An official diagnosis of dermatillomania (also called skin picking or excoriation disorder) should be completed by a qualified healthcare professional. Keep in mind that although awareness of body-focused repetitive behaviors (BFRBs) increased in recent years, there are still many healthcare providers who are not trained to differentiate BFRBs from related disorders. However, preliminary self-diagnosis can be helpful for determining next steps.
First, it is important to understand that skin picking is not a problem because occasionally removing flaky skin or old scabs is normal. It only becomes a problem when a person finds it difficult to stop and the picking causes wounds. Therefore, it is useful to look at different skin disorders and their symptoms. Second, there are official diagnostic criteria specified in DSM5. Third, a person can use an online questionnaire as a means of self-diagnosis. Then, confirm the diagnosis with a physician, dermatologist, psychiatrist, or qualified mental health provider.
The simplest description of dermatillomania is as an urge to pick at the skin. But the behavior patterns and sometimes the underlying motives for the behaviors, vary depending on the area of focused picking.
Regardless of where the skin picking occurs on the body when it becomes excessive and causes injury, it is often a sign of disorder and may require professional assistance.
The DSM-5 is the manual for the classification of mental disorders used by mental health providers, psychiatrists, and some doctors. Doctors also use the ICD-10 classification system. However, for the purposes of determining whether skin picking meets the diagnostic criteria for a disorder, SkinPick.com and its therapists use the DSM-5.
There are 4 criteria for a clinical mental health diagnosis of compulsive skin picking:
Self-diagnosis is challenging because our perception of ourselves and our behavior may not be accurate. For example, some people inflate symptoms as worse than they really or on the other end of the spectrum, ignore them. However, self-diagnosis, such as through our online dermatillomania test, can help someone realize if they have a problem. Keep in mind not all online questionnaires are based on research. Before taking one, determine whether the test is valid. For example, our online test is adapted from several evidence-based tests validated by research. Based on the results of an online questionnaire, a person can decide to see a qualified health provider for a thorough assessment.
Online Test for Skin Picking
Find out the severity of your symptoms with this free online test
In anticipation of discussing skin picking with a doctor, there are several things to consider. A primary care physician or a dermatologist can inspect wounds for infections and evaluate any old scars that did heal. However, some physicians are not well-informed about compulsive skin picking. There are some dermatologists who specialize in psychodermatology and often have a better understanding of the complications related to compulsive skin picking. Either way, a medical provider needs to know that the wounds result from compulsive skin picking so they can treat the wounds and provide information about how to care for the skin even if picking continues.
While it's important to talk to a medical professional who can take care of physical wounds, a behavioral health professional (psychiatrist/psychologist/therapist) can address the mental and emotional aspects of the disorder and how those relate to behaviors. This blog post gives some recommendations for finding the right therapist. Also, skin picking often comes with other mental illnesses, such as obsessive-compulsive disorder, body dysmorphic disorder, anxiety, depression, and substance abuse. After a comprehensive assessment, a therapist will work out a treatment plan to help the person change the undesirable behavior. Cognitive-behavioral therapy (CBT), with an emphasis on habit reversal training, is considered the most effective therapy for this disorder.
It is important to note that sometimes even doctors can underestimate the severity of skin picking. If they suggest to “just stop doing it”, do not be discouraged, but look for a professional who has experience working with excoriation disorder.