Skin picking disorder (or "Excoriation") is a disorder where a person:
- Picks their skin over and over again, AND
- The picking is often or bad enough to cause tissue damage AND
- It causes a lot of distress and/or problems with work, social, or other daily activities.
People with skin picking disorder can (and often do) have other psychological symptoms, like depression and anxiety.
Do all people who pick their skin have skin picking disorder?
No. Research has shown that many people pick at their skin from time to time. It is not uncommon for a healthy person to occasionally pick at pimples, scabs, or even healthy skin. Skin picking is not considered a disorder unless it is often and/or bad enough to cause significant distress or problems in other areas of life. Also, other types of health problems like skin conditions, intellectual disability, and even drug use/withdrawal may cause people to pick at their skin at times. However, people with primary skin picking disorder do not pick at their skin only because they have these other problems.
What is a typical skin picking disorder episode like?
Where, when, and how people pick at skin varies. People can pick skin from one or more parts of the body. Common areas include: face, head, cuticles, back, arms and legs, and hands and feet. People most often pick skin with fingers and fingernails, but people also remove skin in other ways, e.g., by biting, or picking with tools like tweezers or scissors.
People pick for different reasons. People may pick out of habit or boredom, and, at times, may not even be aware that they are picking. People may also pick in an attempt to cope with negative emotions (e.g., anxiety, sadness, anger) and/or in response to feelings of mounting stress and tension. While picking, people may feel relief. However, feelings of relief are often followed by feelings of shame or guilt. After picking, people discard their skin in different ways. Some people discard the removed skin in the trash or on the floor. Some people eat skin after they have picked it.
Who suffers with skin picking disorder?
Skin picking disorder may affect as many as 1 in 20 people. Although it occurs in both men and women,
research suggests that skin picking disorder occurs much more often in women. Skin picking can begin in childhood or adulthood.
What causes skin picking disorder?
The exact causes of skin picking disorder are unknown. It may be that both biological and environmental factors play a role in skin picking disorder.
How is skin picking disorder related to OCD?
Skin picking disorder is currently classified as an impulse control disorder. Skin picking disorder is also sometimes referred to as a “body focused repetitive behavior.” It is also sometimes referred to as an “obsessive compulsive spectrum disorder” (or “OC spectrum disorder”) because it shares features of OCD. For example people with skin picking disorder pick skin over and over again, often in response to recurrent thoughts about or urges to touch or pick skin. In this way, symptoms of skin picking disorder are similar to those of OCD, which is characterized by urges to do repetitive behaviors (rituals) in response to other types of recurrent thoughts, images, and impulses. Skin picking disorder also shares similarities with other OC-spectrum disorders, like trichotillomania (repetitive hair pulling disorder), tic disorders, and body dysmorphic disorder (BDD) (an OC-spectrum disorder characterized by repetitive thoughts about appearance-related concerns - click here to learn more). People with skin picking disorder are more likely than people without it to have OCD and other OC spectrum disorders.
What are the effects of skin picking disorder?
Skin picking disorder can hurt a person emotionally, physically, and socially. In addition to feeling shame and embarrassment, people with skin picking disorder can have other psychological problems like depression and anxiety. Skin picking disorder can also interfere with social life, school, and/or work. Mild to severe pain during or after picking; sores, scars, disfigurement; and other medical problems like infections can also occur. In extreme cases, skin picking can cause sores severe enough to require surgery.
Are there treatments for skin picking?
Yes. Research suggests that the most effective treatment for skin picking is cognitive behavioral therapy (CBT), including the specific types of CBT called Habit Reversal Training (HRT) and the Comprehensive Behavioral Model (ComB). Acceptance and commitment therapy (ACT) may also be helpful in treating skin picking disorder. Research also suggests that skin picking may be effectively treated with medications such as SSRI’s (selective serotonin reuptake inhibitors). SSRI’s include: fluoxetine, fluvoxamine, and escitalopram. Some research suggests that the anti-seizure medicine lamotrigine may also be helpful in treating skin picking disorder. Unfortunately, because many people do not know that there is help for skin picking disorder, many people with the disorder continue to suffer with it.
Author: Jeanne M. Fama, Ph.D., Massachusetts General Hospital