What Is Skin Picking Disorder?

Woman picking skin on her arm

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What Is Skin Picking Disorder?

Pathologic skin picking is a mental illness in which you compulsively pick your skin to remove small irregularities such as moles or freckles, causing skin lesions.

Also known as excoriation disorder or dermatillomania, this disorder is classified as an “obsessive-compulsive and related disorder" in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Symptoms of Skin Picking Disorder

The main characteristic of pathologic skin picking also referred to as excoriation or dermatillomania, is repetitive or compulsive picking, or even digging, in the skin to the point of causing skin damage, scarring, and/or infection.

It is not uncommon for people with skin picking to engage in picking for several hours per day. As a result, people with pathologic skin picking often have difficulty maintaining steady employment or interpersonal relationships.

When picking, people may use their fingers, tweezers, pins, or other instruments to remove a perceived blemish. Common areas of focus include the face, back, neck, and scalp. Although picking can involve normal skin, picking is most commonly triggered by small blemishes, imperfections, scabs, and insect bites.

When to See a Doctor

If you have skin wounds or lesions caused by picking, it is a good idea to talk to a healthcare professional, especially if the injury is bleeding, red, painful, or appears to be infected.

Diagnosis of Skin Picking Disorder

To be diagnosed with excoriation disorder, you must exhibit symptoms that focus on recurrent skin picking. The symptoms must also create significant distress or impairment and must not be caused by a substance, another medical condition, or another psychiatric disorder.

  • Recurrent skin picking that results in skin lesions
  • Repeated attempts to stop the behavior
  • Repeated attempts to decrease or stop skin picking

The use of some substances, such as cocaine or methamphetamine, can also cause skin picking behavior. Medical conditions such as scabies and mental disorders such as psychotic disorder or body dysmorphic disorder can also cause skin picking. Skin picking disorder is not related to these conditions, so a doctor will rule out those as potential causes before making a diagnosis.

Skin picking, or excoriation, is diagnosed when the individual has tried unsuccessfully to lessen or even stop the picking, which causes excessive distress and anxiety and impairs daily functioning.

Recap

To be diagnosed with skin picking disorder, a person must exhibit skin picking that creates lesions. Such symptoms must not be caused by another psychological or medical condition.

Link to OCD

Not surprisingly, there appears to be a strong link between skin picking and OCD. In fact, research shows that skin picking occurs in people with OCD at a much higher rate than in the general population. However, though both disorders can co-occur they are quite different.

Symptoms of skin picking can be similar to those of OCD. Prior to picking, many people describe a compulsion-like urge to pick at imperfections in the skin and a relief of anxiety when the imperfection is removed. Later, however, the person may feel shame or be embarrassed about his picking, which can often lead to depression.

People with OCD who experience skin picking compulsions typically find these thoughts intrusive and distressing. Those with skin picking disorder, on the other hand, find the act of picking their skin enjoyable. While they may find pleasure in the act, they are still vulnerable to consequences of the behavior including skin infections, scarring, anxiety, and social isolation.

Some problems which could be mistaken for skin picking disorder include:

  • Skin infections such as scabies. Scabies can be extremely itchy, but it often missed when it occurs in well-groomed middle-class people. The scratching that almost always accompanies the itch can obscure the diagnosis.
  • Skin diseases such as eczema.
  • Systemic (bodywide) diseases. Elevated bilirubin levels from liver disease can cause intense itching. Itching may also accompany many other medical conditions.
  • Chemical dependency on drug use or withdrawal.

Skin picking may also present as a symptom of another condition. In addition, skin picking may be a symptom of body dysmorphic disorder, a condition that involves a preoccupation with imagined bodily defects.

Causes of Skin Picking Disorder

The exact causes of skin picking disorder are not entirely understood, but a number of different factors likely play a role including genetic, biological, and environmental influences.

Approximately 2% to 4% of the population is affected by pathological skin picking.

Skin picking can start at any age but usually begins in adolescence with the onset of skin conditions such as acne, eczema, or psoriasis. Some research suggests that developmental disabilities, problems with emotional regulation, and childhood trauma and abuse may also play a part in the onset of skin picking disorder.

Treatment for Skin Picking Disorder

Skin picking often causes considerable embarrassment and distress as a result of the unsightly wounds caused by picking, as well as the lengths the affected person may have to go to conceal their picking, such as wearing long sleeves during warm summer months or covering her face with a scarf.

Unfortunately, many people do not seek treatment because of the embarrassment associated with skin picking. This can be dangerous or even life-threatening as people often require medical interventions for their skin wounds, which can easily become infected.

Treatments for skin picking disorder may include the use of psychotherapy, medications, or a combination of the two.

Psychotherapy

Talk therapy may be helpful for relieving symptoms of this condition. Skin picking appears to respond best to treatment with cognitive-behavior therapy (CBT).

Medication

Medications, often selective serotonin reuptake inhibitors (SSRIs) may be needed. These medications may also be helpful for relieving co-occurring symptoms of anxiety or depression.

If you are experiencing symptoms that you think might be skin picking, be sure to talk to a therapist or doctor.

Coping of Skin Picking Disorder

Research suggests that skin picking disorder may be sensory processing conditions that affect how people perceive, process, and regulate sensory information. This can include being overly responsive to sensations such as skin picking.

Finding alternative ways to self-soothe and provide stimulation aside from picking at the skin may be helpful for managing the urge to pick. Squeezing a stress ball or using a fidget spinner, for example, might provide some degree of distraction and relief.

Researchers have also suggested that alternative treatments such as hypnosis, acupuncture, exercise, and yoga may be helpful in the treatment of skin picking disorder. However, studies are needed to determine if these approaches might offer relief either on their own or when used in conjunction with psychotherapy and medication.

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9 Sources
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  1. Craig-Müller SA, Reichenberg JS. The other itch that rashes: A clinical and therapeutic approach to pruritus and skin picking disorders. Curr Allergy Asthma Rep. 2015;15(6):31. doi:10.1007/s11882-015-0532-2

  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.

  3. Hayes SL, Storch EA, Berlanga L. Skin picking behaviors: An examination of the prevalence and severity in a community sample. J Anxiety Disord. 2009;23(3):314-319. doi:10.1016/j.janxdis.2009.01.008

  4. Obsessive-Compulsive Disorder. National Institute of Mental Health. Revised October 2019.

  5. Lochner C, Roos A, Stein DJ. Excoriation (skin-picking) disorder: a systematic review of treatment optionsNeuropsychiatr Dis Treat. 2017;13:1867-1872. doi:10.2147/NDT.S121138

  6. Odlaug BL, Grant JE. Pathologic skin pickingAm J Drug Alcohol Abuse. 2010;36(5):296-303. doi:10.3109/00952991003747543

  7. Lang R, Didden R, Machalicek W, et al. Behavioral treatment of chronic skin-picking in individuals with developmental disabilities: A systematic reviewRes Dev Disabil. 2010;31(2):304-15. doi:10.1016/j.ridd.2009.10.017

  8. Odlaug BL, Hampshire A, Chamberlain SR, Grant JE. Abnormal brain activation in excoriation (skin-picking) disorder: evidence from an executive planning fMRI studyBr J Psychiatry. 2016;208(2):168–174. doi:10.1192/bjp.bp.114.155192

  9. Houghton DC, Alexander JR, Bauer CC, Woods DW. Abnormal perceptual sensitivity in body-focused repetitive behaviors. Compr Psychiatry. 2018;82:45-52. doi:10.1016/j.comppsych.2017.12.005