How Pathologic Skin Picking Is Related to OCD

Woman picking skin on her arm

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Pathologic skin picking, or excoriation, is a mental illness in which you compulsively pick your skin to remove small irregularities such as moles or freckles, causing skin lesions. It's classified as a disorder that's related to obsessive-compulsive disorder (OCD) and its symptoms certainly share some similarities with those found in OCD.

Symptoms of Pathologic Skin Picking

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. 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.


Approximately 2 to 4 percent of the population is affected by pathological skin picking. Interestingly, most people seeking treatment are female.

Skin picking can start at any age but usually begins in adolescence with the onset of skin conditions such as acne, eczema, or psoriasis.

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.

Link to OCD

Not surprisingly, there appears to be a strong link between skin picking and OCD. Skin picking occurs in people with OCD at a much higher rate than the general population.

Also, skin picking is often tied to body dysmorphic disorder, which involves a preoccupation with imagined bodily defects.

So while it's not technically OCD, skin picking is classified by the Diagnostic and Statistical Manual-5 (DSM-5) as an obsessive-compulsive related disorder.

Differential Diagnosis

Before making a diagnosis of dermatillomania, in other words, skin picking as a mental health disorder related to OCD, it's important to rule out other possible causes of the picking. It's also important to note that all picking is pathological. Picking that is considered on the spectrum of OCD usually causes significant distress and impairment of ordinary activities.

Some problems which could be mistaken for picking 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 which 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.

Treatments for Skin Picking

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 her 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.

Skin picking appears to respond best to treatment with cognitive-behavior therapy (CBT). Medications, often selective serotonin reuptake inhibitors (SSRIs) may be needed. If you are experiencing symptoms that you think might be skin picking, be sure to talk to a therapist or doctor.

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6 Sources
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