What's in a Name: Understanding Skin Picking Disorder

Let’s be honest. Names carry power. They shape how we understand the things they describe, how we talk about them, and even how we perceive ourselves in relation to them. Perhaps nowhere is this more evident than in the realm of mental health. The terminology used to describe conditions or disorders can sometimes either validate one’s experience or perpetuate a stigma or misconception.

Skin picking is one of those disorders. It’s been described in a number of ways over time, each carrying its own history and meanings. 

Clinically Speaking

It might surprise you to know that skin picking disorder”, while it sounds quite official, is actually not a clinical term. In fact, it’s a lay term commonly used to refer to a clinically recognized mental health disorder known as Excoriation Disorder. If that’s not complicated enough, Excoriation Disorder is also widely known by an even older clinical name, Dermatillomania. Just how did “mania” become attached to a disorder that involves skin? You have to look way back at its roots.

As many medical terms are, dermatillomania is derived from Greek and Latin terms:

• Derma, meaning “skin” 
• Tillo, meaning “pull” or “pluck” 
• Mania, meaning “madness” 

While history is rich with instances of what would now be considered skin picking, it wasn’t until the late 1800’s that skin picking became recognized clinically with the introduction of the term neurotic excoriation. Using this terminology positioned skin picking within the medical model as a form of compulsive disorder. Still, for decades, skin picking remained unrecognized as a distinct disorder, most often being considered an "impulse control disorder not otherwise specified" or a symptom of another condition. 

Dermatillomania remained the clinical term used in medical literature until 2013 when Excoriation Disorder became a recognized psychiatric disorder. In that year, the American Psychiatric Association officially recognized skin picking as Excoriation Disorder with the release of the DSM-5. It was placed in the category of Obsessive-Compulsive and Related Disorders, alongside other body-focused repetitive behaviors such as trichotillomania (hair pulling). Still, the term dermatillomania remains in use as well.   

The Weight of Words

So why the shift from dermatillomania to excoriation disorder? A primary consideration was the need to more precisely describe and categorize the disorder. The word excoriation is derived from the Latin excoriare and means "act or process of abrading, removal of the outer layers of the skin”. 

The change in terminology also reflects a broader understanding of how language can impact someone living with the disorder. The suffix -mania has historically carried negative connotations, suggesting wild, uncontrolled behavior or even madness. In the not so distant past, people thought to be “mad” were treated poorly and even ostracized from their families and communities. Even today, the term “mania” can carry a stigma, leaving some people living with skin picking feeling isolated and invalidated. 

While the more common term "skin picking" offers a less clinical way of referring to the disorder, it too carries its own risk for misunderstanding. To someone not familiar with the disorder, it can sound more like a bad habit or even a dermatological issue rather than the complex psychological disorder that it is. 

Progress Not Perfection

Describing skin picking has come a long way but naming something is never perfect and skin picking is no exception. Each name for this condition carries its own misconceptions. For example:

• Dermatillomania might evoke ideas of “madness” or someone who as lost control, reinforcing stereotypes about mental illness. 
• Skin picking may be dismissed as more of a bad habit, a lack of willpower, vanity, or even poor self-care rather than a legitimate mental health condition.  
• Excoriation Disorder, the current clinical term for skin picking, removes the reference to “mania” but focuses on the skin damage. It doesn’t fully reflect the scope of skin picking and the significant emotional struggles that perpetuate the cycle of picking. 

So, is there a right or wrong term to use? Not really. The fact is, while Excoriation Disorder is the recognized clinical term, skin picking and dermatillomania are still commonly used in many parts of the world. 

That’s why SkinPick continues to use the term dermatillomania along with skin picking and excoriation given the changes in clinical terminology. Over the years, our readers have become familiar with the term and it’s still very much in use in many parts of the world. We strive to make sure someone can easily find information about skin picking regardless of which term they choose to use. 

The Takeaway

Will the name change again? Maybe. Science continues to reveal new information about skin picking and may lead to better ways of describing it. What’s important is to remember that behind every term are people with their own experiences deserving of empath and understanding. 

In the meantime, if you're living with skin picking, you can use the terms that feel right for you when talking about your experience. Remember, what matters most isn’t the term you use but finding the language that helps you feel heard and understood rather than judged. 

Regardless of the term you use, if you’re living with skin picking, help is available. SkinPick has a team of experienced therapists who understand this disorder and can help you get on the path to healing. And online therapy means you can see your therapist on your schedule. When you’re ready, SkinPick is here to help. 

References

1. Dermatillomania | Description, causes, symptoms, & treatment | Britannica. (2023, October 11). Retrieved from https://www.britannica.com/science/dermatillomania 

2. Grant, J. E., Odlaug, B. L., Chamberlain, S. R., Keuthen, N. J., Lochner, C., & Stein, D. J. (2012). Skin Picking Disorder. Retrieved from https://psychiatryonline.org/doi/10.1176/appi.ajp.2012.12040508

3. Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.28, Excoriation (Skin Picking) Disorder. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t28/

4. Excoriation. (n.d.). Retrieved from https://www.etymonline.com/search?q=excoriation