Finding Psychological Meaning in Skin Picking Symptoms

Dr. Dawn Ferrara
Apr 26th, 2021

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In a recent webinar, Dr. Vladimir Miletic delved into the psychological meaning of dermatillomania or skin picking symptoms.

Skin picking is a common behavior but is more than just picking. It is a behavior that holds tremendous meaning for those who pick.  Each person has a unique set of reasons and meanings attached to their picking. While there is no universal meaning behind picking, there are some general psychological themes that emerge. To understand the meaning picking holds for someone, you have to understand the picking behavior. Using a framework for seeking meaning and a case study, Dr. Miletic takes a closer look at the meaning that skin picking holds.

What is Dermatillomania?

Dermatillomania, also known as excoriation disorder or skin picking, is the repeated urge to pick one’s skin. This picking causes physical injury and psychological damage. For some who pick, their urge is preceded by a sense of mounting tension which culminates with the urge to pick. Picking then brings a sense of release. Along with that sense of release often comes a complex interplay of feelings of guilt and shame, sometimes even a sense of gratification.

Skin picking is classified as an obsessive-compulsive and related disorder in the DSM5. The picking causes significant emotional distress and impairment.

What causes someone to pick is not always clear. It has been linked to parenting styles, trauma, and other intense emotional experiences as well as to biological and neurological factors. Dr. Miletic notes that there are a lot of case studies, anecdotes and some theories, but research hasn’t really pinpointed a clear “why”.

Understanding Psychological Meaning

Meaning is central to the human experience. Our experiences and the meaning we assign to them shape who we are. Freud was among the first to explore meaning with his patients. At first, dreams seem random or meaningless. Using free association, he was often able to help his patients identify elements of the dream and what they represented. The meaning of the dream would come into focus. While not every school of psychology uses that approach, most have some sort of theory of symbolism and meaning. Over time, these experiences accumulate and become part of the way we operate in the world.

So when it comes to symptoms of skin picking, they are experiences. They have meaning too. How do we find that meaning? Again, we turn to George Kelly’s personal construct theory.  Dr. Kelly believed that every person is a scientist and is constantly gathering information and evaluating their world, acting in ways based on what they experience. We create meaning by testing our assumptions about the world and about ourselves. Assumptions that work form our experience and we use those as guides for action. Sometimes, we aren’t good scientists. Symptoms arise when we can’t or won’t change even when our choices are not helpful. Sometimes the cost of change is emotionally too high and symptoms emerge.

Symptoms are also a form of communication. Skin picking may communicate feelings or needs in a way that feels safer than verbal expression. Some people may pick in an effort to correct some perceived flaw. Others may pick as a way to resist or rebel. Sometimes picking is the way of releasing emotion in a way that feels safe. Symptoms can tell you a lot if you know what to look for.

Excavating Meaning

Kelly said that his theory of personality was borne from two simple concepts, “first, that man might be better understood if he were viewed in the perspective of the centuries rather than in the flicker of passing moments; and second, that each man contemplates in his own personal way the stream of events upon which he finds himself so swiftly born perhaps within this interplay of the durable and the ephemeral we may discover ever more hopeful ways in which the individual man can restructure his life.” So, we have experienced over time that we interpret. How we interpret those experiences, what meaning we assign to them, determine how we respond.

In this context, we have to look beyond single instances. These single points of time won’t tell you much. Instead, when searching for meaning, we have to look at the larger context over time. Where have you been? What have you experienced?

Applying this approach to skin picking symptoms, Dr. Miletic offers a framework for moving past surface symptoms and digging for the deeper psychological meaning behind them. Each piece provides clues about meaning.

  • Explore the past – Think about your past picking behavior and how it emerged. There are many questions you could ask. A few examples might be: When did you start picking? How did you start to pick? Where were you? How did you feel? What was happening in your life at that time?
  • Explore the present – What’s happening now? Why are you seeking help now?
  • Explore the moment-to-moment experience – Think about the experience of picking. How do you experience urges? Do they come on suddenly? Are they fleeting? What sensations do you experience? What is the general theme of your thoughts when you experience these urges? It’s those recurrent themes and experiences that can hold clues to meaning. One way to focus on the now is to use focus on that feeling. Dr. Miletic describes using focus and mindfulness as a way to get in touch with those moment-to-moment experiences.
  • Explore solutions – As you gather information, themes emerge and the pieces begin to come together. You can begin to explore solutions that work for you.
  • Exploring resistance – Dr. Miletic acknowledges that resistance is part of the process. At a given moment, you may choose to keep the symptom picking instead of using one of your coping strategies. Resistance is an indicator that picking at that moment holds great meaning for you. Dr. Miletic describes this resistance as a learning opportunity because it has exposed another layer of picking and a chance to look closely for the meaning it holds. Rather than being “good” or “bad”, resistance is an opportunity for growth.

Dr. Miletic then offers a case study to illustrate the process of finding the psychological meaning of skin picking symptoms.

Taking time to delve into the meaning behind skin picking symptoms can reveal important clues that can help you to find solutions that work for you. When you understand the why, you can then find the how. What can your symptoms tell you?

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Dr. Dawn Ferrara


With over 25 years of clinical practice, Dawn brings experience, education and a passion for educating others about mental health issues to her writing. She holds a Master’s Degree in Marriage and Family Counseling, a Doctorate in Psychology and is a Board-Certified Telemental Health Provider. Practicing as a Licensed Professional Counselor and Licensed Marriage and Family Therapist, Dawn worked with teens and adults, specializing in anxiety disorders, work-life issues, and family therapy. Living in Hurricane Alley, she also has a special interest and training in disaster and critical incident response. She now writes full-time, exclusively in the mental health area, and provides consulting services for other mental health professionals. When she’s not working, you’ll find her in the gym or walking her Black Lab, Riley.

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