A Primer on Compulsive Skin Picking

by Trudi Griffin - LPC

04 Aug, 2019

While most people pick at their skin occasionally, there are others who cannot stop picking. For those who feel compelled to pick at their skin recurrently to the point of injury, they likely suffer from excoriation disorder. Also known as dermatillomania or skin picking disorder, it is a body-focused repetitive behavior where a person rubs, scratches, picks, or digs into the skin to the point of injury. Below is some basic information about the disorder.

Symptoms, Causes, and Treatments

Symptoms of disordered picking behavior include:

• Spending long periods of time picking at healthy or blemished skin anywhere on the body.
• Picking behaviors result in skin damage.
• Repeated attempts to stop picking fail.
• Creates considerable distress and impairment in daily life.

Causes of dermatillomania are largely unknown, however, there are some theories. There is some research indicating that skin picking disorders and body-focused repetitive behaviors run in families suggesting a genetic component. Other evidence links the disorder to hormone changes since the typical age of onset coincides with puberty. Another theory suggests that skin picking results from an impaired stress response or impulse control dysfunction. Other research shows differences in brain connectivity and neurotransmitters in people with skin picking disorder.

There are other correlates, or associations often found with skin picking disorder. Correlates are not causes, rather they are conditions that occur in people with skin picking disorder which only suggests a link worth considering. Such correlates include obsessive-compulsive disorder, anxiety, depression, impulsivity, hormone changes, thyroid issues, stress, and physical skin conditions.   

Treatment for skin picking disorder involves comprehensive physical and mental health care as well as social support.

Physical care

• Taking care of the body internally and externally to ensure optimal skin health.
• Caring for damaged skin to reduce infections and promote healing.
• Learning physiological self-awareness.
• Managing stress.
• Consideration of medications that may worsen behaviors as well as those that may reduce behaviors.

Mental health care

• Psychotherapeutic interventions that demonstrate success for people with skin picking disorder include cognitive-behavioral therapy, acceptance and commitment therapy, habit reversal training, and comprehensive behavioral therapy.
• Caring for other mental health issues such as self-esteem, stress management, anxiety, depression, trauma, or social challenges can reduce the urge to pick.
• Practicing self-care.

Social care

• Connection with positive others for validation and support.
• Join support groups in person or online.
• Learn from others.
• Help others.

Skin Picking as a Compulsive Disorder

Compulsive skin picking is closely related to several other disorders and often misdiagnosed. Further, compulsive skin picking can co-occur with other body-focused repetitive behaviors (BFRBs). BFRBs are disorders in which people focus on an area of the body and cause harm to themselves or to their physical appearance. Compulsive hair pulling (trichotillomania), severe and obsessive nail-biting, and repetitive biting of the inside of the cheeks are all BFRBs as well. BFRBs are themselves closely related to OCD and health care providers often categorize them as symptoms of OCD. However, most researchers make a clear distinction between the two, although they agree they are related. Compulsive skin picking is classified independently in the DSM-5, in the category of "OCD and related disorders" under the official name Excoriation Disorder.

Relationship Between Compulsive Skin Picking and OCD

Although there is a close relationship between compulsive skin picking and obsessive-compulsive disorder, there are distinct differences. OCD is a primarily cognitive disorder, with a person’s behavior driven by obsessive thoughts. Any resulting compulsive behavior, then, serves to relieve the obsession. Therefore, it is possible for someone with OCD to have obsessive thoughts about skin blemishes and compulsively pick as a way to do something about the obsession. However, upon picking, the obsession is not satisfied. Compulsive skin picking disorder is a bit different in that the compulsion focuses on the behavior. A person feels the urge to pick, and once completed, feels relief or satisfaction.

Another difference between the two disorders is when they start and what treatments work. Compulsive skin picking usually starts in early adolescence coinciding with puberty whereas OCD starts much later in adolescence. Then, treatment for OCD uses exposure and responses prevention to diminish the power of the obsessive thoughts that drive the compulsive behaviors. Again, because it is a cognitive-focused disorder, SSRI medications tend to be effective. On the other hand, compulsive skin picking treatment focuses on changing the behavior with habit reversal therapy and SSRIs tend not to be very effective.

Compulsive Skin Picking

If you are suffering from compulsive skin picking, be aware that it can be a serious disorder and not just a bad habit. Consult a qualified health care professional for a thorough assessment to determine what treatment methods will work for you. Compulsive disorders are very hard to treat without the help of experts, but it is possible.

For more information about Dermatillomania causes and treatment, get the Complete Guide to Picking Disorders today.

About the author

Trudi Griffin - LPC

Education, experience, and compassion for people informs Trudi's research and writing about mental health. She holds a Master of Science degree in Clinical Mental Health Counseling: Addictions and Mental Health from Marquette University, with Bachelor’s degrees in Communications and Psychology from the University of Wisconsin Green Bay. Before committing to full-time research and writing, she practiced as a Licensed Professional Counselor providing therapy to people of all ages who struggled with addictions, mental health problems, and trauma recovery in community health settings and private practice.