Friday, January 20, 2012

Control obsessive scratching using psychology

This morning I washed my hair (or what's left of it) with tar shampoo. Rubbed some jojoba oil into my scalp, but a few hours later at work I found myself absent-mindedly picking at scabs and dry skin on my head. I wasn't even itchy. It was a bad habit, a sort of obsessive compulsion, which I've had for many years, and which is exacerbated by stress. And with modern life, there's no shortage of stress. Deadlines! Email! Car trouble!

The picking and scratching start up the vicious cycle of eczema--the itch irritates the skin, which generates more itch, which means more scratching. You'd think there'd be a way to break the cycle at some point--where the itch is psychological, and perhaps subject to more control than physical itch. OCD-type scratching is the one aspect of eczema that can be blamed on the patient.

And in fact there IS a method that doctors have developed in the clinic to control psychological aspects of eczema. It's not new, but it's new to me. It's called "habit reversal", and it's employed by Christopher  Bridgett (on Twitter as @ckbridgett. He gives good tweet) at Chelsea & Westminster Hospital in London. I'm sure other doctors use similar techniques elsewhere.

Hat tip to @MarcieMom on Twitter, on whose excellent blog Eczema Blues I learned about Dr Bridgett.

Habit reversal was originally developed in Sweden in the late 1980s, based on earlier work in the US. You can find most of the details here. In fact you can (as I have done) print the pages out from the book, "Atopic Skin Disease: a Manual forPractitioners," by Christopher Bridgett, Peter Noren, and Richard Staughton.

Habit reversal, applied to eczema, consists of four basic elements:
  1. the patient "registers" the behavior, using a clicker or some form of counter, to count the number of times he or she picks or scratches throughout the day. This is key because to control the behavior one must be aware of it. (I often find myself scratching, having started unconsciously.)
  2. thereafter, when the patients realize they have the urge to scratch, they try clenching their fists--this stimulates the motor neurons and muscles involved in scratching.
  3. if this doesn't work, the patient tries pinching the itchy area, or poking a fingernail into it, to provoke pain that quells the itch.
  4. later, the patient follows up with the doctor, who prescribes steroids or other anti-inflammatories to reduce itch that can't be controlled using the first two methods.
The authors report a study in which scratching frequency was reduced by 90% after four weeks in a group using this method (habit reversal + steroids) versus 70% for a group using just steroids.

Sounds like a good thing to try. I have to figure out how to apply it to myself. There’s got to be an iPhone app out there that I can use as a counter!


  1. Thanks for mentioning my blog! Nominated you for Liebster Award, see

  2. Mei, thank you, I am honored. I look forward to a long collaboration. Let me see how I can pass this on.

  3. very interesting. My 3 yr old son I had noticed he would compulsively scratch alot, so what we started doing is getting him fidget toys and puzzles to distract him so he calms down as well. We also limit his scratch time to get the dead skin off then moisturize with butters and oils and give him his fidgets, it has helped immensely. But everyone acted as if I was crazy when I had suggested some of it was compulsive.