Can My Hormones Make My Skin Picking Worse? Understanding the Connection

Let’s talk about hormones. 

Skin picking disorder, clinically known as excoriation disorder, is a body-focused repetitive behavior (BFRB) that generally emerges in late childhood or adolescence and is more predominant in females. So, it’s not surprising that hormones would be a topic of interest when it comes to understanding skin picking. 

While many factors contribute to the course of skin picking, emerging research and anecdotal evidence suggest that hormonal fluctuations may play a significant role. Hormonal fluctuations are a natural part of the reproductive cycle. For women with skin picking disorder, these hormonal shifts can intensify urges, lower emotional resilience, and complicate recovery efforts.

The Role of Hormones in Mood and Behavior

Hormones are chemical messengers that regulate many functions in the body, including mood, stress levels, and energy. For women, estrogen and progesterone levels naturally fluctuate throughout the menstrual cycle, and these changes can significantly impact mental health and behavior.

Many women with skin picking disorder report that their symptoms get worse in the days leading up to their period. This phase, known as the luteal phase, typically occurs after ovulation and before menstruation. During this time, progesterone increases and then drops, while estrogen levels also dip.

Estrogen is known to influence serotonin, a neurotransmitter that plays a crucial role in mood regulation. When estrogen levels drop, serotonin activity may also decline, potentially leading to increased irritability, anxiety, and depression. These mood shifts can make it harder to resist compulsive urges, including the urge to pick at skin.

Progesterone, on the other hand, has complex effects on the nervous system. Some individuals experience increased anxiety or agitation when progesterone peaks during the luteal phase. For those with skin picking disorder, this heightened emotional sensitivity can translate into more frequent or intense picking episodes.

For a woman with skin picking disorder, this hormonal shift can lead to:

• Mood swings and increased anxiety – Both are well-known triggers for skin picking.
• Increased irritability
• Lowered serotonin - Serotonin is the brain’s “feel-good” chemical. A drop in serotonin can significantly affect mood, and may reduce a person’s ability to cope with stress or resist compulsive behaviors.
• Heightened body awareness -  You may become more preoccupied with small blemishes or perceived imperfections, making you more likely to pick.

Hormonal Conditions That May Impact Skin Picking

Certain hormonal conditions may make skin picking worse too. These can include:

• Polycystic Ovary Syndrome (PCOS) - PCOS can cause acne and hormonal imbalances, both of which may lead to increased skin picking.
• Premenstrual Dysphoric Disorder (PMDD) - PMDD is a severe form of PMS that can cause significant mood swings, irritability, and anxiety. It can also cause skin inflammation that can trigger the urge to pick. 
• Perimenopause and Menopause - Estrogen levels decline during these transitions and sometimes lead to increased anxiety or depression, as well as result in changes in skin texture, sensations, or appearance that could trigger picking.

Stress Hormones and the Picking Cycle

Cortisol, the body’s main stress hormone, plays a key role in the picking cycle. When stress rises, cortisol rises. For many women, stress is both a trigger and a result of skin picking. 

Neurobiological research has found that certain areas of the brain responsible for emotional processing and managing stress may function differently for people with skin picking and other BFRBs and contribute to increased cortisol. The findings suggest that picking may be an attempt to soothe or reduce feelings of distress by calming the automimic nervous system, resulting in feelings of calm and relief.

What You Can Do

While you can’t stop hormonal changes from happening, there are things you can do to manage their effects.

Track Your Cycle 

Keep track of your cycle. Tracking allows you to monitor your cycle and prepare for challenges it may bring. Tracking also gives you insight into how your period may affect your picking over time. 

Take Care of Your Skin

Hormonal acne or sensitivity may increase the urge to pick. Use gentle, non-irritating skincare to reduce the likelihood of triggering a picking episode. 

Practice Mindfulness

Managing anxiety and stress is key. Techniques like deep breathing, meditation, and grounding exercises can help soothe the nervous system and may help you better manage urges to pick. 

Seek Therapy

Cognitive Behavioral Therapy, and a specialized type of CBT known as Habit Reversal Training (HRT) are proven and effective approaches to treating BFRBs like skin picking. Therapy can help you recognize triggers, change habits, and learn healthier coping strategies. 

Medical Support

If you suspect that you may be experiencing hormonal imbalances (like PMDD or PCOS) that are worsening your symptoms, talk to your medical provider. Medication may help regulate mood and reduce the urge to pick. 

The Takeaway

Hormones play a powerful role in how we feel and how we behave. For women living with skin picking disorder, hormonal changes can be deeply impactful and sometimes difficult to manage. It’s important to remember that it’s not your fault and you didn’t do anything wrong. Understanding your cycle and how it affects your urge to pick can help you be kinder to yourself and help you manage your symptoms more effectively. 

The good news is you don’t have to manage this situation alone. A therapist skilled in treating skin picking can help you explore your experience and help you decide next steps. At Skinpick.com, we have a team of experienced therapists who understand the complexities of skin picking and can guide you towards healing.  And online therapy makes getting help comfortable and convenient. When you’re ready, there is help and hope waiting for you. 

References

1. Handy, A. B., Greenfield, S. F., Yonkers, K. A., & Payne, L. A. (2022). Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review. Harvard review of psychiatry, 30(2), 100–117. https://pmc.ncbi.nlm.nih.gov/articles/PMC8906247/#sec49

2. https://www.reddit.com/r/CompulsiveSkinPicking/comments/yysor5/to_period_havers_have_any_of_you_noticed_yourself/

3. Handy, A. B., Greenfield, S. F., Yonkers, K. A., & Payne, L. A. (2022). Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review. Harvard review of psychiatry, 30(2), 100–117. https://pmc.ncbi.nlm.nih.gov/articles/PMC8906247/#abstract1

4. https://www.reddit.com/r/Dermatillomania/comments/qlnd2b/picking_worse_near_menstruation/

5. Ellis, R. R. (2024, May 13). What is the luteal phase? WebMD. https://www.webmd.com/women/luteal-phase

6. https://www.reddit.com/r/CompulsiveSkinPicking/comments/b4x4no/does_anyone_else_find_they_pick_more_just_before/

7. Grant, J. E., & Chamberlain, S. R. (2018). Salivary sex hormones in adolescent females with trichotillomania. Psychiatry research, 265, 221–223. https://pmc.ncbi.nlm.nih.gov/articles/PMC5985958/#bib0015

8. Study finds serotonin transport in the brain increases in women with premenstrual dysphoric disorder. (2023, January 30). Medical Express. https://medicalxpress.com/news/2023-01-serotonin-brain-women-premenstrual-dysphoric.amp

9. Carr-Nangle, R. E., Johnson, W. G., Bergeron, K. C., & Nangle, D. W. (1994). Body image changes over the menstrual cycle in normal women. The International journal of eating disorders, 16(3), 267–273. https://pubmed.ncbi.nlm.nih.gov/7833960/

10. Polycystic ovarian syndrome and the skin. (2021, April 29). Harvard Health. https://www.health.harvard.edu/blog/polycystic-ovarian-syndrome-and-the-skin-202104292552

11. Premenstrual dysphoric disorder (PMDD). (n.d.). Stanford Medicine Children's Health. https://www.stanfordchildrens.org/en/topic/default?id=premenstrual-dysphoric-disorder-pmdd-85-P00580