How do you know if you have excoriation disorder?

Tasneem Abrahams
Mar 28th, 2017

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Find out the severity of your symptoms with this free online test


It is not uncommon for people to subconsciously rub, touch, or scratch at their skin, just as it is a common practice for many people to pick at skin imperfections such as acne or blackheads. However, for some, this practice becomes so consuming that it is classified as a skin picking disorder known as excoriation disorder or dermatillomania.  Picking your skin becomes problematic when the picking is repetitive and it becomes difficult for the person to voluntarily stop engaging in the behaviour, and impacts negatively on daily functioning. This poorly understood problem often goes undiagnosed and therefore untreated.

Signs and symptoms of excoriation disorder

Approximately 75% of people with this disorder are women. It occurs in less than 2% of the population. Skin-picking often begins during adolescence in response to acne or another skin condition. Most people will admit to popping a pimple or picking a scab once in awhile. So do we all have skin picking disorder? Well, no. People with this disorder have tried to stop or reduce their picking behavior, but without success. Moreover, like all mental disorders, skin-picking disorder limits a person's functioning. It may be time-consuming and interferes with a person's social, occupational, or educational activities.

Diagnosis of skin picking as a disorder is based on the criteria outlined in the Diagnostic and Statistical Manual 5 (DSM 5) as follows:

  • Recurrent skin picking resulting in skin lesions
  • Repeated attempts to decrease or stop skin picking
  • The skin picking causes clinically significant distress or impairment in social, occupation, or other important areas of functioning
  • The skin picking is not attributable to the psychological effects of a substance (e.g., cocaine) or another medical condition (e.g., scabies)
  • The skin picking is not better explained by symptoms of another mental disorder (e.g., delusions or tactile hallucinations in a psychotic disorder, attempts to improve a perceived defect or flaw in appearance in body-dysmorphic disorder, stereotypes in stereotypic movement disorder, or intention to harm oneself in non-suicidal self-injury)

There is no definitive pattern of picking as the where, when, and how people pick at skin varies. While the most common area to pick skin is the face, picking can occur anywhere on the body where there is skin. Some other common areas include the back, shoulders, arms, legs and scalp. Some people pick only with their fingers or dig into their skin with their finger nails, while others use their teeth, or tools such as tweezers, pins or any other sharp objects they have access to. If you suspect you may have skin picking disorder, you should visit a health professional and express these concerns. However, awareness about skin picking disorder is still limited, even among the health fraternity. Having some knowledge about the condition and these criteria when you visit your health practitioner is therefore recommended.

Skin picking self-screening test

Here at Skinpick we have developed a self-screening online test designed to help you get a better idea of whether or not you exhibit signs of Dermatillomania and if you do, how severe they are. The questionnaire is adapted from various psychometric tests such as the Hair pulling scale (Massachusetts general hospital), the NIMH Trichotillomania Sympton Severity Scale (NIMH-TSS), and other BFRB scales such as Milwaukee Inventory for the Dimensions of Adult Skin Picking (MIDA) (Walther,Flessner, Conelea and Woods, 2009) and the Skin Picking Scale-Revised (Snorrason, Olafsson, Flessner, Keuthen, Franklin and Woods, 2012).

This questionnaire is not exhaustive and is not meant to replace a comprehensive assessment by a qualified mental health professional. Also, it is important to differentiate between Dermatillomania, which is a psychological condition, to medical conditions. Consult a doctor for medical examination if you are uncertain.

Click here to take a test

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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