Do you ever find yourself uncontrollably picking at your skin? For some, picking at acne or pimples is a minor problem that can be treated with simple habit changes. For others, it’s not a matter of will, but a real mental health condition that requires help from a professional.
While it’s natural to pick at a blemish from time to time, those with a condition called skin picking disorder, also called excoriation or dermatillomania, find it impossible to stop the urge to scratch, pick, or pop scabs or pimples on their faces and bodies. A diagnosis of skin picking disorder is made when the habit is either distressing, interfering with daily functioning, or causing severe scarring or injury.
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What is skin picking disorder?
Skin picking disorder, also known as excoriation or dermatillomania, is a condition in which you repeatedly or uncontrollably pick at pimples, scabs, or bumps on the skin, often resulting in scarring or injury. The picking is typically subconscious, which makes it more difficult to stop because it’s hard to notice when you’re doing it. Occasionally picking at a pimple or scab doesn’t qualify as skin picking disorder, though you may also benefit from treatment if you are experiencing scarring or infection.
Medical professionals diagnose skin picking disorder based on the frequency of the habit, whether attempts to stop have failed, the severity of scarring or scabbing, and negative impacts on a person’s lifestyle.
Those that struggle with skin picking may or may not have acne, though acne is a major trigger. In addition to the cosmetic impacts, skin picking can lead to skin infections or blood loss—not to mention the emotional impacts such as shame, depression, and anxiety. The good news is that a combination of at-home remedies, dermatological treatment, and help from a psychologist can minimize or even resolve both your skin picking compulsion and the damage it causes.
Is skin picking OCD?
Not exactly. Skin picking disorder is classified as an impulse control disorder but can also be referred to as a “body focused repetitive behavior (BFRB)”. While they are not the same, there are similarities between the symptoms of skin picking and obsessive-compulsive disorder (OCD)— a mental health disorder characterized by recurrent intrusive thoughts (obsessions) that prompt the people to engage in neutralizing rituals (compulsions). Skin picking disorder also shares similarities with what’s called “obsessive compulsive spectrum disorders”—like trichotillomania (hair pulling disorder), tic disorders, and body dysmorphic disorder.
Some OCD patients suffer from skin picking disorder, although having skin picking disorder does not mean you would have a diagnosis of OCD. “It is the compulsive need to pick that lands this particular disorder in with other obsessive-compulsive and related disorders,” says Kimberley Quinlan, LMFT, a therapist who provides treatment for OCD and other mental health conditions.
One of the main differences between OCD and skin picking disorder is the underlying reason a person engages in repetitive behavior. “An OCD compulsion is always done in response to an unwanted thought, image or urge that provokes a high degree of distress and/or anxiety. The compulsion’s function is always to relieve that anxiety and distress or to prevent something bad from happening,” explains April Kilduff, a licensed therapist and OCD specialist at NOCD.
BFRBs like skin picking, on the other hand, are not necessarily triggered by intrusive thoughts, says Ruth Golomb, a licensed therapist who specializes in treatment of anxiety disorders. Additionally, “there’s some sort of pleasure very often associated with some aspect of the BFRB that is typically not present for OCD.”
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Types of skin picking
Skin picking involves a number of habits or compulsions, including automatic picking, focused picking, or a combination of the two. Most people pick with their hands or fingernails, though it’s also common to use tweezers, needles, scissors, or nail clippers.
Automatic picking
Picking the skin outside of your awareness is known as automatic picking. That means you pick at the skin while focused on another activity like working, reading, driving or watching TV. Research shows that automatic picking is likely to occur in periods of high stress or tension.
Focused picking
Consciously picking at acne, pimples, or the skin in general is called focused picking. If you experience an urge to pick in a certain area of the face or body, or feel a need to remove irregularities like whiteheads or sores, that’s likely focused picking. This type of picking is typically associated with boredom or a specific frustration..
Mixed picking
Classified as a combination of both automatic and focused picking, depending on the trigger or time of day.
Triggers that cause you to pick at your skin and acne
A number of physical and emotional scenarios can cause you to pick at your skin. Acne, particularly hormonal or cystic acne, is one of the most common triggers because of the appearance and frequency of pimples on the face. Other skin conditions like keratosis pilaris (small bumps on arms or legs), as well as things like mosquito bites and blisters may also trigger uncontrollable skin picking. The face, arms, hands and lower legs and feet are the most common areas of the body impacted by skin picking disorder because they are the most visible.
Periods of increased anxiety, stress, shame, and depression can also trigger skin picking, even if you don’t have acne or other bumps. In these instances, skin picking is often a way to cope with negative emotions. Boredom can also be a trigger. “People may turn to picking as a way to relieve their anxiety when they are overstimulated, or because they are under-stimulated and the behavior helps stimulate their nervous system,” explains Kilduff.
People may turn to picking as a way to relieve their anxiety when they are overstimulated, or because they are under-stimulated and the behavior helps stimulate their nervous system.
April Kilduff, MA, LCPC, LMHC
How common is skin picking disorder?
An 2020 study estimated that 2% of Americans actively suffered from skin picking disorder, and 3% had experienced it at some point during their lifetime. Females, on average, are more likely than men to suffer from skin picking disorder. The overall numbers are likely higher when accounting for undiagnosed cases.
How to stop picking your skin: Effective strategies
1. Identify your triggers. Since everyone has different triggers for spin picking, paying attention to yours will help you know what you can do to get better. For example, if you are prone to picking your skin when you have a flare-up of acne, getting help will likely need to involve seeing a dermatologist. On the other hand, if your triggers are strictly emotional in nature, working with a therapist will likely suffice.
2. Create an obstacle. There are several methods that make it harder to pick, including:
- Keeping your nails short
- Wearing gloves or tight fitting clothes
- Applying a face mask or pimple patches
- Using distractions like silly putty or fidget spinners
- Picking up a hobby such as knitting that will keep your hands busy
- Meditation, breathwork, or journaling to calm anxiety and release tension
3. Get the right mix of therapy and (if needed) medication. Skin picking disorder is often treated with a combination of medicine and therapy. Habit-reversal training (HRT) has been shown to be particularly effective at minimizing skin picking habits. HRT has two main components. “The first involves monitoring and tracking the specific details of when the problematic behavior, such as skin picking, occurs,” says Dr. Patrick McGrath, psychologist and Chief Clinical Officer at NOCD. “This process helps people become more aware of their patterns and triggers. By developing increased awareness, they can often reduce the frequency of the behavior itself.” The second component is known as competing response training. With greater awareness of their behavior and triggers, a person can intentionally respond with other actions, such as crossing their arms or gently squeezing their hands into a fist, rather than picking at their skin.
Some people wonder if OCD treatment works for skin picking. The answer? Exposure and response prevention therapy (ERP), which is considered the gold standard treatment for OCD, is a bit different from what’s recommended for skin picking.
When therapy alone isn’t enough, medication may also be included in your treatment plan. While no medication has been formally approved to treat skin picking disorder, there is evidence to suggest that some antidepressants like SSRIs (selective serotonin reuptake inhibitors).and metamine, which is used to help with memory loss in Alzheimer’s patients, can be helpful in addressing underlying symptoms of impulse control disorder.
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When to see a dermatologist for skin picking
As mentioned above, a dermatologist can help treat the physical triggers of skin picking, including acne, keratosis pilaris, moles, and other blemishes. That usually includes topical acne or skin creams, oral medication, or mole removal.
Dermatologists can also help treat cosmetic damages resulting from picking, including infections or scarring, which typically involves laser treatment or ointment. Overall, minimizing the appearance of skin irregularities is helpful in reducing shame or self-consciousness around the appearance of the skin, which is one of the primary causes of skin picking.
When is the right time to see a therapist for skin picking?
If skin picking has started to impede your ability to live the life you’d like to live, professional help is likely necessary. For example, if skin picking has caused you to become self conscious about your appearance, it’s a good time to get treatment, says Dr. Paul Greene, a psychologist who treats BFRBs as director of Manhattan Center for Cognitive-Behavioral Therapy. He adds that if someone finds their behavior concerning and they have a desire to stop, even if it doesn’t visibly affect their appearance or health, seeking treatment can only help.
Golomb agrees: “Even if someone doesn’t pull or pick their skin that much, too many people feel so disheartened because they feel that they’re not in control of their behavior.” Sometimes the outward signs of skin picking are “just a small scab or a small bald spot, but they know it’s there—and they feel so distressed by it because they feel responsible that they’ve done this to themselves. So even if the result is small, the distress can be high, and therefore living with it becomes a huge burden.” If that’s the case for you, help is available—and worth it.