Dermatophagia is a psychological disorder that involves biting the skin. Usually what the person with dermatophagia bites is the skin surrounding the nails (around the fingertips), although there are also cases where the person bites the lips and the inside of the mouth.
These small lesions that cause the bites, eventually cause redness of the skin, which can bleed, and the appearance of sores. In this article, we will learn about the symptoms of dermatophagia, the consequences, the causes and the treatments.
What is dermatophagia?
Dermatophagy is generally associated with people with a rather nervous and / or anxious temperament; it is also linked to states or moments of tension and stress. Outraged, exhibits features of the obsessive-compulsive spectrum and impulse control disorder.
Simply put, it is a disorder with three types of symptoms or components: those related to impulse control, anxiety, and obsessive-compulsive.
These are the main symptoms and signs of dermatophagia.
1. Impulse control: impulsivity
Dermatophagy is related to impulsivity and impulse control. An impulsive act involves not being able to resist the temptation to take a certain action, As well as his relief and the feeling of pleasure that came with it.
Impulsive behaviors are also linked to not thinking about the consequences of our own actions; that is, it would be something like “acting without thinking”. like that, impulsivity involves loss of controlAnd that can lead us to make mistakes already on a larger scale, reaching the extreme case of hurting someone.
In the case of dermatogafia, the direct consequences of biting behavior affect the subject himself who suffers from the disorder.
Anxiety is also very characteristic in people with dermatophagia. Isolated episodes of anxiety may occur (as triggers for impulsive skin biting behaviors), or the appearance of biting behavior in a more general anxiety disorder (For example, generalized anxiety disorder, social phobia, anxiety separation disorder, etc.).
So when the person feels this inner turmoil, alongside the nervousness and physiological symptoms inherent in anxiety, he will seek to attenuate this state by an impulsive action (Or compulsive, as we’ll see later), biting the skin. In other words, it would be a sort of inappropriate coping mechanism, because the subject ends up hurting himself.
3. Obsessions and compulsions
Dermatophagy has also been linked to obsessive-compulsive disorder (OCD) and related (newly created group of disorders in DSM-5). However, it does not really fall into that category in the manual, although we could perhaps place it under the subcategory of “Other OCD and associated specified / unspecified” (where disorders that do not meet all guidelines or criteria are grouped together to be able to diagnose-1 OCD).
Yes, it does show up in the DSM-5, however, excoriation disorder, a similar disorder but not to be confused with dermartophagia; inside, the person scratches the skin (does not bite it).
Thus, by following the spectrum of OCD, it is true that we can find obsessive behaviors in dermatophagy; for example, the person may have certain recurring “negative” images or thoughts (obsessions) in their mind that cause them to have a state of anxiety, which causes them to bite their skin.
In this case, this behavior would be similar to a compulsion, or at least would fulfill its function, to reduce the state of anxiety of the person).
Generally, dermatophagia it is the result of moments of stress and the need to face these moments, Added to a lack of adaptive coping skills.
So, a person who, in times of nervousness, uncertainty, discomfort, stress, etc., chooses to bite the skin around the nails (or other areas of the body like the mouth), and ends up do it systematically. stress, you might end up “learning” to react that way (according to behavioral theories).
But how do you learn such behavior? By reinforcement; that is to say that these own behaviors of dermatophagy would be reinforced by the pleasure that the person experiences in “relieving” the tension by the action of the bite.
Thus, the succession of actions / states would become the following vicious circle: stressful situation → bite the skin → feel pleasure → reinforce the action (and come back to it).
However, sometimes the person does not seek to experience this “pleasure”, but rather the opposite; feel pain. Thus, another possible cause of dermatophagia is related to emotional pain experienced by the person; to fight it, he would choose to bite the skin and generate physical pain that would allow him to decentralize from emotional pain. It would be a kind of self-injurious behavior, but not for the real purpose of hurting yourself, but rather to “distract” someone from the pain or emotional discomfort.
If these behaviors are perpetuated over time, injuries to the skin, mouth and fingers can become more and more serious.
Also, if the dermatophagia does not stop, the person is likely to adopt this stress-coping strategy as the predominant strategy, And this would prevent him from developing truly adaptive and functional strategies (such as using breathing techniques to calm down, relaxation exercises, playing sports, etc.).
Psychological treatment for dermatophagia will focus on finding alternative behaviors that are incompatible with biting the skin. Behavioral treatment can be useful in case of dermatophagia; in other words that is to say, use behavior modification techniques, which eliminate inappropriate actions and establishing appropriate conduct.
1. Incompatible behaviors
To apply a technique that seeks to establish inconsistent behavior, it will be important to first detect when, how and in what context the skin biting behavior develops. Once the applied behavior analysis is done, we will be able to know the antecedents before the appearance of the unwanted behavior (for example when the parent scolds the child and he feels tense, or when we feel anxious). another special situation).
Knowing the background will allow us to avoid the behavior. In the event that this cannot be avoided or there are difficulties in doing so, you will choose to seek incompatible and alternative behavior, as we have said (for example, using your hands to perform another action, or your mouth, avoiding the bite).
It often happens, and especially in children, that it is difficult to rule out one behavior if another is not established in its place. Think for example of people who smoke; very often these people choose to chew gum, eat candy, smoke electric cigarettes, etc. (These are alternative and incompatible behaviors).
In addition to all this, it will also be indicated to treat dermatophagia educate the patient on alternative and functional coping strategies (Psychoeducation), to be able to apply in times of stress.
As mentioned above, some of them can be: breathing techniques, relaxation, sports, yoga, getting out of stressful situation and finding a quiet place, etc.
3. Psychotropic drugs
finally the use of anxiolytic drugs can be chosen (Or antidepressants, for co-morbid depression) to relieve symptoms of anxiety or depression, but you should always consider drug therapy as a rather timely alternative, and always complementary to a psychotherapeutic intervention.
Ultimately, the important thing will be to resolve the situation in the long term and produce deep and lasting changes, and this can only be achieved through appropriate psychological therapy.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: APA. (Transl. Cast .: Madrid: Editorial Mèdica Panamericana, 2014).
- Belloch, A .; Sandín, B. and Ramos, F. (2010). Manual of psychopathology. Volumes I and II. Madrid: McGraw-Hill.