Picking at a scab can bring the same satisfaction as occasionally popping a pimple. Whether they’re dry and beginning to fall off on their own, or you just can’t resist giving them a head start, the urge to pick can be hard to avoid. But picking at scabs often isn’t a harmless habit. For one thing, it puts you at risk for infections and scars. For another, it can be a symptom of an underlying mental health issue like dermatillomania, aka skin picking disorder—which has some similarities to obsessive-compulsive disorder (OCD) but is its own distinct condition.
Estimated to affect 1-5% of American adults, skin picking disorder is known as a body-focused repetitive behavior (BFRB). BFRBs include skin picking as well as other repetitive self-grooming behaviors, such as hair pulling, nail biting, and lip biting.
Keep reading to understand exactly why you pick your scabs and how you can stop.
Is it bad to pick at my scabs?
In short, it can be. Scabs play an important role in the body’s natural healing process. Beneath a scab are white blood cells working hard to repair the wound, protecting your skin from blood loss, germs, and infection. By picking the scab off, you risk contracting an infection it was protecting you from.
Not to mention, when you reopen a wound, the amount of time it takes for your skin to heal increases. Tissue damage and scarring become more likely.
Do I have dermatillomania? Symptoms and signs
If you have the occasional temptation to pick at a scab, that’s not enough to determine that you have dermatillomania. But when you’re picking your scabs regularly and unable to put down the habit—despite wanting to—that may be a sign that skin picking disorder is at play.
Here are some of the symptoms of dermatillomania that a professional will be on the lookout for during an evaluation. Keep in mind, you don’t have to experience every single one of these to receive a diagnosis:
Mental symptoms
- Feeling unable to stop picking
- Satisfaction or a sense of being soothed while picking
- Post-picking anxiety about the worsened state of your skin
- Worry over what others will think of your wounds
- Shame and embarrassment over not being able to stop
Physical symptoms
- Picking at scabs with your fingers, teeth, or a tool, such as tweezers
- Creating new wounds or lesions
- Scarring
- Bleeding
- Bruising
- Infection
Other signs of skin picking disorder
- You want to isolate yourself. The embarrassment and shame that often come with skin picking disorder may lead you to pull back from your social life. “It can make dating and intimacy hard, too,” says NOCD therapist April Kilduff, MA, LCPC, LMHC, “because you don’t want a romantic partner to see the spots you’ve been picking.”
- You have a hard time concentrating. The urge to pick can be so all-consuming that you lose the ability to focus on things that are important to you—school, work, daily responsibilities, and even relationships.
- You lose track of time. You might spend hours standing in front of the mirror picking at a scab and not realize how much time has passed.
- You pick to regulate your feelings or senses. “If you’re bored, for example, you might pick to busy yourself. If you’re anxious, you might pick to soothe yourself,” says Kilduff. You might also pick to regulate your sensory input—as in, the sounds, sights, smells, and touch you’re taking in at any given moment. “If you’re in a loud, crowded place, you might pick to distract from overstimulation.”
- You go out of your way to cover up the spots you’ve picked. Those with skin picking disorder sometimes want to hide their excoriation and scarring. That can leave you wearing long sleeves even on hot summer days, for example, or wearing a full face of makeup at the beach. “This can make certain activities, like swimming, a challenge,” says Kilduff.
- You are preoccupied with making your skin smooth. It sounds counterintuitive, but “people with dermatillomania may feel a refusal to have any marks or bumps on their skin. They might want their skin to be perfect—even if their behaviors don’t actually help and could make things worse,” Kilduff explains.
Types of skin picking
Most picking falls into two categories, referred to as “focused pulling” and “automatic pulling,” and it’s common to experience both.
Focused pulling happens consciously. You sit down, or stand in front of the mirror, with the specific intent to pick at a scab. Kilduff says, “Focused pullings tends to relate to a feeling, like anxiousness or sadness, and you pick to soothe yourself.”
Automatic pulling, on the other hand, is a more passive, absentminded act. “Automatic pulling often happens when someone’s not stimulated, like when they’re bored or sitting still, and they just habitually find a scab and start picking,” explains Kilduff.
What causes skin picking disorder?
It’s not clear exactly what causes skin picking disorder. It may arise as a result of biological or environmental causes, or both. Here are some possible explanations:
- You may be more likely to develop a BFRB if you have an immediate family member with one. In a study of 40 people with skin picking disorder, 43% of them had an immediate family member with the same condition.
- You may have impulse-control issues. Some research has found that those with skin picking disorder displayed emotion-based impulsivity, defined as “the tendency to react impulsively when experiencing heightened emotional states.”
- You may have dealt with excess stress or trauma, especially in childhood or adolescence. One study discovered that adults with skin picking disorder experienced significantly higher levels of childhood trauma than the participants without skin picking disorder. In another study, children and adolescents with BFRBs reported higher levels of stress.
- You may be dealing with another mental health condition. People with BFRBs also display higher rates of depression, anxiety, ADHD, body-dysmorphic disorder (BDD), and OCD. These disorders have not been proven to cause skin picking disorder, but there is a link between them.
If I compulsively pick my scabs, does that mean I have OCD?
Skin picking disorder falls under the category of “OCD and related conditions,” and both include repetitive behavior—so you might be wondering: If I have skin picking disorder, do I have OCD? The answer is no, not necessarily. Although it’s possible to have both conditions, they are distinct diagnoses.
OCD consists of obsessions and compulsions. Obsessions are unwanted thoughts, images, or urges, and compulsions are repetitive mental or physical behaviors that are done in an attempt to “neutralize” the obsession or cope with the resulting distress.
On the other hand, the motivation for compulsively picking your scabs if you have skin picking disorder can be something else altogether. People engage in BFRBs for a variety of reasons, including an attempt to regulate stress or emotions, derive pleasure, or relieve some physical sensation, notes Nicholas Farrell, PhD, NOCD Regional Clinical Director. “A compulsive behavior is any repetitive behavior you feel extremely drawn to do, for various reasons. Meanwhile, an OCD compulsion follows an obsession, and you’re trying to gain certainty around something, relieve distress, or make sure a bad thing doesn’t happen—and you feel anxious or distressed while doing it.”
To put it simply, the motivation behind these repetitive behaviors is very different, even if they look similar on the surface.
How to stop picking scabs
Once you know why you’re picking at your scabs, the next question is usually: How can I stop?
The most important thing to know is that you’ll need to find a therapist who specializes in BFRBs. Not all therapists are trained in one of the specific therapies required to successfully treat skin picking disorder, and seeing, for example, a general talk therapist can do more harm than good.
With the support of a professional, here’s a look at how you can stop picking your scabs:
- Habit Reversal Training (HRT) HRT is the most well-researched treatment method for skin picking disorder, and it’s proven effective in the majority of people. “HRT first involves monitoring and tracking the specific details of when picking occurs,” says Patrick McGrath, PhD, NOCD’s Chief Clinical Officer. “This process helps people become more aware of their behavior patterns, triggers, and how much time they spend picking, and ultimately reduce the behavior.”
Your HRT therapist will help you come up with what are known as competing responses—that is, behaviors that you can do to physically prevent picking. For example, you might learn to gently ball up your fists, play with a fidget toy, or wear mittens whenever you have the urge to pick your scabs.
- Comprehensive Behavioral Intervention (ComB) ComB was built on the foundation of HRT and takes a more individualized approach to treatment. Similarly, it helps you develop awareness around when, where, and why you pick, but you might use a variety of strategies to stop picking—not just competing responses.
“You might learn about healthy coping skills, altering unhealthy thinking patterns, or using sensory substitutions, like chewing gum or smelling essential oils,” Dr. McGrath explains.
- Medication. Research is limited on the use of medication to treat skin picking disorder, and there isn’t a drug formally approved for it yet. Some studies have found improvements in people who take medication, but in any case, it’s not recommended as a standalone treatment.
“When it comes to medication, most people see the best results from the combination of therapy and meds,” says Dr. Farrell.
- Social support. This is such a powerful component that many professionals encourage making social support a part of your treatment plan. “The shame you have around picking can be eased, and your loved ones can also help you notice when you’re picking—and if you’re utilizing your competing response instead, they can offer you positive feedback,” Dr. McGrath says.
When it comes to medication, most people see the best results from the combination of therapy and meds.
The bottom line about picking your scabs
Even though it might sound hard or even impossible right now, you can recover from skin picking disorder with the right help. Take it from Alessandra Rizzotti, LCSW, BFRB sufferer turned BFRB therapist at NOCD: “Just because you pick and pull doesn’t mean there’s anything wrong with you. It’s been an old way of self-soothing, and it doesn’t need to be long-term.”