What There is to Know About Skin-Picking Disorders

It’s not unusual for people to occasionally pick at their skin, due to stress or a nervous habit. But it can become a disorder when it happens too often or causes significant stress and problems in one’s life. This disorder is called Excoriation or Dermatillomania.

I have not been diagnosed with the disorder. But for years, I have had a habit of picking on my skin, on scabs, on the skin around my fingers. I would get a sore and I’d pick at it. It would start to heal and scab, but I pick on the scab. The cycle can last for months. I CAN’T STOP! I can stop for a few days but I always end up with the scab open again. I get so mad at myself if I pick when it’s almost healed – my mom gets mad at me too – but I can’t control it. I don’t know why I do it either.

What classifies it as a disorder?

The Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) diagnostic criteria include:

  • Recurrent skin picking that results in skin lesions
  • Repeated attempts to stop the behavior
  • The symptoms cause clinically significant distress or impairment
  • The symptoms are not caused by a substance or medical, or dermatological condition
  • The symptoms are not better explained by another psychiatric disorder

You should ask yourself, if it takes up a lot of time in your day, if you have noticeable scars or wounds, if you feel upset after you do it or when you think about how much you pick your skin, if it gets in the way of one or more aspects of your life.[1]

“Comprehensive evaluation and accurate diagnosis is important in determining an appropriate treatment plan.”[2] This is because there are many other disorders where skin picking is a symptom.

How Common is It?

Although many people occasionally pick at their skin, research shows that 2% to 5% of the population severely picks their skin, causing them to develop the disorder. About 75% of them are female.[3]

Causes/Development

Although the exact causes are unknown, both biological and developmental factors can play a part.[4]

A person may develop the disorder by picking at a sore, cut, or other small injury, “which causes more injury to the skin and keeps the wound from healing. More itching leads to more picking.” It can also be developed during a time of stress. Some people “may absently pick at a scab or the skin around your nails and find that the repetitive action helps to relieve stress. It then becomes a habit and more scabbing, and the cycle continues.”[5]

Treatment

More research is needed on treatments. But some research suggests the following treatments:

  • Cognitive behavioural therapy (CBT)
  • Acceptence and Commitment therapy (ACT)
  • SSRI medication[6]
  • Habit reversal training
  • Stimulus control[7]

Effects

When severe enough, skin picking can affect a person emotionally and physically. People who engage in skin picking may experience shame and embarrassment, then may avoid certain activities and may go to great lengths to cover their skin. Some people may even start to get mad of themselves for not being able to control it.[8]

Medical complications, due to the skin picking, is not uncommon. Serious infections or open wounds may require medical treatment. “Skin picking can also lead to strained relationships”[9]

Excoriation/Dermatillomania vs. Self Harm

It can be confusing to understand the difference between excoriation/dermatillomania and self-harm. I still get confused sometimes. Sometimes, I have to stop and ask myself “Am I self-harming?”, especially if it really hurts, but the answer is always no. There are a lot of similarities, but what differentiates them from one another is the intent.

When it comes to excoriation/dermatillomania, the intention isn’t to purposely hurt oneself. “Skin pickers are trying to get rid of an imperfection, like a bump, scab, pimple, blackhead, or even just a part of the skin that doesn’t look ‘right.’” Someone who self-harm has the intention of hurting themselves “to try to feel better, feel something, or escape uncomfortable thoughts and feelings.”[10]

[1]  Bhandari, S. (2016). Skin Picking Disorder (Excoriation). WebMD. Retrieved from http://www.webmd.com/mental-health/skin-picking-disorder

[2] The TLC Foundation for Body-Focused Repetitive Behaviors (n.d.). What is Excoriation (Skin Picking) Disorder?. Retrieved from http://www.bfrb.org/learn-about-bfrbs/skin-picking-disorder

[3] The TLC Foundation for Body-Focused Repetitive Behaviors, n.d.

[4] Fama, J. (2010). Skin Picking Disorder Fact Sheet. International OCD Foundation. Retrieved from https://iocdf.org/wp-content/uploads/2014/10/Skin-Picking-Disorder-Fact-Sheet.pdf

[5] Bhandari, 2016

[6] Fama, 2010

[7] Bhandari, 2016

[8] The TLC Foundation for Body-Focused Repetitive Behaviors, n.d.

[9] Ibid.

[10] Barton, L. (2014). Dermatillomania vs. Self-Harm. Canadian BFRB Support Network. Retrieved from http://www.canadianbfrb.org/2014/08/11/dermatillomania-vs-self-harm/

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