Is Skin Picking just a Bad Habit?

Tasneem Abrahams
Jan 21st, 2015

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Picking or popping at pimples or peeling dead skin cells are not uncommon habits. Most people have engaged in some form of skin picking behaviors at one time or another in their lives. However, for some the frequency and consistency of the behavior is concerning and these individuals start to question whether there is more to their actions than simply a bad habit.

What is a habit?

To answer this question, first one needs to establish what a habit actually is. According to the Oxford English Dictionary, a habit is "a settled or regular tendency or practice, especially one that is hard to give up", and in psychological terms it is "an automatic reaction to a specific situation". Habits do not magically appear, at one point the behavior or reaction was new, but with repetition and positive reinforcement the behavior becomes more automatic. Compulsive skin picking also does not have a sudden onset, and many people with skin picking disorder would be able to relate to the definition of a habit as an apt description of their experience with skin picking.

From habit to disorder

From this definition one could conclude that as a behavior, regular skin picking can be classified as a bad habit. However there is a definitive point when the habit evolves into a disorder. The most recent version of the American Psychiatric Association Diagnostic and Statisitical Manual (DSM5)  includes skin picking or excoriation disorder as well as trichotillomania as a recognized clinical condition under the category Obsessive Compulsive and Related Disorders (OCRD). In the DSM5 specific criteria are outlined for the diagnosis of skin picking as a clinical disorder.

These criteria include:

  • 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)

Bad habits are so classified because the behavior is undesirable or not good for your overall health, but when the impact of the habit causes significant dysfunction and hinders daily function, that is when one needs to consider the presence of a clinical disorder. The diagnostic criteria also clearly describes the inability to reduce os stop the behavior. Some might argue that all bad habits are difficult to stop, but the combination of this with functional impairment and emotional distress is what separates habit from disorder.

Diagnosis is key

If you are feeling overwhelmed by your skin picking habit and are concerned you may have a skin picking disorder it is recommended that you seek a professional diagnosis. The lack of awareness of skin picking disorder means that it is one of the highly undiagnosed, and therefore untreated conditions, with many people sufferring in silence and alone. Fortunately awareness raising efforts by organizations like the Trichotillomania Learning Centre  (TLC) and the Canadian BFRB Support Network (CBSN), have been highly successful in recent time leading to increased research and development of treatment techniques. It may be that your doctor is not knowledgable about skin picking disorder, but will be familiar with the DSM5 and will be able to apply their medical expertise to determine a diagnosis based on the criteria outlined. Diagnosis is key as it gives you a clear direction and focus in finding solutions to manage your picking habit.



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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