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?
Skin-picking disorder, which can be formally known as “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.
Additionally, some people with skin-picking disorder might scratch at their skin to remove an imperfection 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 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 hair-pulling. 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 anywhere from 1% to 5% of the population can be affected by it.
Skin-Picking/Excoriation Disorder Diagnostic Criteria
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 skin lesions
- Repeated efforts to minimize or stop skin-picking
- The skin-picking leads to clinically remarkable distress or disability in occupational, social, 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.
*If you or a loved one are experiencing thoughts of suicide, please know that help is available. You can call the National Suicide Prevention Lifeline anytime, 24/7, at 988.
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
What triggers skin picking disorder?
Skin picking disorder (SPD) can involve many different triggers that prompt picking in affected individuals. Negative emotions of any kind are common triggers, especially:
Large periods of time without structured activities may also trigger skin picking behavior. Some people with dermatillomania may pick at their skin reflexively or automatically when their mind is otherwise occupied. Others may have sensory triggers, such as seeing or feeling minor skin irregularities.
The initial onset of recurrent skin picking may happen during a period of prolonged or intense stress. Major, disruptive life events such as divorce, moving, or the loss of a family member might contribute to the development of this condition in some at-risk individuals.
How do you fix skin picking disorder?
Treatment strategies for resolving skin picking disorder are similar to those for trichotillomania (hair pulling disorder), as these conditions appear to have many neurobiological and behavioral similarities. The approach with the best evidence base is a type of behavioral therapy called habit reversal training (HRT). This treatment can involve several components, including:
- Awareness training, in which the client learns to better understand their skin picking behavior, including triggers and risk factors
- Self-monitoring, in which the individual practices paying attention to their habitual actions and learns to spot when they’re about to start picking
- Competing response training, in which the client develops alternative actions to take in response to the urge to pick skin (for instance, they might squeeze a stress ball or put their hands in their pockets)
- Stimulus control, which involves modifying a person’s environment or routines to reduce the factors that often trigger skin picking.
Evidence suggests that HRT can work even better when paired with therapies designed to address the distressing thoughts and emotions that may push affected individuals toward skin picking. A combination of HRT with cognitive-behavioral therapy (CBT), acceptance and commitment therapy (ACT), or dialectical behavioral therapy (DBT) may be the most effective treatment for skin picking disorder. This approach may be referred to as the Comprehensive Behavioral Model (ComB) for treating body-focused repetitive behaviors.
In addition to these psychological treatments, some studies have shown potential benefits from medications such as selective serotonin reuptake inhibitors (SSRIs). The evidence for medication is weaker than that for psychotherapy, though.
Is skin picking disorder treatable?
Several treatments for skin picking disorder have shown effectiveness in trials and clinical practice. How well these therapies work may vary from client to client, but systematic reviews have found substantial positive effects from most forms of treatment.
Unfortunately, studies also indicate that less than half of people with SPD seek treatment. This may be for a variety of reasons, including embarrassment or the belief that their behavior is “just a bad habit” rather than a serious condition. But for many people, the biggest barrier may be the belief that there’s no effective treatment. This view may result from repeated attempts to address the problem without success.
However, as noted above, several treatment options with substantial evidence from scientific trials are available for SPD. If you’re experiencing difficulty with skin picking, it may be worth talking about it with a qualified mental health provider.
Is skin picking a mental illness?
Most people occasionally squeeze, pinch, or pick at their skin in response to blemishes or pimples. Doing this every so often may not be a sign of any psychological disorder.
But frequent, severe, damaging skin picking may be a sign of SPD, which is also known as excoriation disorder or dermatillomania. The American Psychological Association classifies this as a mental illness related to obsessive-compulsive disorder.
One of the key differences between ordinary and pathological skin picking may be the level of skin damage that results. The presence of noticeable lesions is an important diagnostic criterion for SPD. Other potential consequences include serious emotional distress, low self-esteem, and social isolation.
How long does it take for skin picking to heal?
The speed at which skin heals after being damaged by repetitive picking can depend a great deal on the severity of the damage. A small scratch or popped pimple may heal in a few days to a week. Large sores or wounds can take months to heal and may leave permanent scarring.
In cases of extremely severe dermatillomania, large skin wounds may become seriously infected. These major lesions may not heal properly without medical intervention, and could require treatments such as antibiotics and tissue grafts.
What home remedy will heal skin picking wounds fast?
Some natural substances or easily available products may help small wounds from skin picking heal more quickly and cleanly. Many of these have mild antibacterial and anti-inflammatory properties, including:
Topical application of these substances may also help keep skin wounds moisturized. Some, like aloe vera, could also have a soothing sensory effect. This might reduce the sensory triggers that lead people to pick at both damaged and healthy skin.
You may be able to enhance the effectiveness of these home remedies by combining them with skin care products such as sticky patches covering spots that you’re tempted to pick. Broad application of a gentle, fragrance-free moisturizer could also help, as could commercial anti-inflammatory or antibacterial formulas. It’s often a good idea to consult with a professional dermatologist for additional advice.
What medication is used for skin picking?
There is currently no pharmaceutical medication known to be a first-line treatment for skin picking disorder. That said, some drug therapies have shown potentially positive effects in trials, such as SSRIs.
Other medications have demonstrated helpful effects in trichotillomania (TTM). Since TTM and SPD are obsessive-compulsive disorders with similar features, these medications might also help with skin picking disorder. Candidates include:
- Clomipramine, a tricyclic antidepressant sometimes used in obsessive-compulsive disorder
- N-acetylcysteine, a drug moderating excitatory neurotransmitters that has shown promise for managing impulse control disorder
- Olanzapine, an atypical antipsychotic thought to help with manic behavior
How serious is skin picking disorder?
The severity of skin picking disorder can vary considerably between individuals. Many people with this condition experience significant personal consequences, such as:
- Embarrassment and shame
- Social isolation
- Low self-esteem
- Long-term skin damage
- Impaired romantic life
- Diminished career opportunities
Is skin picking caused by trauma?
Researchers have found some evidence that trauma may play a role in causing skin picking disorder and trichotillomania. Individuals with these conditions were significantly more likely to report traumatic experiences in childhood. Some studies also indicate a greater likelihood of trauma in adulthood as well. People who undergo significant mental strain may form habits like skin picking and hair pulling in an attempt to cope with the severe stress they feel.
Still, the presence of trauma probably can’t fully explain how skin picking disorder develops. Other factors could include genetic inheritance, personality characteristics, and brain structure. For example, some neurological studies have found differences in the cerebellum — part of the brain involved in motor behavior control — between healthy individuals and those with SPD.
Can picking skin cause nerve damage?
Nerve damage is not a typical complication of skin picking disorder. That said, in some cases, the consequences of SPD-related skin injuries can be extreme and unpredictable. Repeated picking may cause wounds to get worse and worse, resulting in large-scale, severely infected lesions.
Neurological consequences are not unheard of in the clinical literature on SPD. Individuals with serious injuries from this condition could be at risk of nerve damage due to inflammation and infection.
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