Excoriation disorder- widely experienced, little known

Tasneem Abrahams
Jan 26th, 2017

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Excoriation disorder is also known as dermatillomania, skin picking disorder, neurotic excoriation, acne excoriate, compulsive skin picking or psychogenic excoriation. It is a mental disorder characterized by the urge to pick at one’s own skin, often to the extent that damage is caused. In the event that you live with this challenging condition, you know precisely the sort of crude, painful and difficult toll it takes – both physically and emotionally. A skin picking episode may be a conscious response to anxiety or depression, but is frequently done as an unconscious habit. Those who live with dermatillomania know that the negative effects extend far beyond the physical. Approximately 75% of people with this disorder are women. It occurs in less than two percent of the population. Skin picking often begins during adolescence in response to acne or other skin condition.

Why do you pick?

People who pick their skin sometimes do it subconsciously, medical doctors found that the clear liquid that comes out after squeezing out all of the blood and pus actually releases endorphins, which is why skin picking often makes individuals feel better. And that's also why, for some, it is highly addictive. The skin picking is frequently accompanied by a feeling of relief or even delight because of the diminishment in tension levels. However, once the harm has been done, those affected will frequently be left with a sentiment sorrow or sadness. In spite of the fact that the harm that is brought on can be extremely serious, the compulsion is just too strong for the person to resist.

Self-esteem issues arise or are exasperated by this disorder because suffers often feel alone, can’t control our urges, and blame themselves; it also prevents them from feeling accepted, makes them feel judged (if the truth came out), not understood. The stigma of the disorder and the judgments concerning the marks on the faces/ bodies are what drive most suffers to further feelings of isolation and self-loathing.

Excoriation symptoms

  • Marks or scabs on the face
  • Attempts to cover or hide up both the act and resulting marks or scabs
  • Blemish, scabs, infection and tissue damage
  • Guilt shame and embarrassment
  • Significant distress or impairment in functioning

How to let go of the cycle

There are various options that one can opt for to try and let go of the cycle of picking their skin. Treatment options for skin picking such as Habit Reversal Training (HRT), this common treatment for excessive skin picking is a form of Cognitive Behavioural Therapy. The therapist will work with you to identify the emotional and environmental triggers for your urge to pick, and teach you strategies for coping with skin picking disorder. The goal is to learn to manage urges in a healthy way rather than pick on your skin.

The second type of treatment is Stimulus Control (SC), this type of therapy helps you find ways to alter your physical environment so you’re less likely to pick. And finally the last treatment option is Medication. Some therapists may recommend medication as part of a treatment strategy. To date, no drug has been FDA-approved specifically for the treatment of CSP. However, selective serotonin reuptake inhibitors (SSRI) medications, such as Paxil and Zoloft, have been found to be effective for some people

Usually treatment options take time to work mainly because treatment options offered are process treatments which means that they do not work immediately. For some individuals, treatment may start working after weeks, while for some the treatment might not work at all. It is important to note that different things work for different people which is why it is important to find things and follow patterns that work for you as an individual.

Skin picking disorder myths:

  • Skin pickers can just stop anytime
  • All skin pickers have an underlining skin disorder causing the urge to pick
  • Picking at your skin is the same as cutting everyone pops some zits… does this mean everyone has skin picking disorder to some extent?
  • Skin pickers see things on or under their skin that isn’t there, they are experiencing a psychosis.
  • Picking at your skin is just a bad habit
  • Skin picking isn’t a serious issue, its superficial because it only hurts someone’s appearance

These assumptions have a negative impact on the chances of someone who picks their skin from seeking help and that is why today the condition is still not very well known despite its's prevalance.


Tasneem Abrahams

Tasneem is an Occupational Therapist, and a graduate of the TLC foundation for BFRBs professional training institute. Her experience in mental health includes working at Lentegeur Psychiatric hospital forensic unit (South Africa), Kingston Community Adult Learning Disability team (UK), Clinical Specialist for the Oasis Project Spelthorne Community Mental Health team (UK). Tasneem is a member of both the editorial team and the clinical staff on Skinpick, providing online therapy for people who suffer from excoriation (skin picking) disorder.

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