Understanding Skin Picking Disorder: Causes and Treatments

April 2, 2024

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Excoriated skin refers to skin that is damaged from repetitive picking and scratching, often due to underlying psychological issues. This article provides an in-depth look into the causes, symptoms, diagnosis and treatments for chronic skin excoriation syndrome encompassing conditions like skin picking and skin picking disorder (dermatillomania).

What Causes Excoriated Skin?

Excoriated skin results from habitual rubbing, squeezing, biting or picking of one’s own skin over months or years leading to visible tissue damage.

Underlying psychiatric causes include:

  • Obsessive compulsive disorder (OCD) – sub-type with compulsive skin picking urges
  • Body-focused repetitive behaviors (BFRBs) – impulse control issues
  • Addiction – skin picking activates reward centers in the brain
  • Anxiety/stress – picking is an emotional relief outlet

Certain medications, substance abuse and medical issues like psoriasis, scabies etc. can also trigger skin picking behavior.

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Key Features of Chronic Skin Picking

People with maladaptive skin picking disorder tend to picker skin on arms, face, hands, shoulders and legs. Common characteristics include:

  • Picking for hours daily despite negative consequences
  • Failed efforts to reduce or stop picking
  • Significant distress or functional impairment

Skin lesions thus caused may bleed, bruise, scar or get infected. This can cause social, emotional and physical distress.

Diagnosing Skin Picking Disorder

Diagnosis involves:

  • Physical examination of skin
  • Assessment of behavior patterns
  • Clinical evaluation for underlying disorders
  • Ruling out substance use

Skin picking disorder is classified under “obsessive-compulsive and related disorders” in the DSM-5 diagnostic manual.

Evidence-Based Treatment Options

An integrated treatment plan with medical, psychological and self-directed components works best.

Habit Reversal Training

Habit reversal training (HRT) is a form of behavioral therapy proven effective for addressing maladaptive skin picking. Steps include:

  • Identifying triggering cues
  • Relaxation techniques
  • Competing response development


Pharmacotherapy like SSRIs may augment behavioral training for skin picking disorder. Research shows:

  • Fluoxetine helped reduce picking frequency
  • Clomipramine and fluvoxamine trials had mixed results

Online Self-Directed Training

Studies on self-guided online programs based on evidence-based methods like HRT show reduced skin picking frequency, severity and related distress. These are more convenient and low-cost.

Support Groups

Joining a community like the TLC Foundation for Body-Focused Repetitive Behaviors provides validation, tips and resources for managing skin picking challenges among those with neurotic excoriation.

Prevention of Skin Picking Disorder Recurrence

Preventative strategies include:

  • Identifying emotional and situational triggers
  • Managing stress with self-care
  • Removing objects around house that enable picking
  • Keeping hands occupied and skin covered
  • Celebrating every skin picking-free day

Seeking therapy at first signs of skin damage can help mitigate long-term tissue destruction and scarring.

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FAQs about Skin Picking Disorder

Is skin picking a mental disorder?

Yes, chronic skin picking is classified as an obsessive-compulsive related disorder in the DSM-5. It is also considered a body-focused repetitive behavior (BFRB) reflecting underlying psychological factors.

How do you stop skin picking disorder?

Stopping skin picking involves a combination of habit reversal training, medical support, lifestyle changes and community support. Identifying triggers and managing anxiety is key.

Can you overcome dermatillomania?

Skin picking disorder or dermatillomania is challenging to overcome but possible in many cases through diligent mental health treatment and self-care strategies. Long term remission requires sustained lifestyle changes.

What medication is used for skin picking?

Antidepressants like SSRIs (fluoxetine, fluvoxamine) show efficacy for skin picking disorder. Anti-anxiety meds, mood stabilizers and opioid antagonists may also help in some cases along with behavioral therapy.

Does skin picking cause infection?

Yes, chronic skin picking can result in bleeding, bruises, scabs and skin lesions prone to fungal, viral and bacterial infections. Picking should be avoided and medical care sought for infections.

In Summary

  • Repetitive, compulsive skin picking leading to bodily tissue damage is termed excoriated skin.
  • Chronic skin picking arises from underlying psychological triggers like OCD, BFRBs and emotional disorders.
  • Diagnosis is through physical, behavioral and psychosocial assessments.
  • Treatment takes a multi-modal approach of habit reversal training, meds and lifestyle changes.
  • Avoiding triggers, managing stress, and seeking timely care prevents recurrence.
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