Dermatophagy is a psychological disorder that involves biting the skin . Usually, the person with dermatophagy bites the skin around 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, end up causing the skin to redden, which can bleed, and the appearance of wounds. In this article we will know the symptoms of dermatophagy, the consequences, causes and treatments.

What is dermatophagy?

Dermatophagy 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. In addition, presents characteristics of the obsessive-compulsive spectrum and impulse control disorders .

In other words, it is a disorder with three types of symptoms or components: those related to impulse control, anxiety and obsessive-compulsive.

Symptoms

These are the main symptoms of dermatophagy.

1. Impulse control: impulsivity

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

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

In the case of dermatogaphy, the direct consequences of biting behaviors affect the subject who suffers from the disorder.

2. Anxiety

Anxiety is also very characteristic in people with dermatophagy. It can happen that isolated anxiety episodes appear (as triggers for impulsive skin-biting behaviours), or that biting behaviours appear within a more global anxiety disorder (e.g. Generalised Anxiety Disorder, social phobia, separation anxiety disorder, etc.).

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

3. Obsessions and Compulsions

Dermatophagy has also been linked to Obsessive-Compulsive Disorders (OCD) and related disorders (a group of newly created disorders in the DSM-5). However, it doesn’t really belong in this category in the manual, although we might be able to place it in the subcategory of "Other specified/unspecified OCD and related disorders" (where disorders that don’t meet all the guidelines or criteria for being diagnosed with OCD are grouped together).

On the other hand, DSM-5 includes excoriation disorder, a similar disorder but not to be confused with dermarthrophagia , where the person scratches the skin (does not bite it).

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

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

Causes

Generally, dermatophagy originates as a consequence of moments of stress and the need to face those moments , added to a lack of adaptive coping skills.

Thus, a person who, when faced with moments of nerves, uncertainty, discomfort, stress, etc., chooses to bite the skin around his nails (or other areas of the body such as the mouth), and ends up doing this systematically during moments of stress, may end up “learning” to respond in this way (according to behavioral theories).

But how do you learn such behavior? Through reinforcement; that is to say, these behaviours typical of dermatophagy, would be reinforced by the pleasure the person feels when “discharging” the tension through the action of biting himself .

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

However, sometimes the person does not seek to feel that “pleasure”, but rather the opposite; to feel pain. Thus, another possible cause of dermatophagy is related to an emotional pain that the person is feeling; to fight it, the person would choose to bite the skin and generate a physical pain that would allow him/her to get rid of the emotional pain . This would be a kind of self-injurious behavior, although not with the real purpose of hurting oneself, but rather to “distract” oneself from the emotional pain or discomfort.

Consequences

If these behaviors are perpetuated over time, injuries to the skin, mouth and fingers may become increasingly important.

Moreover, if the dermatophagy is not stopped, the person has the risk of assuming this strategy of coping with stress as the preponderant one , and this would prevent him/her from developing really adaptive and functional strategies (such as using breathing techniques to calm down, relaxation exercises, practicing sports, etc.).

Treatment

The psychological treatment of dermatophagy will focus on finding alternative behaviors incompatible with biting the skin. A behavioural treatment can come in handy in cases of dermatophagy; that is, using behaviour modification techniques, which allow the elimination of the inappropriate action and the establishment of an appropriate behaviour.

Incompatible behaviors

In order to apply a technique that seeks to institute incompatible behavior, it will be important to first detect when, how and before what background the skin-biting behavior develops. Once the analysis of the applied behavior is done, we will be able to know the previous antecedents to the appearance of the unwanted behavior (for example, when the parent scolds the child and the child feels under tension, or when one feels anxious about another specific situation).

Knowing the background will allow us to prevent behavior . In other words, it would be a kind of maladaptive coping mechanism, since the subject would end up hurting himself.

3. Obsessions and Compulsions

Dermatophagy has also been linked to Obsessive-Compulsive Disorders (OCD) and related disorders (a group of newly created disorders in the DSM-5).
However, it doesn’t really belong in this category in the manual, although we might be able to place it in the subcategory of "Other specified/unspecified OCD and related disorders" (where disorders that don’t meet all the guidelines or criteria for being diagnosed with OCD are grouped together).

In addition to all this, it will also be indicated to treat dermatophagy to educate the patient in alternative and functional coping strategies (psychoeducation), to be able to apply in moments of stress.

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

Psychopharmaceuticals

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

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

Bibliographic references:

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