Acne

Excoriation Disorder: The Truth Behind Skin Picking Compulsions

Everyone picks at their skin. You may spend more time than you’d like to admit in front of the mirror squeezing blackheads. When you’re bored, you might pick at the skin around your fingernails or scratch your scalp. You may even go overboard sometimes — popping or picking at a pesky pimple, scratching off a scab, or pulling off dead skin. The experience may be oddly satisfying, but usually ends with sore skin or a little blood — and you wishing that you’d just left it alone. The question is: is this normal grooming behavior, or a diagnosable compulsion?

With skin picking, there can come a point when it’s not just a bad habit, it’s an actual, diagnosable mental illness. It’s called excoriation disorder, but you may also hear it referred to as dermatillomania, or chronic skin picking. Excoriation is a serious, behavioral disorder that is estimated to impact around 5% of the population, although the actual percentage is unknown because many people with the disorder are hesitant — or don’t know — to seek help.

What is excoriation disorder?

Excoriation disorder is officially classified as a “Body-Focused Repetitive Behavior” (BFRB) in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). A similar disorder, called trichotillomania, or hair pulling disorder, has the same classification. In fact, many patients with excoriation disorder also have trichotillomania. Both are classified in the group of obsessive-compulsive related disorders.

People with excoriation disorder become fixated on real or perceived imperfections on their skin. This leads them to pick, scratch, and rub their skin — sometimes to the point of bleeding. Skin infections and permanent scars are common side effects, and some people experience skin lesions and tissue damage. For those with excoriation disorder, the face is most frequently where they pick, but people also pick at their arms, legs, scalp, lips, and the skin around their fingernails. Some spend hours a day picking at their skin.

What causes skin picking disorder?

This is complex. There’s research that shows that skin picking is linked to genetic predispositions, but environmental factors — like temperament, environment, family situations — also play a role.

Some experts believe it’s a maladaptive way (an adaptive behavior that is actually harmful as opposed to helpful) that people cope with emotional stress. Skin picking becomes a way to deal with anxiety, obsessive thoughts, avoidance, or even boredom.

The onset of the illness can occur at any age, but typically coincides with adolescent acne. People with eczema, psoriasis, and other skin conditions may be susceptible to excessive skin picking. It’s also more common in women than in men.

How is excoriation disorder diagnosed?

To be diagnosed with excoriation disorder, a person’s picking behavior is both impulsive and persistent, and results in damage to the skin. People with this disorder feel like they can’t stop the behavior no matter how hard they try — many have made several, unsuccessful attempts. Exclusionary criteria include other mental health issues, drug use, and the use of certain medications, which may cause skin picking as side effects.

Unfortunately, excoriation disorder is often minimized and misunderstood. Sufferers experience significant emotional distress and guilt for not being able to stop their picking habit, and as a result of the physical damage they’re causing to their own skin, sufferers of this disorder often feel embarrassed and ashamed to go out in public. Many spend additional hours each day trying to cover up the lesions or scars with bandages, clothing, and heavy makeup. Some just avoid leaving the house altogether becoming isolated and reclusive.

Does any of this sound familiar? Are you starting to wonder if maybe you are at-risk of skin picking disorder? Don’t be scared — just ask yourself the following questions:

Do you impulsively pick at your skin?

Do you sometimes pick at your skin for hours at a time?

Do you pick without even realizing you are doing it?

Does skin picking greatly interfere with your everyday life and cause you to avoid social events or going into public?

Do you feel significant emotional distress because of skin picking?

If the answers to several of these questions are yes, it’s important that you set up an appointment with a therapist, who can help you treat your disorder.

What treatments are available?

Treatment recommendations for excoriation disorder include both pharmaceutical and behavioral interventions. The most common medications prescribed for skin picking disorder are Selective Serotonin Reuptake Inhibitors (SSRIs), such as Prozac and Zoloft. These drugs are believed to be effective for those with a skin picking disorder because they also treat the related disorders of OCD, depression, and anxiety.

There is also evidence of success with behavioral treatments with licensed therapists, such as cognitive behavioral therapy, mindfulness training, and habit reversal training.

If you feel like skin picking is affecting your life (or the life of someone you love and care about) it’s important to remember this is a treatable illness, and that help is available. To get the help you need, reach out to a professional: therapists, dermatologists or a loved one who can offer support.


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