Dermatillomania: The Skin Picking Disorder

Compulsive skin picking is also known as excoriation disorder or dermatillomania. This problem can be treated very effectively with cognitive-behavioral therapy (CBT).

What Is Dermatillomania, or Excoriation Disorder?

It’s not uncommon for many people to pick at their skin. For most people, it’s a harmless habit. However, sometimes the habit can get out of hand and results in bleeding, scarring, or other skin damage. When it gets to that point, it is known as excoriation disorder or dermatillomania.

Typically, this behavior starts with the intention of correcting a problem with the skin — whether it’s a pimple, a bump, an uneven cuticle, or something that “just doesn’t feel right.” When picking causes bleeding and eventually scabs, the scabs can become the targets of further picking. This process can become a recurring cycle.

Dermatillomania is an example of a body-focused repetitive behavior, or BFRB. Other examples of BFRBs include trichotillomania (hair pulling), cheek biting, and nail biting. Remember, each of these behaviors is common — they are only a disorder if they create a significant problem for the person. For example, if cheek biting results in frequent bleeding, or hair pulling results in visible bald patches, the habit is creating a significant problem.

Skin picking has been estimated to be a problem for 1.4% of the American population; this would represent approximately five million people in the United States alone. The problem can surface during adolescence or adulthood; childhood cases are less common.

Understanding Severity Levels Of Dermatillomania

Excoriated acne

When skin picking is more severe, the repeated damaging of the skin leads to skin irregularities called “excoriated acne.” Often these irregularities then become the target of further skin picking, creating a cycle that can be hard to break.

Excoriated skin

Bleeding and skin damage can sometimes become pronounced, creating what is known as an “excoriation wound.” It can take a long time for excoriated skin to heal. Sometimes the scars created can become permanent. Excoriated skin refers to skin that has been damaged through dermatillomania (whether or not there is excoriated acne).

Why do people engage in skin picking?

Skin picking sometimes begins as a mindless habit. If the person finds it to be gratifying in some way, the habit becomes stronger. Unlike some habits (e.g., cigarette smoking), little to no conscious effort is required to pick your skin. Most people with dermatillomania say that they often pick their skin without realizing it. The ease with which people can pick their skin is what helps make this such a hard habit to break. Contrast this with smoking, where people need to put in some effort to go get cigarettes — your skin is always very close by!

Other times skin picking begins as a conscious effort to fix a blemish on the skin. The picking can lead to uncomfortable physical sensations that the person then tries to resolve with further picking. People who are displeased with some aspect of their skin are more vulnerable to this onset of dermatillomania. Once the habit starts, it is strengthened by the factors described in the preceding paragraph.

Skin picking is often done in private. A consequence of this is that there is no immediate social pressure to stop the behavior — regardless of how the habit started. Social pressure can be a powerful force to change our behavior. For people with dermatillomania, this only occurs after the behavior has done its damage — when others see the scabs or scars.

Is Skin Picking Part of OCD?

Excoriation disorder is considered a “related disorder” to obsesive-compulsive disorder (OCD), but it is not the same thing. Compulsions, a symptom of OCD, are similar to skin picking but typically are not focused on one’s body.

CBT for Skin Picking

Fortunately, BFRBs such as dermatillomania are considered very treatable problems. The primary treatment for dermatillomania is behavior therapy. Behavior therapy is a form of cognitive-behavioral therapy (CBT).

Although some forms of CBT involve efforts to change your thinking, behavior therapy for dermatillomania typically does not. The first step in the CBT treatment involves learning about the disorder and how to understand it. The following step is typically what is called “behavioral monitoring.” In this phase, you may be asked to keep track of your skin picking behavior. The next step will be your making observable, physical changes that will result in fewer instances of skin picking.

Dermatillomania treatment with CBT usually involves weekly sessions with your therapist. Much of the focus is on assessing what worked and what didn’t since your prior session. Attention is also given to new techniques that are likely to further decrease your skin picking.

Finding Dermatillomania Treatment Near You

The Manhattan Center for Cognitive-Behavioral Therapy provides treatment for adults and children suffering from repetitive skin picking. If you’re interested in working with one of the therapists at our Midtown Manhattan office or via teletherapy, please contact us. If you’re looking for a provider elsewhere, try the clinical directory or the support groups listing at the website of the TLC Foundation.

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