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).
Skin picking disorder can significantly impact a person’s quality of life and overall health.
What is skin picking disorder?
Skin picking disorder is a body focused repetitive behavior (BFRB) that affects about 1.4%Trusted Source of adults in the United States.
People with skin picking disorder may repeatedly pick, pull, or tear at healthy skin, pimples, blisters, or scabs.
Skin picking disorder occurs more frequently in females than males. Symptoms most often develop during adolescence and adulthood.
Symptoms of skin picking disorder include:
- engaging in skin picking despite multiple attempts to address the behavior
- developing recurring skin lesions or open wounds due to picking
- experiencing significant psychological, physical, or social impairment as a result of skin picking
People may pick their skin for various reasons. Some may feel compelled to remove perceived imperfections, while others pick in response to stress, boredom, or out of habit.
In many ways, skin picking disorder is a repetitive or obsessive grooming behavior similar to other BFRBs, such as hair pulling and nail picking.
Skin picking behaviors can last anywhere from a few minutes to several hours or several months, with periods of remission in between.
If untreated, skin picking can lead to painful lesions, bleeding, scars, and significant psychological distress.
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.
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.1
- 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.
Causes
People can develop skin picking disorder in response to:
- An infection, rash, or injury that creates a scab: The scab may itch while it heals, which leads people to scratch or pick it until it bleeds and a new wound forms. They may then pick at the new scab. A picking cycle forms and the behavioral pattern becomes a habit.
- Stress or mental health conditions: During times of stress, people might pick or scratch their skin, pull their hair, or bite their nails to relieve it. Others might feel compelled to pick their skin as a form of self-grooming or in an attempt to remove real or imagined imperfections in the skin.
Although skin picking has no specific cause, it may result from biological and environmental factors.
Skin picking disorder can develop alongside OCD or another mental health condition. We discuss this in more detail below.
OCD
OCD is a mental health condition characterized by unwanted repetitive thoughts and behaviors. According to the National Alliance on Mental Illness, OCD affects more than 2% of the U.S. population.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)Trusted Source lists skin picking as a common compulsion that develops in people with OCD.
Trichotillomania
Trichotillomania is a compulsive condition related to OCD. It leads to habitual behaviors such as hair pulling, nail biting, and teeth grinding.
An estimated 38% of people who have skin picking disorder also have trichotillomania.
ADHD
ADHD is a neurodevelopmental condition that interferes with a person’s ability to pay attention and control impulsive behaviors.
The Centers for Disease Control and Prevention (CDC)Trusted Source list ADHD as “one of the most common” neurodevelopmental conditions among children.
People with ADHD may develop skin picking disorder in response to their hyperactivity or low impulse control.
Autism spectrum disorder
Autism spectrum disorder (ASD) is a neurodevelopmental condition that affects behavior and communication.
Doctors consider autism a spectrum disorder because it can cause a vast range of symptoms that appear at different intensities.
Although autism symptoms can differ from person to person, common symptomsTrusted Source include:
- inconstant eye contact
- showing little or no enjoyment during activities or interactions involving other people
- showing more or less sensitivity to sensory information, such as noise, lights, or temperature
- repeating certain behaviors or phrases, which is known as echolalia
The behavioral symptoms of ASD can manifest as repetitive behavior, such as skin picking, that often includes self-injuryTrusted Source.
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.
Treatments
Treatment options for skin picking disorder usually include medication and therapy. Treating any underlying condition can help alleviate the impulse to pick.
Medication
Skin picking disorder related to an underlying mental health or developmental condition might respond to medicationsTrusted Source such as:
- selective serotonin reuptake inhibitors (SSRIs) and other antidepressants
- anticonvulsants such as lamotrigine (Lamictal)
- antipsychotics such as risperidone (Risperdal)
Therapy
People with skin picking disorder may benefit from cognitive behavioral therapy (CBT), which focuses on addressing negative habits and impulse control issues.
During CBT, a mental health professional or counselor will help a person identify and address emotional, physical, and environmental triggers that contribute to negative behaviors.
They can suggest safer alternative activities for people who pick in response to stress, anxiety, or boredom. Alternatives can include:
- squeezing a rubber ball
- using a Rubik’s cube
- drawing, painting, or knitting
Those who unconsciously pick their skin may benefit from wearing gloves or adhesive bandages to prevent tissue damage and reduce the urge to pick.
People can take action at home by practicing stress management techniques and altering their environment to reduce exposure to potential triggers.
Tips for managing skin picking disorder at home include:
- applying soothing topical ointments, such as aloe vera gel or high quality coconut oil
- exercising regularly
- practicing yoga, meditation, or deep breathing exercises to reduce stress or anxiety
- removing or covering mirrors to avoid seeing skin blemishes
- hiding any tools used to pick or pull skin, such as tweezers, nail clippers, and scissors
-
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
-
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.
-
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
-
Obsessive-Compulsive Disorder. National Institute of Mental Health. Revised October 2019.
-
Lochner C, Roos A, Stein DJ. Excoriation (skin-picking) disorder: a systematic review of treatment options. Neuropsychiatr Dis Treat. 2017;13:1867-1872. doi:10.2147/NDT.S121138
-
Odlaug BL, Grant JE. Pathologic skin picking. Am J Drug Alcohol Abuse. 2010;36(5):296-303. doi:10.3109/00952991003747543
-
Lang R, Didden R, Machalicek W, et al. Behavioral treatment of chronic skin-picking in individuals with developmental disabilities: A systematic review. Res Dev Disabil. 2010;31(2):304-15. doi:10.1016/j.ridd.2009.10.017
-
Odlaug BL, Hampshire A, Chamberlain SR, Grant JE. Abnormal brain activation in excoriation (skin-picking) disorder: evidence from an executive planning fMRI study. Br J Psychiatry. 2016;208(2):168–174. doi:10.1192/bjp.bp.114.155192
-
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
