Excoriation Disorder (Skin-Picking)
Excoriation (Skin-Picking) Disorder is characterized by recurrent skin picking resulting in skin lesions, despite repeated attempts to decrease or stop the behavior. It often involves feelings of tension before picking and relief afterward. It's classified as an obsessive-compulsive related disorder.
Prevalence: 1.4% of population. More common in females. Onset typically in adolescence.
Common Symptoms
- Recurrent skin picking resulting in lesions
- Repeated attempts to decrease or stop picking
- Picking at face, arms, hands, or other body areas
- Skin damage, scarring, or infections
- Tension or urge before picking
- Relief or gratification during/after picking
- Significant time spent picking
- Avoiding social situations due to appearance
- Using makeup or clothing to hide damage
- Shame or embarrassment about behavior
- Picking in response to stress or anxiety
- Automatic picking without awareness
- Focused picking with awareness
- Examining skin for imperfections
- Using tools (tweezers, needles) to pick
- Difficulty stopping once started
- Interference with daily activities
Risk Factors
- Family history of excoriation or OCD
- Female gender
- Adolescence
- High stress
- Perfectionist traits
- Anxiety disorders
- Acne or other skin conditions
- History of trauma
- Depression
Treatment Approaches
- Habit Reversal Training (HRT) - First line
- Comprehensive Behavioral Model (ComB)
- Cognitive Behavioral Therapy (CBT)
- Acceptance and Commitment Therapy (ACT)
- Dialectical Behavior Therapy (DBT)
- Mindfulness-Based Therapy
- Psychoeducation
- Group therapy
- SSRIs (may help if comorbid conditions)
- NAC supplementation
- Dermatological care for skin damage
Self-Help & Natural Approaches
- Habit Reversal Training
- Awareness training
- Competing response training (fidget toys)
- Stimulus control (covering mirrors)
- Wearing gloves as barrier
- Keeping hands busy
- Stress management techniques
- Mindfulness meditation
- Exercise for tension relief
- Journaling triggers
- Support groups (TLC Foundation)
- Cognitive restructuring
- Deep breathing
- Progressive muscle relaxation
- Skin care routine as alternative
- Bandages on common picking sites
- Reward system for pick-free periods
- Cold compress instead of picking
- Art or craft activities
- Yoga or tai chi
When to Seek Professional Help
- Visible skin lesions or scarring
- Unable to stop despite trying
- Skin infections
- Significant distress
- Avoiding social situations
- Interference with work/school
- Depression or anxiety
- Low self-esteem
- Excessive time spent picking
- Quality of life impaired
- Using dangerous tools
Crisis Resources
- 988 Suicide & Crisis Lifeline
- TLC Foundation for BFRBs: www.bfrb.org
- Crisis Text Line: Text HELLO to 741741
- SAMHSA National Helpline: 1-800-662-4357
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.