Do you often deal with ragged cuticles? Do you feel the urge to pick at hangnails, scabs or skin bumps? Does picking at your skin distract you from daily routines, lead to bleeding or sores, or feel impossible to stop? It’s possible you may be dealing with skin picking disorder, also known as excoriation or dermatillomania.
Compulsive skin picking is a condition that occurs in about three to eight percent of the population—which makes it almost as common as generalized anxiety. While skin picking may seem like just a bad habit, it can be a mental health condition, and may lead to serious complications if left untreated. Read on to learn more about the signs and symptoms of skin picking disorder, and when to reach out for professional help.
What is skin picking disorder?
Lots of people might occasionally pop pimples, or pick at a hangnail when bored. But, skin picking disorder is a mental health condition characterized by compulsive picking, squeezing or scratching at areas of your skin. While skin picking can occur anywhere, the most common target areas include the head, scalp, arms, face, lips, fingers, nails, and cuticles.
Like biting the inside of your cheek or pulling out your hair, skin picking is a body-focused repetitive behavior (BFRB). BFRBs are repeated behaviors performed on your body that may provide a sense of satisfaction or stimulation. “Some might pick in response to anxiety or stress…others may pick to fill a void,” says Nicholas Farrell, PhD, a licensed clinical therapist and Regional Clinical Director at NOCD. “Skin picking fills a perceived need for gratification or stimulation of some sort.”
Farrell adds that this behavior usually starts young and can be prevalent in kids.
When does skin picking become a problem?
It can sometimes be challenging to figure out if you have skin picking disorder, or you’re just messing with a scab. Dr. Farrell notes that skin picking can become so automatic, you may not be aware that you’re doing it. This can make it even harder to identify the condition. He recommends talking to a mental health professional to gain clarity.
Dr. Farrell says it can also be helpful to consider the degree to which the behavior impacts your life. He suggests asking yourself two questions:
- Does this behavior take time away from things I’d rather be doing?
- Am I hurting myself as I do this? Skin picking sometimes causes bleeding and sores that can lead to infection, or scarring. In some cases, medical intervention is necessary.
BFRBs like skin picking disorder are typically difficult to stop on your own, and can cause people to withdraw socially—due to shame about the behavior, or an overwhelming desire to regularly pick at yourself in private. Consider whether your skin picking may be impacting your social life to get a better sense of whether you may be dealing with a mental health condition.
Is skin picking a symptom of OCD?
Skin picking disorder often occurs alongside other mental health conditions, including anxiety, depression, obsessive-compulsive disorder (OCD), attention-deficit hyperactive disorder (ADHD), and autism. However, BFRBs like skin picking disorder are their own diagnosis, rather than a symptom of another mental health condition. Read on to learn more about the connection between skin picking and OCD.
What is OCD?
OCD is a complex mental health condition characterized by unwanted intrusive intrusive thoughts, feelings, urges, sensations, and images—known as obsessions. Everyone experiences these passing thoughts and feelings from time to time, but with OCD they become overwhelming. In response, people with OCD perform compulsions—rituals or repetitive mental or physical actions—meant to relieve discomfort.
BFRBs vs. OCD compulsions
BFRBs and OCD compulsions can look very similar, and may occur together, but these are two different mental health diagnoses with two different treatments. “For folks who repetitively pick their skin, there is a strong compulsive quality to it, which can make it seem like it must be OCD,” says Dr. Farrell.
Like OCD compulsions, BFRBs are often performed to soothe discomfort or provide a temporary sense of satisfaction or relief. The main difference is what triggers these behaviors. BFRBs can occur at any time and are not typically linked to a specific intrusive thought. “Skin picking isn’t technically considered OCD, since [OCD] involves compulsions that are specifically done in response to…the obsessions you feel,” Dr. Farrell explains. “It’s a nuanced line.”
Treatment for skin picking disorder
While skin picking disorder can feel embarrassing and difficult to stop, it is treatable with the right strategy.
Habitual Reversal Training (HRT)
Habit-reversal training (HRT) is a type of cognitive behavior therapy that is recommended for BFRBs like skin picking disorder. HRT includes a few components: awareness training, competing response training, stimulus control, and social support.
1. Awareness Training
Awareness training aims to help you become more aware of the circumstances or situations that trigger the desire to pick your skin. Because people are often unaware of their skin picking behavior, awareness training can be necessary to begin addressing the problem.
“I’ll hear things like, ‘I didn’t realize what was happening until all of a sudden there was a pile of hair, or bits of skin on the bathroom counter…it was almost as though I was in a trance-like state,’” Dr. Farrell says. “That’s where awareness training comes in.”
2. Competing Response Training
After you’re aware of your triggers, your therapist will help you identify a “competing response”—or healthier activity you can turn to instead of picking your skin. The goal here is to simply do something else with your hands. Dr. Farrell recommends knitting or using a fidget spinner. “Whatever the competing response is, we want it to be something that makes it increasingly difficult for you to carry out the behavior [of skin picking],” Dr. Farrell says.
The ultimate goal is to break the connection between your desire to pick and the behavior of skin-picking. Dr. Farrell says that competing response training can further your progress by teaching you to sit with unpleasant feelings and resist urges. “Then, the feeling gradually fades and goes away,” he explains.
3. Stimulus Control
In addition to awareness training and competing response training, it can be helpful to spend some time identifying potential triggers in your environment that may be exacerbating your urge to pick. “You might recognize that, wow, a lot of my skin picking occurs when I’m in a particular bathroom in my house where I have a high-resolution mirror or very intense lighting,” says Dr. Farrell. “If that’s the case, then what can we do to modify that environment so it becomes less conducive to skin picking?” He says adjustments might include removing the mirror, or switching out the light for a dimmer bulb.
4. Social Support
Like many mental health conditions, social support can be immensely helpful for recovery. Trusted loved ones can help you recognize the signs of skin picking, and gently intervene with a suggested competing response.
Since skin picking often occurs in young kids, it’s especially important for parents and guardians to become knowledgeable on the elements of HRT. “Mom and dad could learn to notice the warning signs, and use a competing response strategy before the skin picking starts,” says Dr. Farrell. “It can make a huge change over time.”
Other treatment options
In addition to HRT, the comprehensive behavioral model (ComB) can be effective for BFRBs. ComB utilizes an individualized approach to focus on the underlying factors that may be causing you to pick at your skin. Like HRT, ComB eventually utilizes methods for determining triggering feelings, activities or environments, so you can learn to turn to alternative behaviors during these moments.
It’s important to note that while HRT is typically the most effective treatment for BFRBs like skin picking, this treatment won’t address other mental health conditions that may also be occurring, like OCD. Exposure and response prevention (ERP) therapy is a highly effective, evidence-based treatment specialized for OCD. If you think you may be dealing with both skin picking disorder and OCD, speak to your therapist about a combination treatment of HRT and ERP.
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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 a trained therapist and 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.
- Without treatment, skin picking disorder can cause serious damage, like scarring or skin infections.
- 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 form of therapy for skin picking disorder.
- In time, you can learn to identify the triggers that lead you to pick, and substitute skin picking with healthier coping mechanisms.
- Learning to sit with discomfort and resist your urges is key to feeling relief.