Compulsive skin picking isn’t just a bad habit—it can be part of a cycle that temporarily eases distress but ultimately leads to more frustration and skin damage. Understanding its role in the OCD cycle can help break the pattern with treatments like habit-reversal training (HRT) and/or exposure and response prevention (ERP) therapy.
Do you often deal with ragged cuticles? Do you feel the urge to pick at hangnails, scabs, or bumps? Does picking at your skin distract you from daily routines, lead to bleeding or sores, or feel impossible to stop?
You might think of skin picking as just another bad habit, but if you’re finding it difficult to stop the behavior, it could be a sign of a larger mental health condition, such as body-focused repetitive behavior (BFRB) and/or obsessive-compulsive disorder (OCD). BFRB and OCD are both conditions that involve repetitive behaviors or actions that require specialized treatment to address symptoms.
Read on to learn more about the signs and symptoms of compulsive skin picking and when to reach out for professional help.
What is skin picking disorder?
Skin picking disorder, also known as excoriation disorder or dermatillomania, is a mental health condition characterized by compulsive picking, squeezing, or scratching areas of your skin, such as scabs or pimples. While skin picking can occur anywhere, the most common target areas include the scalp, arms, face, lips, and fingers.
Skin picking disorder is a body-focused repetitive behavior (BFRB), which are a group of disorders that involve self-grooming to the point of causing significant damage.
So, how can you tell the difference between a bad habit and a BFRB like compulsive skin picking? According to NOCD Therapist MaryBeth Overstreet, LPC, the key differences between the two are severity and compulsiveness. “A bad habit is a repeated behavior that is often triggered, but can usually be controlled and doesn’t cause distress or significant harm,” she explains. In contrast, she says BFRBs are much harder to control—even when they cause pain, scars, and embarrassment.
When does skin picking become a problem?
It’s difficult to know whether you have a skin picking disorder, or are just messing with a scab. However, there are a few signs that can indicate that the behavior is a larger issue.
Picking at your skin may be a sign of a mental health condition if:
- It interferes with daily responsibilities.
- It causes significant pain.
- You isolate yourself due to shame or to pick in private.
BFRBs like skin picking disorder are typically difficult to identify or stop on your own, which is why it’s important to speak with a mental health professional to gain clarity on what’s going on.
Impacts of skin picking
Repetitive skin picking can lead to significant physical damage to your skin over time. The most common effects of this behavior are excessive bleeding, bruising, scarring, and infections. Skin picking can also affect your self-esteem, and you may avoid social situations out of shame or embarrassment.
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Why am I compulsively picking my skin?
You might engage in BFRBs like compulsive skin picking for various reasons. “Some people might pick [their skin] in response to anxiety or stress, while others may pick to fill a void,” says Nicholas Farrell, PhD, NOCD’s Director of Clinical Development & Programming. “Skin picking fills a perceived need for gratification or stimulation.”
Specific rituals may also surround skin picking, such as searching for a certain scab to pick, playing with it, or sometimes swallowing the scab after its removal. However, skin picking can also be more automatic and outside your awareness, meaning it occurs without tension or anxiety.
While excoriation disorder has its own classification in the Diagnostic and Statistical Manual of Mental Illnesses, Fifth Edition (DSM-5), it can also co-occur with other mental health conditions, such as:
Body dysmorphic disorder (BDD)
Body dysmorphic disorder, or BDD, involves a preoccupation with your physical appearance and the perception of how you look. If you have BDD, you may fixate on a perceived “flaw” in your body.
Compulsive skin picking can be an effect of an obsession with your appearance, as you might pick at perceived “flaws” in your skin. You might do this by removing or minimizing nonexistent or slight imperfections in your appearance, such as pimples or bumps.
OCD
OCD is a condition involving a cycle of intrusive thoughts, images, urges, feelings, and sensations known as obsessions, followed by repetitive physical or mental behaviors called compulsions.
If you have OCD, you may spend a lot of time wondering what your thoughts mean and worry what might happen (typically something bad) if you don’t engage in compulsive behaviors—such as checking or rumination. The issue with compulsions is that they only provide short-term relief, if even that.
Is compulsive skin picking an OCD symptom?
Since skin picking has a compulsive nature to it, some might assume that it is a symptom of OCD, says Dr. Farrell. Plus, BFRBs and OCD fall under the same category of a wide range of conditions called “obsessive-compulsive and related disorders,” according to the DSM-5.
However, while they share some similarities and often co-occur, OCD is not the same as a BFRB. Like OCD compulsions, BFRBs are often performed to soothe discomfort or provide a temporary sense of satisfaction or relief. However, the difference is what triggers these behaviors. BFRBs can occur at any time and are driven by tension, anxiety, or boredom—not an intrusive thought. While skin picking may seem compulsive, it isn’t technically considered OCD, as OCD compulsions are performed as a direct response to obsessions.
If you have OCD, you might compulsively pick at your skin in response to intrusive thoughts—such as those involving perfectionism. However, skin picking is usually a BFRB, not OCD.
How skin picking reinforces the OCD cycles
If you have OCD, using skin picking as a compulsion can reinforce the cycle, which comprises four stages: obsession, distress, compulsion, and temporary relief.
It starts with an intrusive urge—such as the need to fix a perceived imperfection—leading to rising anxiety that feels uncomfortable. You might pick at your skin to reduce distress and ease this discomfort. However, this relief is fleeting and is soon replaced with feelings of guilt, frustration, or shame—especially if the picking causes noticeable damage. Over time, this reinforces the cycle, as those negative emotions can lead to even more skin picking.
Despite providing a brief sense of control, compulsive skin picking doesn’t offer long-lasting relief and can instead lead to ongoing frustration and distress.
How to stop skin picking
If you believe you have excoriation disorder, it might feel embarrassing to seek help, and that’s completely understandable. However, skin picking is a known mental health condition and there’s effective treatment available to address your symptoms.
One of the most effective therapies for skin picking disorder—and any BFRB, for that matter—is habit-reversal training (HRT). HRT involves tracking specific details about when you’re most likely to engage in a habit so that you can gather as much information as possible about when it occurs.
Habit-reversal training involves increasing awareness of when you have the urge to pick, and learning behaviors that directly compete with the skin-picking—clenching your fists, clapping your hands, or putting your hands underneath your legs until the feeling subsides. It is typically a short-term treatment, lasting about 12 therapy sessions or fewer, and has been highly effective when people follow the therapist’s guidance.
If your compulsive skin picking is linked to body dysmorphia disorder (BDD), the preferred treatments for this condition are cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). CBT is an evidence-based form of therapy that helps you manage anxiety and identify the core beliefs driving your decisions, while DBT focuses on developing skills to manage intense emotions and tolerate distress.
Exposure and response prevention (ERP) therapy for OCD
The most effective treatment for OCD is a specialized form of CBT called exposure and response prevention (ERP) therapy. During ERP, a therapist will teach you response prevention techniques, which are exercises that help you refrain from engaging in compulsions.
If you believe you might be dealing with a BFRB and OCD simultaneously, speak with your therapist about a combination of HRT and ERP to get your symptoms under control.
Bottom line
If you’re picking at your skin regularly and noticing damage—or finding it difficult to stop—you may be dealing with skin picking disorder. While it’s common to feel shame while navigating this mental health condition, you are not alone in your experience. With the right treatment approach, you can regain control and focus on what really matters again.
Key takeaways
- Picking at your skin is a common bad habit, but it can also be a mental health condition.
- Similar to nail-biting and hair-pulling, skin picking disorder is a type of body-focused repetitive behavior (BFRB).
- While BFRBs and OCD compulsions can look similar and may occur together, these are two different mental health conditions with two distinct treatments.
- Habit-reversal training (HRT) is an effective treatment for skin picking disorder, while exposure and response prevention (ERP) therapy is used to treat OCD.
