What Is Skin Picking Disorder?

Updated August 28, 2020

Medically Reviewed By: Laura Angers

Skin picking disorder is a severe mental health concern that can be chronic, very distressing, and damage a person’s self-esteem. In this article, you will learn about skin picking disorder, or excoriation disorder, and its symptoms, how it affects those with the condition, and how people can find help for it.

What Is Skin Picking Disorder?

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Skin picking disorder, which is formally known as excoriation disorder or dermatillomania, are all synonyms for a psychiatric condition that 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. [1]

However, the main issue with excoriation disorder is how much it can disrupt a person’s daily life, and how it affects their appearance and their self-esteem. People with this disorder might find normal skin to pick at, or they might find some minor flaws, and potentially spend hours each day picking at it.

A harmless pimple, a piece of loose skin around the fingernails, or a scab that formed around a wound can develop into skin lesions and scars. Nonetheless, it doesn’t just end when these things are “addressed” – those with excoriation disorder can continue to pick at their skin and create more sores that weren’t there before.

Additionally, some people with skin picking disorder might scratch at their skin to remove an imperfection that only they believe is there, but there might actually be nothing there at all, at least initially. [2]

Excoriation disorder belongs to a category of mental health conditions in the DSM-5 (Diagnostics and Statistical Manual 5th edition) by the American Psychiatric Association known as Obsessive-Compulsive & Related Disorders. [3]

It doesn’t mean that all people with skin picking disorder have obsessive-compulsive disorder (OCD), but they do often coexist with each other and have some similarities.

Skin picking is also known as something called a body-focused repetitive behavior (BFRD), which can include other problems such as nail-biting disorder (onychophagia) or hair-pulling disorder (trichotillomania).

Like OCD, many of these BFRDs often exist alongside excoriation disorder, and it’s estimated that up to 38 percent of individuals that pick their skin will also have problems with hair-pulling. In hair-pulling disorder, or trichotillomania, people will repetitively pull hair from their scalp, eyebrows, or eyelashes, which can cause significant hair loss, and then feelings of shame or embarrassment.

Excoriation disorder can occur at any age, but it typically begins during a person’s adolescent years, and it’s estimated that anywhere from 1 to 5 percent of the population can be affected by it. Out of everyone with a skin picking disorder, 75 percent of them are female. [1] [3]

Although many of the indicators of excoriation disorder, or skin-picking have been discussed already, the next section will cover the signs and symptoms of it and how medical professionals diagnose it.

Skin Picking/Excoriation Disorder Diagnostic Criteria

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Compared to many other mental disorders in the Diagnostic and Statistical Manual, the details on how skin picking disorder is diagnosed is very straightforward with a handful of things to look out for. Excoriation, or skin picking disorder, is also a new addition to the DSM-5, and in previous editions, it didn’t have its own listing. Here it can currently be found in the Obsessive-Compulsive and Related Disorders family.

Similarly, it didn’t have a listing in the International Classification of Diseases (ICD) by the World Health Organization (WHO), until the 10th edition, and it was also listed as factitial dermatitis, and in 2018, with the ICD-11, excoriation disorder has been listed under body-focused repetitive behaviors, which can be found under the Obsessive-Compulsive and Related Disorders parent category. [4]

These are two of the primary ways that medical professions will diagnose all mental health conditions, including excoriation disorder, and both share very similar criteria when diagnosing skin picking disorder. Here are the diagnostic criteria for excoriation disorder as listed in the DSM-5: [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 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 disorder (e.g., misconceptions or hallucinations in a psychotic condition, efforts to enhance a perceived impairment or flaw in body dysmorphic disorder, an intent to hurt oneself although not suicidal, or stereotypies in stereotypic movement disorder).

Therefore, to receive an accurate diagnosis for excoriation disorder, other conditions must be ruled out first as other substances and conditions can cause someone to pick at their skin.

However, for those who truly have excoriation disorder, as opposed to having skin-picking due to the effects of a substance or another mental health issue, the causes of the condition aren’t as clear, unfortunately. Nonetheless, some of the possible causes of excoriation disorder will be covered in the next section.

Why Do People Pick At Their Skin?

Like many mental health issues that exist, the specific cause of excoriation disorder is unknown. However, genetics can be 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. [1]

On the other hand, external factors can also 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 leads to itching and irritation, and then it can cause the individual to continue to pick at it, leading to a larger and more unsightly wound than before. [2]

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

Similar to other body-focused repetitive behaviors, like hair-pulling disorder, skin picking doesn’t always have to be a conscious decision, and it can also happen automatically without much thought from the individual. Unfortunately, this can lead to negative consequences before they even realize 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.

It can cause people to feel embarrassed and shameful, have low-self esteem, and it can eventually develop into depression and other mood disorders.

Because of this, people with excoriation disorder may avoid socializing and going out to public places where people can notice them, such as shopping centers, gyms, beaches, and countless other locations. This can make life feel limited for those who suffer from 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, 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. [3]

In addition to these emotional and mental health concerns that 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 crucial that people seek out help as soon as possible since the skin-picking disorder is usually chronic if left untreated.

Treatment For Skin Picking Disorder

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Treatment protocols for skin picking disorder usually involve a combination of therapy and medication.

One form of psychotherapy called cognitive-behavioral therapy (CBT) can especially be useful because it involves changing a person’s thoughts so they can avoid skin-picking behaviors. [1] This can mean addressing a person’s feelings and emotions that compel them to pick at their skin, and it can also give them new ways of coping so that they have less of an urge to pick.

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

Finding a therapist who can make you aware of these feelings and how you respond to them is easy, and at BetterHelp you can connect to licensed professionals online who specialize in helping people overcome body-focused repetitive behaviors, like skin-picking, obsessive-compulsive disorder, anxiety and depression, and many of the other issues that come along with these conditions.

Online therapy is also convenient and affordable, and it can be ideal for those who don’t quite feel comfortable with in-person sessions due to their skin lesions. All sessions are discrete and safe and are dedicated to helping you get better.

In some cases, medication can also be helpful or necessary, and it can help reduce anxiety and the urge to skin pick. Always consult with your doctor or a psychiatrist to see if a prescription is right for you. They may also be able to help you find relief for scarring, discoloration, or other cosmetic concerns that typically come with excoriation disorder.

Conclusion

With the right help, excoriation disorder, or skin-picking can be overcome. You can live your life to the fullest without the need to pick at your skin, and for many people, this can feel like a brand new experience. Hopefully, this article has given you a better understanding of what skin picking disorder is and how it can be beaten so that you or someone that you care for can get the help that is needed to start feeling better both emotionally and on the surface.

References

  1. Mental Health America. (2020). Excoriation Disorder (Skin Picking or Dermatillomania). Retrieved from https://www.mhanational.org/conditions/excoriation-disorder-skin-picking-or-dermatillomania
  2. Bhandari, S. (2020, February 18). Skin Picking Disorder (Excoriation): Symptoms, Treatment, and Causes. Retrieved from https://www.webmd.com/mental-health/skin-picking-disorder#1
  3. The TLC Foundation for Body-Focused Repetitive Behaviors. (2020). What is Excoriation (Skin Picking) Disorder? Retrieved from https://www.bfrb.org/learn-about-bfrbs/skin-picking-disorder
  4. OCD UK. (2018, July 3). Clinical Classification of Excoriation Disorder (skin picking disorder). Retrieved from https://www.ocduk.org/related-disorders/skin-picking/clinical-classification-of-skin-picking/
  5. Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.28, Excoriation (Skin Picking) Disorder. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t28/

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