Autism, Anxiety, and Dermatillomania
Several years ago, we noticed skin lesions on the legs of our middle son who has been diagnosed with both autism and ADHD. Initially we thought it was due to some allergic reaction or skin irritation. I researched several possible causes and went into full management mode. We began separating his clothing and using a milder laundry detergent for him. I bought oatmeal bath material which clogged up our drain. We tried everything from Eucerin, to Goldbond, to Aquaphor. He even started using Shea Moisture African soap. What I thought was just uncontrolled skin itching would come and go in cycles despite our best efforts.
As the stress of senior year and then transitioning to college during a global pandemic took hold, the intense skin digging returned. This bout seems as intense as the last when the doctor had to prescribe antibiotics for the spots that were infected. At that time his pediatrician suggested the digging was due to anxiety, but we were unsure and did not want to add an anxiety medication during his senior year. We were already aware that children and adults with autism could also have anxiety. In fact, one study suggests up to 47% of adults with autism also deal with some type of anxiety disorder (Hollocks et al., 2019). Our middle son was anxious about a lot of things from the time he was first diagnosed, yet the skin picking didn't begin until around middle school. What we were not aware of was dermatillomania, what it was, and how it can present in our son and others like him.
Dermatillomania is a skin-picking disorder also known as excoriation disorder per the DSM-5. It is a chronic issue where the individual repeatedly picks at the skin causing lesions and in some cases tissue damage. The disorder is characterized by both physical damage and psychological distress, where those impacted typically experience impulse control issues, tension, stress, depression, etc. In some cases, embarrassment from the scars can lead to shame, fear of exposure, and usage of various methods to cover them up (Psychology Today, 2021). Our son is not ashamed of his scars when he goes out in public. They do not define him or make him shy away from wearing shorts. The only time he seems embarrassed or ashamed is when we examine his skin and show concern over how they look and for his health.
Various methods have been used to help control dermatillomania, including cognitive behavioral therapy, medication, and gloves or bandaging fingers and fingernails. Left untreated the skin can become infected and require antibiotics or surgery in extreme cases (Psychology Today, 2021). We have yet to discover what works for our son. So far, he has tried gloves, avoidance tactics, and cognitive behavioral therapy. At present it is too early to tell if any of those will make an impact. What I realize is that by trying to micromanage that which I did not understand, it was like pouring gasoline on a fire, only adding to his distress and shame. As parents of children and adults with autism co-conditions, our role is not so difficult. We are to journey along side of them, holding space for that which is difficult, helping to explore that which could be helpful, and showering them with unconditional love long the way. May you encounter every co-condition and challenge with wonder and an open heart. And may every challenge allow you to bridge a deeper connection.
"Dermatillomania (Skin Picking)". Psychology Today. August 5, 2020. Dermatillomania (Skin Picking) | Psychology Today.
Hollocks, M. J., Lerh, J. W., Magiati, I., Meiser-Stedman, R., & Brugha, T. S. (2019). Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis. Psychological medicine, 49(4), 559–572. https://doi.org/10.1017/S0033291718002283.
Image - Dermatillomania/Skin Picking Disorder Test. OCD Center. www.ocdla.com. Accessed Nov 26, 2021.