What Is Skin-Picking Disorder?

Medically reviewed by Laura Angers Maddox, NCC, LPC
Updated May 15, 2024by BetterHelp Editorial Team
Please be advised, the below article might mention trauma-related topics that include suicide, substance use, or abuse which could be triggering to the reader.
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Skin-picking disorder or excoriation disorder can be a serious mental health concern that is often chronic and potentially damaging to a person’s self-esteem. It is often tied to other mental health disorders, including obsessive-compulsive disorder (OCD), but it doesn’t necessarily have to be. It usually involves symptoms like chronic skin-picking that leads to significant distress, as well as unsuccessful attempts to stop picking. If you believe you may be living with skin-picking disorder, working with a licensed therapist can be helpful. You can seek out a local mental health professional or match with one through an online therapy platform.

What is skin-picking disorder?

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Learn to overcome the urge to pick at your skin

Skin-picking disorder, which can be formally known as a condition called “excoriation disorder” or “dermatillomania,” is a psychiatric condition that typically involves the chronic picking of the skin. There may be periods where it is very intense, and it may go into remission, but nonetheless, if it isn’t treated, it can last for years.

A primary concern with excoriation disorder can be how much it may disrupt one’s life and self-esteem. People with this disorder may spend hours each day picking at their skin, even to the point of causing harm, such as open wounds. A harmless pimple, a piece of loose skin around the fingernails, or a scab that forms around a wound can develop into skin lesions and scars.

Additionally, some people with compulsive skin-picking disorder might scratch at their skin to remove a perceived defect that they believe is there, but that imperfection may not exist in reality—until they begin to pick at it.

Skin-picking disorder generally belongs to a category of mental health conditions in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) by the American Psychiatric Association known as obsessive-compulsive and related disorders. This doesn’t necessarily mean that all people with skin-picking disorder have obsessive-compulsive disorder (OCD), but the disorders often coexist and can have some similarities.

Skin-picking can also be referred to as a body-focused repetitive behavior (BFRB), which is something that can also be found in other types of conditions, like nail-biting disorder (onychophagia) or hair-pulling disorder (trichotillomania).

Like OCD, many of these BFRBs exist alongside excoriation disorder, and it’s estimated that up to 38% of individuals who pick their skin may also have problems with pulling one’s hair. In hair-pulling disorder or trichotillomania, people may repetitively pull hair out of their scalp, eyebrows, or eyelashes, which can cause significant hair loss, as well as feelings of shame or embarrassment.

Excoriation disorder can occur at any age, but it typically begins during a person’s adolescent years. It’s estimated that this condition affects anywhere from 1%-5% of the population can be affected by it. 

Skin-picking/excoriation disorder diagnostic criteria

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Compared to many other mental health disorders in the DSM, the details on how skin-picking disorder is diagnosed tend to be very straightforward and include a handful of symptoms to look out for. 

Here are the diagnostic criteria for excoriation disorder as listed in the DSM-5:

  • Chronic picking of the skin that leads to dermatological conditions, such as skin lesions

  • Repeated efforts to minimize or stop skin-picking

  • The skin-picking leads to clinically remarkable distress or disability in their occupational abilities, social life, or other important aspects of functioning

  • The skin-picking is not caused by the physiological effects of a chemical, substance (e.g., cocaine), or another medical illness (e.g., scabies)

  • The skin-picking can’t be further understood by knowing the symptoms of another mental health disorder (e.g., misconceptions or hallucinations in a psychotic condition, efforts to enhance a perceived impairment or flaw in body dysmorphic disorder, intent to hurt oneself although not suicidal*, or stereotypies in stereotypic movement disorder).

Therefore, to receive an accurate diagnosis of excoriation disorder, other conditions must usually be ruled out first.

However, for those who truly have excoriation disorder, as opposed to skin-picking related to substance use or another mental health concern, the specific causes of the condition aren’t typically as clear.  

Why do people pick at their skin?

The exact cause of excoriation disorder may be unknown. However, genetics may be at least partially to blame, and it’s possible that those with a family history of the condition, as well as obsessive-compulsive disorder, can be predisposed to excoriation disorder.

On the other hand, external factors can be responsible as well, and excoriation disorder can start to develop after a person picks at a scab, rash, or any small injury. The picking often leads to itching and irritation that may lead the individual in question to pick even more, potentially causing a larger and more severe wound than before.

Stress and anxiety can also play a role, and many people cite that skin-picking provides a sense of temporary relief despite experiencing distressing consequences. It can also arise out of boredom.

Similar to other body-focused repetitive behaviors, like hair pulling, skin-picking doesn’t always have to be a conscious decision. It can happen automatically without much thought from the individual. This can lead to unwanted consequences before a person even realizes it.

The effects of skin-picking disorder

Aside from the actual physical appearance aspect of skin-picking, it can also have a tremendous impact on how an individual behaves and interacts with the rest of the world.

Skin-picking can cause people to feel embarrassed and shameful. They may develop low self-esteem, and excoriation disorder can eventually contribute to the development of depression and other mental health disorders.

Because of this, people with excoriation disorder may avoid socializing and going out to public places, such as shopping centers, gyms, beaches, and countless other locations. This can make life feel limited for those who experience skin-picking disorder.

If the individual must go out, they will often go to great lengths to conceal the damaged skin. This can involve camouflaging it with makeup or covering up extremities with long sleeves or pants. Additionally, it can cause issues with time management and lateness due to requiring extra time to hide the signs of skin-picking.

In addition to the emotional and mental health concerns that can come with excoriation disorder, there are physical effects that can be very common when people habitually pick their skin, and some of them can require medical treatment. For instance, picking an open wound can lead to infection, and in some cases, it can cause discoloration or even disfiguration.

Therefore, because skin-picking disorder can negatively impact a person’s mental and physical well-being, it’s often crucial that people seek out help as soon as possible. This may be especially true since skin-picking disorder is usually chronic if left untreated.

Treatment for skin-picking disorder

Learn to overcome the urge to pick at your skin

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There are several potential treatments for this psychiatric disorder, ranging from wearing gloves to prevent self-injury. According to the TLC Foundation for Body-Focused Repetitive Behaviors, recent research indicates that 2-5% of people experience skin picking to a degree that causes negative impacts like tissue damage. 

Skin picking is a medical condition and indivudals who experience it have activation in specific brain areas when their symptoms activate. This knowledge has guided many modern treatments. These treatments might include habit reversal therapy, medication, talk therapy, and more. 

Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors or SSRIs are a type of medication to help manage the body-focused repetitive behavior associated with this medical condition. 

Habit reversal training 

Habit revesral training involves teaching individuals who deal with negative impacts from skin picking disorders to recognize situations that might trigger their urge to pick at their skin to feel relief. They can learn to redirect their behavior to avoid picking their skin with specific types of activities that involve using their fingers (e.g., drawing, fidget toys, etc.) 

Psychotherapy for obsessive-compulsive disorder 

One form of psychotherapy called cognitive-behavioral therapy (CBT), can be particularly useful because it usually involves changing a person’s thoughts so they can avoid skin-picking behaviors. This can mean addressing a person’s feelings that may compel them to pick at their skin, and it can also give them new ways of expressing these emotions, so they feel less of an urge to pick.

Like the compulsions that often accompany OCD, skin-picking can be considered a way to soothe anxiety, and eventually, it can grow out of control and become compulsive. Therefore, it may be essential to focus on the thoughts and feelings that cause skin-picking, as well as provide strategies to reduce and eliminate these compulsive behaviors.

Benefits of online therapy

Finding a therapist who can make you aware of these feelings and how you respond to them is often the first step, and you can connect to licensed professionals online who specialize in helping people overcome body-focused repetitive behaviors. Online therapy also tends to be convenient and affordable, and it can be ideal for those who don’t feel comfortable with in-person sessions. 

Effectiveness of online therapy

In addition to its convenience, online therapy also tends to be quite effective. Research suggests that it can produce the same results as traditional, in-person treatment options. One review of studies regarding online cognitive behavioral therapy (CBT) found that online therapy could significantly reduce symptoms of mental illnesses like anxiety, depression, PTSD, and more. 

Takeaway

Skin-picking disorder usually involves chronic skin-picking that leads to distress. It can be important to note that you can overcome skin-picking disorder with the right support. With online or in-person professional treatment, it’s often possible to discover what drives skin-picking so that you can develop alternative solutions for expressing emotion, managing stress, and feeling in control of your experiences.
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