Excoriation Disorder (Skin-Picking Disorder): Information, Symptoms, Treatment and More

Excoriation Disorder, also known as Skin-Picking Disorder or Dermatillomania, is a mental health condition which involves an individual having an irresistible need to pick at their own skin – which normally results in skin lesions.

The condition is difficult to live with and makes an individual vulnerable to developing medical issues such as scars and infections.

Excoriation Disorder is closely linked to Obsessive-Compulsive Disorder and is an Obsessive-Compulsive Spectrum disorder.

Someone with this condition will often feel an overwhelming urge to pick at their own skin, and will experience intense tension until they perform the act. They may also pick at their skin in response to stress. However, relief is typically short-lasting, resulting in a vicious cycle developing.

What are the symptoms of Excoriation Disorder?

As with other conditions on the obsessive-compulsive spectrum, an individual with Excoriation Disorder will often have obsessions and compulsions:

Obsessions: An obsession is an unwanted and unpleasant thought, doubt, image or urge that repeatedly enters a person’s mind. As a result, the person experiences anxiety or general unease. Examples include fear of contamination, and a need to organise items symmetrically.

Compulsions: A compulsion is a repetitive action that the person then carries out to temporarily relieve the anxiety brought on by the obsession. Examples include rituals, checking and reassurance.

In terms of Excoriation Disorder, the person involved will feel an overwhelming urge to pick at their skin. Until they do so, tension will grow – eventually to the point where it becomes unbearable.

Once the individual does pick at their skin, temporary relief will follow. But soon enough, the cycle starts again, and becomes nearly impossible to escape. Sometimes, the actions are related to stress.

In terms of the signs and symptoms, the individual will normally:

• Want to stop picking at their skin, but feel unable to do so
• Be unable to stop picking at their skin
• Sometimes not realise they are picking at their skin
• Exhibit a range of cuts, bruises or lesions from their skin-picking
• Target specific areas like freckles, acne or scars in an effort to change their appearance
• Pick at their skin when asleep
• Will often pick at their skin in times of stress
• Will commonly spend significant time either picking, or thinking about picking.

The cycle will often begin with a stressful event or situation. As a result, the person may feel a compulsion to pick at their skin. The person may believe that by picking at their skin, that they will relieve their stress.  

The individual will normally use their fingers or fingernails to pick at their skin. Sometimes, they may resort to using their teeth, or use scissors, razors or tweezers. Any area of the skin may be targeted, though commonly picked areas include the face, arms, legs and torso. They may leave one area to heal, before picking a new area.

In most cases, bruises and skin lesions will follow, which can worsen an individual’s appearance. This will normally lower their self-esteem to the point where they don’t want to see others. This causes impairment in a range of contexts, and understandably causes significant distress.

Excoriation Disorder may also run alongside another mental health condition, such as Depression or Anxiety. Excoriation Disorder also appears to be linked with substance abuse [1].

What are the causes of Excoriation Disorder?

While the causes of Excoriation Disorder aren’t entirely known, there are a few factors that appear to be involved in its onset.

Genetics appears to be an important area – with Obsessive-Compulsive Spectrum disorders commonly running in families [2].

The way that a person processes stress is important. While everyone has stress and anger to deal with, most people are able to process these feelings in a way that doesn’t cause problems. But those with Excoriation Disorder react to stress by picking their skin. It is easy for this to become a habit.

Certain personality traits can play a role. For example, those with low self-esteem are likelier to have the condition. Any traumatic event could cause Excoriation Disorder, including childhood maltreatment [3].

Moreover, those who feel badly about themselves may be desperate to correct a supposed blemish or issue – and may resort to skin-picking to achieve this. Those with particular blemishes, or heavy acne, may try and get rid of their appearance by skin-picking.

It has also been suggested that hormonal changes may cause Excoriation Disorder. The majority of Excoriation Disorder cases develop around puberty – which is when hormones change rapidly. There may be a distinct link between these areas.

It seems that a wide range of factors can be involved in the onset of Excoriation Disorder. Many of these factors, or maybe just one area, may be responsible for the onset of the condition.

Diagnosis of Excoriation Disorder

It is important for an individual to see a Doctor or mental health professional if they are suffering from the symptoms of Excoriation Disorder.

It is sometimes down to the parent or a close friend of someone with Excoriation Disorder to notice the symptoms and stage an intervention. An individual who picks at their skin may not wish to seek treatment out of feelings of guilt and shame.

It can normally be determined relatively easily if an individual has Excoriation Disorder, due to the otherwise-unexplained appearance of bruises, cuts or lesions. An individual will often admit to picking their skin.

In any case, at first, an appointment should be made with a Doctor. At an appointment, a doctor will have an in-depth discussion with their patient and ask several questions. They will ask questions about the severity of symptoms, possible causes, and the impact of the symptoms on day-to-day functioning.

An individual may be referred to a specialist for diagnosis. A referral to a dermatologist may also follow if skin is seriously damaged, or if the Doctor believes an underlying condition e.g. Eczema or Acne may be present.

In terms of the diagnostic criteria for Excoriation Disorder, the following should be met:

• The patient has the urge to pick at their skin
• The individual then carries out this urge
• If this doesn’t happen, the individual experiences emotional distress
• The individual will have attempted to ignore their urge to pick at their skin
• The symptoms cause disruption in the day-to-day life of an individual
• The symptoms cannot be attributed to substance abuse
• The symptoms aren’t better explained by a different mental health condition

How is Excoriation Disorder treated?

Treatment is available for Excoriation Disorder, with the aim of full recovery from symptoms. While this is always the objective with treatment, sometimes an individual may not be able to recover.

However, at the very least, the impact of their symptoms should lessen. Treatment generally involves self-help and talking therapy. In severe cases, medication may be prescribed.

Self help

Certain things can be done that may facilitate an improvement in symptoms. Many people find that using a stress ball or toy can act as a suitable substitute for skin-picking.

Wearing gloves or clothes that cover the body may also provide an individual with less of an urge to pick at their skin. Following the picking of skin, applying a moisturiser or other cream may help prevent damage.

As with any other mental health condition, regular exercise, consistent sleep and a healthy diet can be beneficial.

Talking Therapy

Excoriation Disorder is primarily treated by Cognitive Behavioural Therapy (CBT). CBT can help an individual become more aware of their thoughts, and the damage they can do. An attempt will be made to make an individual replace their skin-picking with a less harmful behaviour.

Cognitive Behavioural Therapy (CBT): CBT is a type of therapy that is used to treat a range of mental health conditions. CBT involves an individual talking face-to-face with a therapist, although sometimes CBT can be conducted in a group setting. CBT attempts to improve an individual’s wellbeing and mood. The therapy focuses on the link between thoughts, feelings and actions. This can be useful for those with low self-esteem, anxiety, unhelpful personality traits or intrusive thoughts. CBT can help an individual understand their feelings more, and in the long run should lead to an improvement in quality of life.

If CBT doesn’t work, then there are a range of other types of talking therapies available. Therapy is recommended as the first line of treatment as there are many ways it can help. We have more information on our Therapy section.

Medication

In cases where talking therapy alone may not provide relief, an individual may be prescribed medication. The medication normally used for Excoriation Disorder are antidepressants, though they may be prescribed by a specialist, as opposed to a Doctor.

Antidepressants will need to be taken for a few months after cessation of symptoms in order to prevent relapse.

Antidepressants: Antidepressants can help to improve and regulate mood. They should improve motivation and restore energy. SSRI Antidepressants are the most commonly prescribed. They act on the brain chemical serotonin – which is thought to help in regulating mood and emotion. They may include side-effects such as a dry mouth, sexual problems and nausea, though these should hopefully be short-term. Other classes of antidepressants are available in the event of an inadequate reaction.

Summary

Excoriation Disorder has the potential to cause significant distress in an individual. But as seen, treatment is available, which should hopefully lead to an individual recovering from their symptoms, and leading a healthier life.  

It is important and highly recommended that anyone suffering with their mental health seeks help. There is plenty of information on our website to assist you.

See Also

• Obsessive-Compulsive Spectrum Section
• What is the Prognosis for Obsessive-Compulsive Spectrum Disorders?
• Therapy Homepage
• Medicine Homepage