Last updated 03/19/2021
Skin picking also called Dermatillomania or Excoriation disorder is a BFRB. It consist of grooming habits that involve; repeated touching, rubbing, scratching, digging, picking, peeling, pulling, biting or scraping the skin, turn compulsive and cause damage to the body leaving painful sores.
It is common to have both dermatillomania and trichotillomania (hair pulling). More people are familiar with hair pulling.
Disclaimer: This website is for informational purposes and not for diagnosis.
The skin picking disorder that many aren’t aware exist, officially became a diagnosis in 2013. This disorder lacked research studies and treatment options.
Those who are skin pickers may have the irresistible urge to pull off their scab as soon as it forms. Even while possibly realizing they shouldn’t be doing this they simply can’t help it. There is an opportunity provided if something can be picked; lesions, acne, insect bites and hangnails. It doesn’t matter if bleeding should occur.
The BFRB may have been misdiagnosed in the past as a compulsive order but there are differences. While there are similarities between the two and skin pickers seem more likely to also have OCD and anxiety.
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) has listed it in a new category called ‘obsessive compulsive disorder and related disorders’. There has been the misconception that skin picking is not a mental health problem.
OCD is controlled by obsessions (such as thoughts and worries that something bad will happen) and the compulsion aims to prevent these uncomfortable feelings. While compulsively picking the skin serves more as a tension /stress reliever, or the skin picker is trying to fix/remove something that doesn’t look perfect to them, instead of dealing with the uncomfortable thoughts.
So skin picking is usually considered an impulse control problem versus OCD which is more driven by anxiety.
Are you a Skin Picker?
Obviously, everyone may have picked at something at one time on the skin. This does not mean you are a skin picker. It is important to take into account the time spent on the activity, as well as any distress this may cause you. Helpful questions to ask are:
- How often are you doing this?
- Is this interfering with my life?
- Is this behavior happening even though I don’t notice it?
- Is this causing visible scars and damage?
- Is this problem really upsetting me?
- Is this what I really want to be doing?
- Can I just walk away and start doing anything instead?
Skin Picking Results with
Skin picking brings other concerns. If you find this a common occurrence for you, please consider pursuing some action.
- Tissue damage
Skin Picking Treatments
Like OCD skin picking treatments may include cognitive behavioral therapy (CBT) and maybe an SSRI antidepressant.
CBT is the most common treatment for BFRBs. It involves a therapeutic approach that aims on the person’s thoughts, feelings and behaviors resulting in improvement of the behavior. Treatment is structured on the person’s needs. Especially useful, the Habit Reversal Training (HRT) where focus is on becoming aware of their unconscious habit and training to turn to alternative actions.
The techniques that are used:
- Social Skills Training (assertiveness training and anger management)
- Dialectic Behavioral Therapy
Help for Skin Picking
In addition to consulting your doctor and joining a support group to discuss the problem, here are some other tips.
Identify triggers – Be aware of places where the most time is spent picking. For example, are you picking more in front of your bathroom mirror or your work desk? Knowing this you can actively try to stop the behavior. Posting a note on your mirror or desk with some encouraging words should get your attention. To prevent a long picking session, setting a bathroom timer might also be useful. Put into practice to pay attention when and where you are picking.
Soothing cream – Placing a jar of soothing cream by your mirror (or the place you pick at/pack in your bag) would draw you instead. A cream with aloe vera is good to take away redness. This offers a healthy habit that feels better. It gives a positive effect helping with healing both emotionally and physically with the soreness and appearance.
Create a barrier – Use of a thick cream can put distance between picking and your skin. An essential oil that can be applied directly to the skin can leave an oily, smooth surface. For pimples, you may purchase salicylic acid patches used in acne products. By putting the small clear stickers on, you can’t get at the pimple. Bonus, the sticker helps the pimple heal quickly. You can also place tape or bandages on a few fingers to make picking harder. Or wear pretty gloves! Make a fashion statement.
Fidget Toy (aka stress ball, fiddle toy) - For a welcome distraction occupy your hands with a fidget toy, stress ball (crochet your own) or a piece of ribbon. Having a bracelet or a loose rubber band/ponytail band around the wrist can also be used to keep hands busy. But don’t cause a distraction to others by snapping too loudly.
Scribble/doodle – Getting in the habit of scribbling or doodling when you feel hands drawn to your skin may relieve tension.
Knitting or crocheting can also be helpful with busy hands. You may do this anywhere other than class, use common sense.
Keep clean – By all means. With the regular use of hand sanitizer these days this should be easy as we have all formed this habit. But if you pick and use any tool (tweezers, pin, hairclip) this as well as the affected area, should all be sanitized. This helps to prevent infections. MRSA can be deadly.
Other Body-Focused Repetitive Behaviors
- Nail biting (onychophagy or onychophagia)
- Nail picking (Onychotillomania)
- Cheek biting (morsicatio buccarum)
- Lip biting (Morsicatio labiorum)
- Knuckle cracking
- Tooth grinding (bruxism)
- Nose picking (rhinotillexomania)
- Tongue biting (Morsicatio Linguarum)
With help these behaviors can improve or stop. You are not alone.
Do you have any of these behaviors? Which one?
https://www.bfrb.org/learn-about-bfrbs/treatment/therapy accessed 10/01/2020
https://www.lecturio.com/magazine/cognitive-behavioral-therapy/ accessed 10/01/2020