Skin Picking Disorder (Dermatillomania) – Symptoms and Treatment

The primary characteristic of Skin Picking Disorder (also known as Dermatillomania or Excoriation) is the repetitive picking at one’s own skin to the extent of causing damage. Usually, but not always, the face is the primary location for skin picking. However, Skin Picking Disorder may involve any part of the body. Individuals with Skin Picking Disorder may pick at normal skin variations such as freckles and moles, at actual pre-existing scabs, sores or acne blemishes, or at imagined skin defects that nobody else can observe. Individuals with Dermatillomania may also use their fingernails or teeth, as well as tweezers, pins or other mechanical devices. As a result, Skin Picking Disorder may cause bleeding, bruises, infections, and/or permanent disfigurement of the skin.

Sometimes skin picking is preceded by a high level of tension and a strong “itch” or “urge”. Likewise, skin-picking may be followed by a feeling of relief or pleasure. A skin picking episode may be a conscious response to anxiety or depression, but is frequently done as an unconscious habit. Individuals with Skin Picking Disorder often attempt to camouflage the damage caused to their skin by using make-up or wearing clothes to cover the subsequent marks and scars. In extreme cases, individuals with Dermatillomania may avoid social situations in an effort to prevent others from seeing the scars, scabs, and bruises that result from skin picking.

As demonstrated above, Skin Picking Disorder / Dermatillomania has obsessive-compulsive features that are quite similar to OCD, BDD and Trichotillomania. It is sometimes found in individuals with these disorders, as well as in patents with certain medical conditions. In fact, a recent study found that 23% of those with OCD, and 27% of those with BDD, also had Skin Picking Disorder.  

Treatment of Skin Picking Disorder / Dermatillomania

The primary treatment modality for Skin Picking Disorder / Dermatillomania is a combination of various types of Cognitive-Behavioral Therapy (CBT). Perhaps the most important of these is called Habit Reversal Training (HRT). HRT is based on the principle that skin picking is a conditioned response to specific situations and events, and that the individual with Dermatillomania is frequently unaware of these triggers. HRT challenges Dermatillomania in a two-fold process. First, the individual learns how to become more consciously aware of situations and events that trigger skin picking episodes. Second, the individual learns to utilize alternative behaviors in response to these situations and events.

Other Cognitive-Behavioral Therapy techniques can be used as adjuncts to HRT in the treatment of Skin Picking Disorder. Among these are Stimulus Control techniques and Cognitive Restructuring. Stimulus Control techniques involve utilizing specific physical items as “habit blockers” to restrict the ability to pick skin, while Cognitive Restructuring helps an individual with Dermatillomania learn to think differently in response to the urge to pick their skin.

One of the most effective CBT developments for the treatment of Skin Picking Disorder is Mindfulness-Based Cognitive Behavioral Therapy. The primary goal of Mindfulness-Based CBT is to learn to non-judgmentally accept uncomfortable psychological experiences. From a mindfulness perspective, much of our psychological distress is the result of trying to control and eliminate the discomfort of unwanted thoughts, feelings, sensations, and urges. In other words, our discomfort is not the problem – our attempt to control and eliminate our discomfort is the problem. For those with Skin Picking Disorder, the ultimate goal of mindfulness is to develop the ability to more willingly experience their uncomfortable thoughts, feelings, sensations, and urges, without picking their skin. To learn more about Mindfulness Based CBT for the treatment of Dermatillomania / Skin Picking, click here.

Individual Therapy for the Treatment of Skin Picking Disorder / Dermatillomania

The OCD Center of Los Angeles offers individual therapy for the treatment of adults, children, and adolescents with Skin Picking Disorder / Dermatillomania. Using the Cognitive Behavioral Therapy techniques outlined above, clients with Skin Picking Disorder learn to respond differently to thoughts about their skin, and to resist the urge to pick their skin.

We have 14 therapists on staff, and offer services six days a week, including evenings and Saturdays. If you would like to discuss treatment options at the OCD Center of Los Angeles, please call one of our client coordinators at (310) 824-5200 (ext. 4), or click here to email us.

Group Therapy for the Treatment of Skin Picking Disorder / Dermatillomania

In addition to individual therapy, the OCD Center of Los Angeles also offers six weekly, low-fee, therapy/support groups for adults with OCD and related conditions, including a group exclusively for adults with Dermatillomania and Trichotillomania. This group is led by one of our professional staff therapists, Chanel Taghdis, MA, and uses the same treatment protocol as our individual Cognitive-Behavioral Therapy program. Our weekly Dermatillomania / Trichotillomania group meets online via webcam each Thursday evening. This group is limited to eight (8) members, and requires an assessment prior to participation. Please note that this group is limited to residents of California. For more information on any of our five weekly low-fee groups, please click here. 

Telephone and Online Therapy for the Treatment of Skin Picking Disorder / Trichotillomania

The OCD Center of Los Angeles also offers webcam based online therapy and telephone therapy to clients around the world suffering with Skin Picking Disorder / Dermatillmania. Telephone and online therapy are cost-effective options for clients who have physical and/or psychological limitations that restrict their ability to come to our office, and for those in remote areas who cannot find specialized Skin Picking Disorder / Dermatillomania treatment close to their home.Telephone and internet therapy have repeatedly been found to be safe and effective in numerous research studies, and have been legal in California since 1997. If you would like to learn more about telephone and online therapy for Skin Picking Disorder / Dermatillomania, please click here.

Intensive Treatment for Skin Picking Disorder / Dermatillomania

We also offer an intensive treatment program for adults, adolescents, and children with Dermatillomania / Skin Picking Disorder. This program is designed to meet the needs of those for whom standard outpatient Dermatillomania treatment is either unavailable or insufficient. 

Our intensive outpatient program is ideal for clients from other states or countries who cannot find effective treatment near to their homes, and for those whose symptoms require a more rigorous treatment protocol. To learn more about our intensive outpatient treatment for Dermatillomania / Skin Picking Disorder, click here.

About the OCD Center of Los Angeles

The OCD Center of Los Angeles is a private outpatient treatment center specializing in Cognitive Behavioral Therapy (CBT) for the treatment of OCD and related conditions, including Dermatillomania. We have 13 therapists on staff, all of whom are either licensed or registered, and all of whom specialize in CBT.  We treat adults, adolescents, and children, and offer services six days a week, including evenings and Saturdays.

Our Southern California office is located in Brentwood.

If you are experiencing any of the above symptoms of Dermatillomania / Skin Picking Disorder, and would like to discuss treatment or a consultation, please call one of our client coordinators at (310) 824-5200 (ext 4), or click here to email us.

You can also click here to read our article “Excoriation (Skin Picking) Disorder, aka Dermatillomania”.

Please note that the above is not meant to replace a complete and thorough evaluation by a licensed Cognitive-Behavioral therapist or other qualified mental health professional. As with OCD, some individuals with Skin Picking Disorder / Dermatillomania may benefit from medication, and may therefore require a psychiatric evaluation. Likewise, a psychiatric assessment may be necessary to differentiate between Skin Picking Disorder and other psychological conditions. If a psychiatric evaluation is indicated, the OCD Center of Los Angeles can refer you to a qualified psychiatrist in the our area. Furthermore, it is imperative to make the distinction between Skin Picking Disorder and other medical conditions. For this reason, a medical examination may be necessary.