satisfied, but Silver Spring was a long haul for us. I am unaware of any psychiatrists here who do CBT. Did you use one and if so who? I would guess that the down side of using a psychiatrist rather than a psychologist is cost.

Rover, The tic symptom arising from Ritalin is pretty well known. I had never heard particularly about OCD arising as a side effect. The proximate cause of my ds’s skin itching was an increased dosage of prozac (which ironically he was taking for OCD type symptoms). In retrospect, I would have stopped the prozac much earlier due to side effects like weight gain, feeeling hot all the time etc. He managed to get through the CBT without it, although the first month or two was pretty grim. I feel we approached this backward—first prozac, then CBT when, after a period of initial success, it not only didn’t work but the side effecets became intolerable. But I didn’t know about the CBT option at the time.

The Silver Spring guy is who I couldn’t remember — I haven’t used but know one person who did.

I’m checking with our shrink, I’m quite sure she does CBT, but will get back to the BB Friday or so and let you know.

RE: long distances — isn’t the beltway your 2nd home :))) we drive anywhere when we find the right therapist.

Depending on the kids’ diagnosis, a psychiatrist can be better becuase of more reimbursement. All depends on your “health” plan!

More later,

Unfortunately I’m in Wisconsin. I have contacted the Children’s Hospital in the area and received a referral.

Thanks to everyone!

If you go to a dermatologist they will give you a cortisone cream that will clear this up very quickly.

A good dermatologist will try to find out why it happened to begin with.

I agree with Rover, ask about med side effects. I have heard about OCD occuring from adhd meds. Check into this before you do anything else.

The worst thing you can do is pile on more meds if it truely is a side effect of another med.

Per my shrink, here’s the DC guy, might be worth a call to see if he can recommend someone in your part of the country. Good luck.

The best expert in the area for cognitive behavioral therapy for OCD is Charles Mansueto, Ph.D. in Silver Spring. His office phone number is 301-593-4040 and he is the director of the Behavior Therapy Center of Washington.

What about getting acrylic nails done at a salon? This would make the picking hard to do, as the acrylic nails would be thicker and not as sharp and if she tried scratching she wouldn’t be able to break the skin. The benefit of this is that she would have nice looking hands without scabs on her arms…I know people who have acrylic nails stop chewing their nails and picking at their cuticles…the thickness of the nails makes the sensation of picking different and the behavior tends to subside.

My mother has been picking on her skin ever since I was a little girl. She is on Paxil and will take Xanax on occasion for anxiety. She does the picking unconsciously…and when I see her doing it, I want to scream stop because her arms are just riddled with scars…it has gotten worse as she has gotten older…