Compulsive Skin Picking (Excoriation Disorder) Symptoms
It is not uncommon for any of us to pick the occasional pimple or black head. However, people who experience Dermatillomania, also known as Compulsive skin picking, Picking Disorder, Obsessive Skin Picking, or Excoriation Disorder experience strong urges to pick their skin and struggle immensely to resist their urges, despite genuine desires to do so.
It’s estimated that between 2-5% of the population suffers from Excoriation Disorder or Skin Picking Disorder. Excoriation Disorder can begin at any age, but most commonly begins between 11-15yrs old. Common examples of include scalp picking, chest and face picking, nail picking, cuticle picking, and lip picking. However, these behaviors can be focused anywhere on one’s body.
Excoriation Disorder Symptoms
- Recurrent and frequent skin picking or picking scabs that may consume many hours per day
- The experience of a “trance” when picking their skin, scalp, lips or nail biting.
- Excoriated skin
- Scalp scabs
- Peeling scabs, touching scabs or rubbing scabs
- Tissue damage
- Skin picking anxiety- involves anxiety about when, where and how one will pick their skin in the future
- Skin picking that interferes with daily life and daily functioning
- Hours spent trying to cover up damaged skin with clothing, makeup, first aid products, etc. Withdrawing from social settings/developing social anxiety out of fear of judgment
- Stress, anxiety, and/or depression from not being able to control oneself
- Recurrent picking of skin that commonly results in skin lesions, scalp problems, skin conditions, infections, and scarring.
What causes this condition?
There is no one exact cause of Excoriation disorder. However, one important step of learning how to stop picking your skin involves identifying the stressors and triggers that cause your urges.
Common reasons people engage in skin picking, lip biting, and nail biting include:
- The desire to remove skin imperfections such as small skin bumps, acne, pimples, skin scabs or scalp scabs.
- As a response to stress, anxiety, or panic
- As a response to boredom, or lack of stimulation
- Habit
- After the onset of a skin condition such as acne, seborrheic dermatitis, head lice or damaged skin or hair follicles.
- Some medication can cause the onset of these symptoms. For those who are on medication for ADD or ADHD skin picking may be the result.
- Some may also engage in OCD skin picking. OCD Skin Picking involves skin picking that is done as a compulsion to remove the anxiety, uncertainty, doubt or disgust. Your therapist would need to do a thorough clinical obsessive compulsive disorder test and a clinical Dermatillomania test to identify if this type of skin picking is present.
How to Stop Skin Picking
Overcoming these and other body-focused repetitive behaviors such as trichotillomania is not as easy as a quick Google search of “how to stop picking your nails” and is not just a matter of willpower. Many patients come to us feeling hopeless after being told by medical and mental health professionals that they just need to “stop procrastinating” or “just stop” picking their skin. While their intentions may have been good, this advice is not only unmotivating, but it can also be damaging, causing you to beat yourself up emotionally for not being able to stop these behaviors.
Our staff are all thoroughly trained in Cognitive Behavioral Therapy (CBT), the gold-standard treatment for Excoriation Disorder. There are two components of CBT that can help you to learn how to stop picking your lips, skin and nails. The first complement is Cognitive Therapy. Cognitive Therapy teaches you how to identify when you are experiencing urges and triggers, as well as how to restructure your unhelpful distorted thoughts into more rational, reasonable and helpful thoughts. The second component is Behavioral Therapy. Behavioral Therapy involves making small but significant behavioral changes that will help you manage life stressors, change how your respond to your thoughts and urges, and retrain and teach you how to stop picking cuticles, skin and other skin areas.
Compulsive Skin Picking Disorder Treatment
Habit Reversal Training (HRT) is a specific science-based behavioral modality used by our staff to help you reduce your urges and strategically plan for triggers and urges. Habit Reversal Training involves strategic implementation of physical blockers (such as wearing gloves, lip gloss or fake nails etc.) and competing response (such as the use of fidgets, silly putty or other interventions etc.).
We also teach our patients and clients how to implement mindfulness skills into their daily life. Mindfulness can be an incredibly helpful tool to increase awareness of our behaviors, which is incredibly helpful for those who pick habitually or unconsciously. Mindfulness training also teaches you how to tolerate uncomfortable thoughts, feelings, and sensations commonly experienced in excoriation disorder. (Read more about Mindfulness here)
Lastly, research has shown that implementation of compassion-focused therapies can improve your recovery success and can increase relapse prevention. People who struggle with these symptoms often treat themselves poorly and engage in a lot of self-criticism and self-punishment. As a part of our behavioral inventions, we will help you identify these self-punishing behaviors and instead use self-compassion and self-care strategies to help you tend to the struggles you are having instead of being hard on yourself. We all know that self-criticism is not a very effective form of motivation, so we aim to help you practice other forms of motivation, instead of self-punishment.
Our therapists are all highly skilled in assessing and treating Excoriation Disorder. It is important to note that there are co-existing mental struggles such as obsessive compulsive disorder, panic disorder, social anxiety, post traumatic stress disorder, or an eating disorder that may impact treatment and recovery. Our clinicians will be sure to do a thorough assessment to rule out any other diagnosis that may interfere with your treatment and long term recovery.
