By Katie Distaso
What Is Excoriation (Skin-Picking) Disorder?
Excoriation disorder is a skin picking disorder and can manifest in a repetitive and compulsive picking of the skin and only affects an estimated 2% of people. Occurring in both men and women although, women are affected more and typically begins during childhood or adulthood. This disorder is characterized with the need to pick at one’s skin causing bleeding, cuts, or bruising. Most frequently people with this disorder find imperfect places on their body to make perfect. For example, picking at a mole or scars and trying to make them smooth. Feelings of stress or anxiety can induce this behavior. Oftentimes this condition is in a category called body focused repetitive behaviors (BFRBs) which are classified as Obsessive-Compulsive Disorder (OCD). Furthermore, OCD can be described as an automatic behavior which can be very damaging because people do not always realize that they are in a picking episode. Oftentimes people are heavily focused on something else while the picking occurs. This type of obsessive picking goes beyond an occasional imperfection, people with this disorder engage in picking behaviors in which they are left with severe tissue damage, causing day to day life to be interrupted with pain and emotional discomfort.
Causes:
- Genetic component linked to BFRBs
- A variety of mood and anxiety disorders such as negative moods, ADHD, depression or anxiety itself
- Can also be linked to perfectionism
- To avoid a stressful situation or event
- Boredom
Symptoms Include:
- Recurrent skin picking results in skin lesions
- Repeated attempts are made to decrease or stop skin picking
- Skin picking causes clinically significant distress such as shame, embarrassment or feeling a loss of self-control
How Does Excoriation Disorder Affect Mental and Physical Health?
Days after a picking episode some wounds become so deep that they require first aid and medical care to wrap up the wound. Picking on legs and feet are common, in which limping and other mobility issues can result from a session.
Oftentimes these prolonged periods of picking will not only lead to physical damage but as well as severe distress and self blame. Trying to hide visible injuries or feelings of shame when they are out in public can become a source of anxiety, self isolation and depression. There are two types of picking: automatic and focused. Automatic picking is characterized as “scanning” because it involves running fingers over their skin to find an area that feels different from the rest. OCD and other repetitive behaviors can leave people feeling frustrated because of the automatic or unconscious nature of the disorder. The other type of picking is focused; which involves the “focusing” on a specific area on the skin and picking can take place here for hours.
Such mental abnormalities can impact their work and social lives making it important to remember to be honest about your condition, see your healthcare provider and get mental health support to unlearn harming behaviors.
Treatment Options
Treatment with people who have dermatillomania often includes;
- Cognitive behavioral therapy helps patients through talk therapy about possible causes or triggers
- Acceptance and commitment therapy will help people accept their behaviors and understand its cause or purpose
- Habit reversal training (HRT) helps clients recognize potential triggers and to be aware of their picking, often times finding safe behaviors to replace their skin picking
- Group therapy and peer support can provide benefits and create a sense of community when on the path to recovery.
References
“Dermatillomania (Skin Picking).” Cleveland Clinic, 11 Apr. 2022, https://my.clevelandclinic.org/health/diseases/22706-dermatillomania-skin-picking.
“Dermatillomania (Skin Picking).” Psychology Today, Sussex Publishers, 5 May 2021, https://www.psychologytoday.com/us/conditions/dermatillomania-skin-picking.
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition … https://www.appi.org/dsm-5-tr.
“Skin Picking Disorder.” NHS Choices, NHS, 24 Mar. 2021, https://www.nhs.uk/mental-health/conditions/skin-picking-disorder/
