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Excoriation (Skin Picking) Disorder, aka Dermatillomania

Excoriation (Skin Picking) Disorder is an obsessive-compulsive spectrum condition in which sufferers repeatedly pick at their skin. Crystal Quater, MMFT, of the OCD Center of Los Angeles discusses her personal experience with, and recovery from, Excoriation Disorder, and how she treats clients struggling with this condition.


Excoriation (Skin Picking) Disorder, aka Dermatillomania
Excoriation (Skin Picking) Disorder, also known as
Dermatillomania, can be effectively treated with
Cognitive Behavioral Therapy (CBT).

“I’m not going to do it, I’m not going to do it”I repeatedly thought on my way home from work. Yet, once again, I found myself in front of my bathroom mirror, picking at those pesky bumps that wouldn’t seem to go away. When something came out, I felt an overwhelming sense of relief and accomplishment.

Next, I grabbed a needle that I had carefully hidden in a small bathroom drawer and went to town on the stubborn bumps that didn’t respond to mere picking. I thought I was being clever by creating smaller incisions and doing what I imagined my facialist did when my eyes were closed. But when I finished, all I saw were raw wounds and a face that looked worse than it did before. I was left wondering how I would ever face the outside world with my unmistakable marks of humiliation.

Unfortunately, it was often difficult to remind myself of these painful episodes the next time I had the urge to pick. That’s because I always thought “I can resist the urge this time”.

If you’ve ever suffered from the seemingly irresistible urge to pick at your skin, you may have experienced a similar thought process. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), calls this condition “Excoriation (Skin Picking) Disorder”, but it has historically gone by any number of other “unofficial” names, including Dermatillomania, neurotic excoriation, acne excoriee, psychogenic excoriation, pathological skin picking, compulsive skin picking, and chronic skin picking. It was formally introduced as an “official” diagnosis into the DSM-5 in 2013 after much debate over whether skin picking symptoms were evidence of a distinct condition, or were better explained by another underlying disorder such as OCD, or were just a “bad habit”. Ultimately, the psychiatric establishment and the editors of the DSM-5 categorized it as a separate and distinct diagnosis within the larger category of “OCD and Related Disorders”. In other words, it’s not OCD per se, but it has enough features that are similar to OCD that it is classified as being related to OCD.

Excoriation (Skin Picking) Disorder is defined by the following symptoms:

  • Recurrent skin picking resulting in skin lesions.
  • Repeated attempts to decrease or stop skin picking.
  • The skin picking causes significant distress or impairment in social, occupa­tional, or other important areas of functioning.
  • The skin picking is not attributable to the physiological effects of a substance (e.g., co­caine) or another medical condition (e.g., scabies).
  • The skin picking is not better explained by any of the following:
    • Symptoms of another mental disorder (e.g., delusions or tactile hallucinations in a psychotic disorder,
    • Attempts to improve a per­ceived defect or flaw in appearance in Body Dysmorphic Disorder (BDD),
    • Stereotypies in ste­reotypic movement disorder
    • Intention to harm oneself in non-suicidal self-injury).

Excoriation (Skin Picking) Disorder is also less formally described as a Body Focused Repetitive Behavior (BFRB), along with similar conditions such as Trichotillomania (Hair Pulling Disorder), Onychophagia (Compulsive Nail Biting), and compulsive cheek biting. All of these conditions have one thing in common – the repeated touching of one’s body in ways that result in physical damage.

BFRBs are often brought on by anxiety, boredom, physical tension, or other emotional states that leave a person longing for relief. Many sufferers also pick at slight imperfections, pimples, ingrown hairs, calluses, or scabs using their fingernails, tweezers, needles, or other sharp objects. Some may also examine, touch, or swallow any of their removed pieces of skin or scabs.

Skin picking episodes may last anywhere from less than a minute to several hours. For some, their picking is the result of a conscious effort, while for others it is an automatic, unconscious process of which the individual is unaware. And if the perceived “flaw” is successfully removed, the sufferer may feel a sense of gratification or pleasure. Conversely, depending on the severity of the damage, the individual may become socially withdrawn and very insecure about the appearance of their skin. As a result, Social Anxiety Disorder is a common comorbid condition for some struggling with Skin Picking Disorder. Likewise, many people with this condition also experience Body Dysmorphic Disorder (BDD).

While the above explains much of what defines Excoriation (Skin Picking) Disorder, it’s equally as important to define what this condition is NOT:

  • Some therapists tell their clients that their picking is a form of self-harm and that they are intentionally punishing themselves. This can be confusing to hear since picking often starts out as a pleasurable act, but ultimately causes feelings of guilt and shame once the damage has been done. Conversely, self-harm is typically fueled by the need to regulate one’s mood and externalize or release intense emotions by creating pain.
  • Virtually everybody picks at his or her skin as a part of normally grooming. But normal pimple popping is not the same as Dermatillomania. Unfortunately, many people have difficulty drawing the distinction between simply popping a pimple or two, versus meeting the diagnostic criteria for Excoriation (Skin Picking) Disorder. Those with this condition frequently, repeatedly, and compulsively scan their skin either with their fingers or by closely examining it in the mirror before picking. Conversely, the casual pimple popper does not generally pick compulsively at their skin, does not frequently spend time looking for the minor imperfections, and does not experience the extreme sense of guilt and shame once they’ve completed the act.
  • Although Excoriation Disorder is grouped in with OCD in the DSM-5 due to some similarities, there is a significant difference in the intention behind the behaviors that distinguish these two conditions. People diagnosed with OCD do not generally want to engage in their compulsions, but do so in an effort to relieve themselves of the profound anxiety they experience in response to specific obsessive thoughts. Conversely, Dermatillomania is often experienced in the moment as a strong desire or urge. In fact, many sufferers report initially feeling gratification or even pleasure when they pick. It is the undeniable consequences of their picking – the blood, the scabs, the scarring – that leads to so much self-loathing.
  • Many well-meaning doctors, family members, and others often label this picking behavior as “just a bad habit”. Most people who suffer from Excoriation (Skin Picking) Disorder have attempted to interrupt their behaviors numerous times and become deeply frustrated with how difficult this can be. Labeling skin-picking as “merely a bad habit” ignores the complexities and profound emotional pain associated with this disorder.

Excoriation-Skin Picking-Dermatillomania e-courseFor many people struggling with Dermatillomania, the discomfort of having their struggle described as “just a bad habit” is further compounded in therapy because one of the main treatment modalities used to treat this condition goes by the unfortunate moniker of “Habit Reversal Training (HRT)”. In fact, it is not unusual for this name to lead those seeking treatment to reject a therapeutic approach that can be extremely effective in reducing or eliminating their symptoms.

Unfortunately, some clients hear the word “habit” and immediately assume that their therapist is assailing their “weak” character, or suggesting that their picking is “merely” a simple habit that a stronger person would be able to easily change. On the contrary, therapists who specialize in treating Dermatillomania know that this condition is a function of a deeply ingrained brain pattern that develops over time, and which will require great effort to change. Brain research has found that what are often dismissively described as “habits” involve multiple regions of the brain that work in concert to create deeply entrenched neurological paths that are incredibly rigid and difficult to change. In his book The Upward Spiral, UCLA neuroscientist Alex Korb, PhD, discusses how our brains develop these neural paths when we repeatedly perform similar behaviors again and again over time:

“Each time you follow the same path, it becomes more and more defined in your brain…In addition each time you activate that brain pattern, it becomes easier to activate the next time. So pretty soon, it’s nearly impossible to create a new path – all your brain wants to do is follow old tracks.”

Think of it like driving your car through deep snow. When multiple drivers repeatedly drive through the same tire tracks, the ruts in the snow become deeper and deeper, eventually making it almost impossible for the following drivers to negotiate the road in any way other than to drive in the now deeply entrenched ruts created by previous drivers.

After repeatedly and secretly acting on these picking urges, often for months or years, sufferers typically feel incredibly ashamed about their behavior, and have difficulty asking for support, let alone professional help. One of the consequences of keeping these experiences hidden from others is having to live with the emotional pain, never exploring why this self-destructive behavior continues to happen.

Treatment for Excoriation / Skin Picking / Dermatillomania

All that being said, the good news is that Excoriation/Skin Picking responds extremely well to therapy that focuses on the following treatment modalities:

  • Cognitive RestructuringThis is the “C” part of Cognitive Behavioral Therapy (CBT). Cognitive Restructuring helps an individual with Excoriation (Skin Picking) Disorder think differently in response to the urge to pick their skin. Using Cognitive Restructuring, the sufferer learns to identify distorted thoughts (e.g., cognitions) that they have about their skin and about their urge to pick, and to challenge those thoughts with alternatives that exhibit a more balanced and realistic perspective. The basic goal of this technique is to help the sufferer become less likely to automatically buy into their reflexive picking thoughts, and to become more likely to challenge those thoughts, thus giving them the opportunity to behave differently by not picking.
  • Habit Reversal Training (HRT)As noted above, this treatment modality is poorly named. That said, HRT can be an enormously helpful component of successful treatment for excoriation. HRT is based on the principle that skin picking is a conditioned response to specific situations and events, and that the individual struggling with this condition is frequently unaware of their personal triggers. HRT challenges this condition in a two-fold process. First, the sufferer uses standardized logs as a tool to become more consciously aware of the situations and events that trigger their skin picking episodes. Second, they learn to prevent or interrupt their picking with alternative behaviors that are not damaging.
  • Stimulus Control TechniquesOver time, compulsive skin picking essentially becomes a “behavioral addiction”. And as with any addiction, it is crucial to reduce the frequency of maladaptive behaviors by making it more difficult to accomplish them. In this regard, stimulus control techniques can be extremely beneficial. Some simple examples of stimulus control techniques include wearing gloves, bandages on the fingertips, or getting gel nails. While this may seem simplistic, we have seen many clients for whom this sort of intervention is the single factor that has had the most profound impact in reducing their picking.
  • Mindfulness and Acceptance Skills Training: While the above treatment modalities can be extremely helpful, they may not fully address the issue. For many, learning a more mindful and accepting attitude towards their perceived ”flaws” (and their reactions to them) is the key to recovery. From a mindfulness perspective, skin picking is often the result of misguided efforts to control the normal and natural discomfort we experience in response to our unwanted thoughts, feelings, physical sensations, and urges to pick. But the problem is not really the discomfort, but rather our obsessive desire to control and eliminate that discomfort. Utilizing elements of so-called “third wave” mindfulness-based CBT treatment approaches such as Acceptance and Commitment Therapy (ACT) and Dialectical Behavioral Therapy (DBT), the goal of treatment is two-fold: to build greater awareness of our thoughts, feelings, sensations, and urges related to picking, and to learn how to non-judgmentally accept our discomfort with these experiences, without capitulating to the desire to pick.
  • Self-careSince there is often a sense of emotional or physical discomfort before, during, and after an episode of picking, paying closer attention to the need for self-care can be crucial. For many, fitting in time for a relaxing and enjoyable activity can reduce the likelihood of using picking as a coping mechanism.

Dermatillomania / Trichotillomania ebookDespite these effective treatment interventions, skin-picking isn’t given much attention in the counseling world, mostly due to a lack of awareness. In fact, in my graduate program in counseling psychology, skin picking was never once mentioned. Unfortunately, this is not an uncommon experience – most graduate programs do not focus on lesser known conditions such as Excoriation/Dermatillomania, and as a result, most mental health treatment providers know virtually nothing about this issue and how to effectively treat it.

I only learned about Excoriation Disorder after researching my symptoms online during my undergraduate studies. After stumbling onto this previously unknown diagnosis, I soon realized that others were just as clueless. When I spoke with coworkers or friends about my self-diagnosis, I often heard them say, “Wow, I wonder if I have that too”. Then, there were family members and friends who offered well-meaning but unhelpful advice like, “Well, just try to stop”.

If only it were that simple.

At the time, I thought it was normal to scan my face, fix my “flaws” and use heavy makeup or antibiotic cream until they healed. Over time, my picking eventually got much worse. Once I started experiencing both intense physical and emotional pain, I realized that this had gone too far. However, I couldn’t stop, nor did I really want to.

Eventually, I realized that I couldn’t interrupt the cycle of skin picking, shame, and avoidance on my own. I decided to start individual therapy, even though I was unsure whether my symptoms even warranted a visit. The first time I told my therapist the real reason I was seeking therapy, I burst into tears. It certainly wasn’t an easy process, but I’m not sure that I could’ve kept that secret to myself for much longer.

Over time, I’ve learned that the goal of therapy isn’t simply to eliminate these behaviors. It is also to understand what this disorder means to me, to gain skills that can give me a better chance of not acting on my urge to pick, and to practice self-forgiveness when I do. I’m fortunate enough to have identified what I was struggling with for so long, and to feel passionate about specializing in the treatment of Excoriation Disorder so that I can help others do the same.

• Crystal Quater, MFT is a psychotherapist at the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD), Excoriation Disorder, and related anxiety based conditions. In addition to individual therapy, the center offers five weekly therapy groups, including a weekly group for adults with Excoriation Disorder, as well as online therapy, telephone therapy, and intensive outpatient treatment. To contact the OCD Center of Los Angeles, click here.

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78 Comments

  • Oh wow. Just scanning this article and I already love it. I am so grateful for all the information that your incredible staff always makes available to us…… I know once I break down this article. When I get out of work. It will help me just as every single piece I had the pleasure to read from your organization.

    Reply
    • A good look into the picking. My psychiatrist always attributed my picking to my OCD. I wouldn’t wear short sleeves for a very long time. I think Lexapro helps a bit. Anxiety sometimes is a catalyst. I truly hate this aspect of my disorder. I even will enlist the aids of others to help and then regret it and go long sleeves. In the heat of Texas it will get you very strange looks. I remember someone telling me one time that my picking at them was a mating ritual. I literally gagged. Though it is satisfying that thought made me sick. I can not stop sometimes picking at myself. Sometimes the need will be so strong I will pull over in the car to continue or to get some that are stubborn. But I have a couple areas that I can pick that never see the light of day. I will be reading this and taking it with me to a new therapist. I don’t get any CBT. She just talks with me, I don’t feel like I have any real help. I hate it when people claim OCD, if they truly had it they wouldn’t just throw it out there. I hate it.

      Reply
    • Thank you Debbie! So happy that you found the article helpful.

      Reply
  • Thank you so much for writing about this and sharing your personal experience. This all resonates so strongly with me. I have been suffering from all these symptoms since my childhood but it was always brushed off by my family as an annoying habit of mine that I should “just stop”. As I entered university and started facing more stress, my behavior took a turn for the worst. I would pick at the skin on my feet until they bled and I could no longer walk because the pain was too great. I face(d) so much shame that I would wrap my feet up to hide the wounds from my family and have to tend to them to prevent infection and to contain the bleeding. This article makes me feel more normal and gives me more confidence to seek professional help with my condition. Thank you.

    Reply
    • Hi CJ,

      I can understand how frustrating it must’ve been to hear your family members say “just stop.” I’m so glad that you were able to relate to this article and that you feel encouraged to seek treatment. When seeking help, I encourage you to select a therapist who truly specializes in treating Excoriation, as most treatment providers have little or no experience with this condition.

      Reply
      • “Stop leave it alone” drives me nuts. it started when my dad got sick. worse after he passed. it’s hard to deal with.

        Reply
    • CJ, I have the same problem. I pick on the bottom of my feet to get rid of any imperfections and as I peel large pieces of skin, I end up with bleeding and pain. I have to try to wear shoes. I can never tell when I am doing it until it’s over and I’m in pain.

      Reply
      • I do this too, ripping great chunks of skin off the soles of my feet so deep its’ agonising the next day. It was at its worst when both my parents died & shortly afterwards my brother was killed in a car accident about 15 years ago. The good news is I haven’t done it for years , I still pick at the skin round my nails & any healing sore place, but the actual ripping /harming element has stopped. I put it down to the fact that there is less stress & upset in my life now as I’m retired & financially reasonably stable , I really believe stress aggravates the condition as I definitely found it a sort of mesmerising comfort, as though everything else fades away as you do it , because there’s no room in your brain for anything but the moment of gradual tearing, almost giving your brain a short rest from the stress or problems, even though you know it will hurt the next day , the pain as I do it is secondary to the compulsion. It’s good to know there are other people out there who do this as I never told anyone about it & it must help to discuss & understand these conditions

        Reply
        • Hi Jenny,

          I agree with you that grief and other stressors certainly exacerbate skin-picking behaviors. I also think that with time, we can learn to respond to these stressors with more positive coping mechanisms. I’m glad that you’ve been able to decrease the severity of the skin-picking behaviors.

          Reply
  • Hi there! I was wondering if you know anyone in Miami, Florida who specializes in any of the mentioned therapies? I’ve tried different therapy styles and mindfulness and everything in between – and I can’t seem to find anything that helps. I feel helpless honestly. Please let me know if you know anyone in Miami. Thank you!!!

    Reply
  • This is such a useful piece, and a great place to start if you’re looking for advice on skin picking. I have been dealing with skin picking since I was about 11. I am now 32, and I really began to address my skin picking about 6 months ago. I have made enormous progress, more than I ever thought would be possible.
    The most important changes for me happened in my mindset: 1) Acknowledging that it is a problem in my life. 2) Deciding that I can and will do something about it. 3) Thinking about my skin picking more and more, not avoiding it and putting it in a box. Become aware of it in all its aspects and confronting it. This unlocked the door for me.
    I began to throw everything at my skin picking. I looked at CBT, diet, hobbies, skin care regime, supplements, journaling, tracking my picking.
    It takes effort. But it’s a completely different type of effort to the past exhaustion of ‘just trying to stop.’ It’s effort which empowers, feels productive, and gives you freedom. If you are struggling, take heart- you can get control of it. It’s a part of you- that can’t be denied. So come to terms with it and work through it. Thank you for this article!

    Reply
    • Hi Elena,

      It sounds like you’ve done a fantastic job of embracing Mindfulness and Acceptance Skills Training along with the other treatment modalities you mentioned. Thank you for sharing your experience.

      Reply
  • Thank you so much, wonderful article. I can relate so much to it.
    However, I don’t know how to feel about the fact that I was picking my skin while reading this article.

    Reply
    • Hi OS,

      I’m delighted to hear that you related to this article. As I noted in the article, skin-picking can often be an automatic, unconscious behavior. It can be frustrating to realize that the skin has already been damaged without your knowledge of it happening in the first place. Nonetheless, treatment can always be adapted to address behaviors that are automatic, conscious, or both.

      Reply
  • Thank you for this. It opened my eyes. I tried to tell my mum about my self-diagnosis but she just said it was a bad habit and that i should just stop.
    I have had it since I was about 4 years old and it has now escalated as i am now 14 and have acne.
    I don’t know what to do honestly and I’m really worried. Thinking about it now brings tears to my eyes. I have never been taught about this in school; I agree with you. You hear schools teaching about depression, anxiety and ,though they are also important, never once was skin picking mentioned.
    I have tried to stop picking at my skin as well as other things such as nail biting yet have not once been successful.
    I want to get help but my mum will find out if I try to get therapy. Right? Therapy sessions need to be paired for and have to have parental permission as far as I’m aware. I am also not allowed to just go out by myself to go to a session, therefore trying to stop his is very difficult for me.
    Please could I have some advice on what to do? I’m very worried that I will permanently deform my body. My back and face have lots of scars already and many fresh wounds and being a teenager is hard with that as people at school…

    Reply
    • I’m in a similar position as you, I’ve been struggling with this since I first started having acne and now I’m 18 years old with scars all over. But in the past year or so, I’ve been trying to meditate, track when my urges are and come up with my own phrases and thoughts to tell myself to avoid the urges. You are already taking an incredible leap toward recovery by researching your symptoms and reading articles such as this, especially considering how young you still are. You and I are still very young and our skin has potential to grow back healed and beautifully. Keep your mind on an end goal of not only having beautiful skin, but psychological health. Keep talking to your mother about the issue, in time she will understand your struggle if she doesn’t already. It’s very important to have a support system in this as well, no matter how uncomfortable the topic may be to discuss. Share with your mother, or find another person you can confide in.
      More than anything, keep a positive attitude. Stay conscious and mindful of your picking, and try to gently coax yourself away from the mirror when you realize you’re having an episode.
      Stay strong, stay positive, stay healthy.

      Reply
    • Hi Cristiana,

      When a family member or loved one labels skin-picking as a “bad habit” and offers advice like “just stop,” it can feel very alienating. The lack of awareness around this disorder makes it so difficult to ask for help and expect anything other than what you’ve heard so far.

      To answer your other questions, in the state of California, therapists are legally required to have permission from a parent or guardian before treating a minor. I truly feel for you and hope that you can discuss treatment options with your mother at some point. Assuming that your mother comes to understand just how devastating this is for you, be sure to seek help with a therapist who actually specializes in treating Skin Picking Disorder.

      Reply
    • Christina: I just wanted to say that I have had some bad scars that with time healed up completely.
      What has worked well for me is the artificial nails & keeping a busy schedule.

      Reply
  • Thank you for writing this! Seeing it all laid out helps me accept the fact that I (extremely certain) have this disorder. I want to stop, and it helps to know there’s a community out there, and that people are trying to bring awareness to this issue, and that remedies are being researched and taught. It means a lot to know that it isn’t just me, and that it’s not my fault, and I can change my behavior. Thank you, so much.

    Reply
    • Hi Echo,

      I’m so glad to hear that you’ve gained more clarity about your symptoms and that you feel encouraged to address these behaviors. I wish you the best in your journey.

      Reply
  • I’ve been a long time sufferer, thinking at first I was just popping pimples as a teen. Now I have no acne whatsoever but I’m finding tiny (invisible) little bumps on the backs of my arms and hips. I started picking at them and their odd characteristics is what made me addicted to picking. They seem a little thorny, and if I scrape it out it leaves a tiny hole, but when it scabs over the scab is stuck pretty firmly to my skin. Once I pull the scab away there seems to be another weird layer underneath. As a result I’m disfigured on the arms (including forearms!!) and my right leg down to the ankle. Also I can’t wear skirts, shorts, nothing that even shows ankles or forearms. It’s depressing because on hot weather I’m trapped under either long sleeves and pants or body makeup. I have extreme guilt and embarrassment. I don’t seem to learn my lesson and it’s depressing. I feel imprisoned. I miss the sun on my skin (today is 90 degrees and I’m covered up)… everyone is in cute summer clothes and showing skin and I’m going around like a nun…why can’t I listen to myself…or protect myself?! My skin condition shouldn’t determine my wardrobe…. and it is! ?

    Reply
    • Hi Katerina,

      I can relate to that thought of “I don’t seem to learn my lesson.” I encourage you to remember that this disorder is complex and not simply a choice we make everyday. Though it is difficult to practice self-compassion once the guilt and embarrassment have kicked in, they are truly important steps to recovery. Remember that you are not alone in this, and that you can get the help of a professional who specializes in treating Excoriation to help you.

      Reply
    • OMG! How similar we are all here… This can be such a debilitating condition!
      I also have to cover myself ( chest) and feel terrible in the summer. Yes, it turns out that this problem can determine what we wear and weather we go places or hiding from everyone. How bad!

      Reply
  • I have been in CBT for almost eight months after being diagnosed with dermatillomania and related disorders. I never thought there was hope for me because I was in such a bad place. Now I am in such a different place then I was. This article may seem like a small deal, but just the fact that time was taken to spread information about my conditions means a lot.

    Reply
  • Thank you so much for being open about your experience. I have been in therapy for anxiety, depression, and bulimia, but honestly nothing has made me feel more alone and more ashamed than my skin picking. There is so SO little awareness of this condition that I have always felt like this is the really dark thing, the thing I can’t talk about because it is true evidence that I am not well. The shame is so powerful, I remember going to try and get help from a dermatologist and being told that she couldn’t help me until I stopped traumatizing my own skin, and I burst into tears in her office. The behavior started for me as a teenager, and I was always told, jokingly, to “stop picking!” when I would be caught in the bathroom. I have spent hours and hours alone, locked in front of the mirror, and talk to no one about it. It is just so liberating to hear words that so aptly describe my experience, and I feel hopeful that there is progress being made so that others who are experiencing this pain and shame will be met with true help, and not simply told to “stop picking.” Like you said, “if only it were that simple.” Thank you.

    Reply
    • Hi Tara,

      You’re absolutely right – there is very little awareness about Excoriation Disorder, which makes it so difficult to talk about. I’m so sorry to hear about your encounter with the dermatologist and know what it’s like to have a professional minimize your experience with the disorder. Thank you for sharing.

      Reply
  • Had the symptoms since childhood. Thought of it as a bad habit not a disorder.
    Read an article by your organization on the internet and realized I could no
    longer ignore this as just a habit, so I self treated by mentally concentrating on the word
    “EXCORIATE” whenever the urge to pick at scabs or bumps erupted, usually
    during stressful times. After three weeks my skin was clear of the vestiges of this
    disorder. Still use this focus method nearly every day. Thanks.

    Reply
  • I am not sure if I fit into the category of skin picking or not. I only do it when I see that I have dry skin somewhere, usually on my hands or if I have a wound caused by external things then I will pick and take off the dry skin or scabs. Usually my wounds will take a long time to heal because I am always picking at them. Do I just have a habit or do I have this disorder?

    Reply
    • Hi Jessica,

      While I can’t provide a formal diagnosis via a blog comment, the symptoms you described sound like Excoriation Disorder. As noted in the article, this disorder is often erroneously referred to as a “habit.” I encourage you to read through more articles on this topic to see whether you identify with other symptoms mentioned.

      Reply
  • Thank you for putting a name to what I have been going through for over 50 years now. I started this behavior since early childhood. Instinctively I knew it was wrong, but I couldn’t stop. It made me feel better after doing it. I kept it hidden as best I could, because when my parents or older siblimgs saw sores on my legs or arms I would be scolded & shamed. I never really picked bumps, & I didn’t have acne, but I’d dig at my skin until a sore formed, then I’d keep ripping open the scabs. As I got older I started scratching at the skin behind both my ears. This way it was well hidden by my hair. As an adult it got so bad that I started mutilating my ears. Both of rhem are so misfigured now that I only have 1 earlobe, & I can’t wear earphones, etc. I also have had a large open wound on my left forearm. I had a skin graft there, but that’s been a few years & have been told it might not take if the docs were to try again. I too have to wear lo g sleeves during hot days & long sleeves. I want to stop ripping & tearing my flesh but like I said, I’ve done this all my life & it’s hard as usually I’m already bleeding by the time I realise what I’ve done.

    Reply
    • Hi Donelle,

      Thank you for sharing your story. Skin-picking behaviors can be difficult to address because there are components of both gratification and pain. You’ve also mentioned what sounds like automatic behavior, which can be equally as frustrating since the person is not consciously aware that they have started picking. With that being said, I believe that this disorder is highly treatable, and I encourage you to seek treatment with a therapist who specializes in treating Excoriation / Dermatillomania.

      Reply
  • Thank you for this informative article. I do wish there was more awareness. I’ve done all the behavioral therapy possible. At some point it comes to acceptance and knowing your triggers. Not being frustrated with them non ability to stop. I have a student that I noticed her habits and was able to tell her mom. How ironic I was the teacher who has the same condition. It’s a painful struggle for sure.

    Reply
    • Hi T,

      I completely agree with you – awareness and acceptance are crucial steps in recovery. Though it can be frustrating to repeatedly explain your symptoms to others, it is incredibly empowering to help others put a name to something that is usually misunderstood. Thank you for helping your student and spreading awareness.

      Reply
  • Thank you so much for this article! I cannot stop picking spots on my scalp, and every day I tell myself that “today’s the day I’m going to stop,” and I always fail. While I’m still struggling to surpass this condition, it’s comforting to know that there are other people who experience the same thing as I do.

    Reply
    • Hi Grace,

      I remember the sense of relief I felt when finding articles that described what I had been going through for years and I’m grateful that you experienced something similar. Recovery is possible and accurately identifying what’s going on is often the first step.

      Reply
  • I can relate to this as well. I have picked at my skin since I was a small child. I don’t know exactly what age though. My mom used to yell at me and tell me to stop picking. Just stop. She used to catch me picking with fingers of blood and embarrass me more in front of others showing them what I had done. At times she would threaten me saying she would take me to a psychiatrist but it never happened. She would also dab rubbing alcohol on my picked areas. I remember picking in bed before tucking myself in for the night and then there would be blood all over my sheets. Instead of getting in trouble I would use soap and water to scrub out the blood spots. When I was in my early 30s I was using acrylic nails and I stopped for about 3 years…. but unfortunately I have started again. I don’t know how to stop this and everyone just thinks I am nuts. My boyfriend says “just don’t do it” and of course doesn’t believe it is a condition of sorts. I try and talk about it but I get ignored. That helps none. I am now 40 and not looking forward to the mosquitos again this summer. :'(

    Reply
    • Hi Glenda,

      Parents and loved ones who do not understand Excoriation Disorder may resort to certain “strategies” in an effort to decrease or eliminate skin-picking behaviors. I’m sorry that you’ve experienced embarrassment and received threats as a result of others’ ignorance about this disorder. I hope that articles like this and the online community that exists to provide awareness will help you feel supported. I also encourage you to consider getting treatment form a therapist who specializes in treating Excoriation / Skin Picking Disorder.

      Reply
  • Thank you so much for this article! It is the most useful text I’ve ever read about this condition.
    I live in Russia and I have this disorder from my teens but nobody ever understood how difficult it is for me to “just stop” or “control my hands”. Even therapists here don’t know what to do with skin picking and underestimate the seriousness of it.
    I’m almost 22 now and I have many scars on my back. They remind me of that period when I hated myself and was extremely ashamed of my “weakness”. After I found out the name of this condition and read about it in English (there is almost zero information on it in Russian) I accepted my behavior and my emotions that I can’t control. I told my family that this is a really serious problem for me and my brain, that it’s not just a habit, that it is a disorder caused by certain emotions (not by my weakness) and they can’t judge me for it.
    Thanks to the people like you, who speak loudly about Excoriation, now I don’t pick that much. Well, I still often look at my skin in the mirror searching for an ugly elements or scan my skin with fingers, but I really rarely pick them.

    Reply
    • Hi Darya,

      Thank you for sharing your story. I’m so glad that you sought out as much information as you could about this disorder. Having knowledge about this disorder allows us to be our own advocates with friends, family, and professionals. We hear from people all over the world who are unable to find therapists in their home country who are qualified to treat this condition. If you are interested in online therapy, we can be reached via the contact page of our website at https://ocdla.com/contactus/.

      Reply
    • Hi, Darya!

      I’m also from Russia (actually from Ukraine. But I live in the US.
      This is such a difficult problem that we have to deal with! And it affects us in so many ways!!!

      Reply
  • Thanks for this article. I suffer from this periodically. I get a scab in my ear and then will pick for months until its smooth. Then I wont pick again for years until another one comes. I have been working through stopping all of my compulsions. Such as nail biting. Vaping. Weekend drinking etc. This and mild intrusive thoughts which i relieve with affirmations are left. Since no one can see the scab I dont feel too bad about it but obviously something is wrong for me to do it in the first place. i wonder if i need therapy for this.

    Reply
    • Hi Claire,

      I’m unable to provide a formal diagnosis via this blog, but Excoriation symptoms can wax and wane over time. It is possible to have periods of “remission” where skin-picking behaviors are intermittent or nonexistent. However, stressors can exacerbate urges and cause previous symptoms to return. It is also common for people to pick in specific areas, such as the area inside the ear. I encourage you to read more articles on Excoriation Disorder and monitor your own symptoms to determine whether treatment may be beneficial.

      Reply
  • I run a fb support group for this. I’ve been dealing with Excoriation, dermaphagia, and trich since childhood. Felt so alone and disgusted with myself…for 2 years my FB group had 3 members…now I get 1-5+ requests to join daily. One thing most have in common is, “thank God, I thought I was the only one.” I’ve been seeking help for 3 years and no one knows what to do with me. The only person who knew anything about it was my dermatologist who dx it with one look, but could only offer me a lifelong Rx to antibiotics and acne meds/washes(I’m on immuno suppressant therapy for RA)I always get the just stop from loved ones, and as a recovering addict (5 years!) This is harder than heroin ever was to kick. Thank you for spreading the awareness and giving hope to those of us whom thought they were hopeless.

    Reply
    • Hi Jessica,

      Thank you so much for creating an online presence and community for others who are going through this. While I’m glad that you had a positive experience with your dermatologist, I’m sure it’s frustrating that the treatment offered was not a viable option. I wish you the best, and kudos to being five years in recovery!

      Reply
  • Thank you so much for this article, your professional objectivity combined with your empathy provide a degree of clarity for me. I feel I have some vocabulary to better explain my behaviour, one that’s waxed and waned my whole life, but in what I describe as “clinical” for the last 3 years. I’ve done a bit of DBT work for anxiety and believe very strongly in our ability to re-train our brains. I’m most grateful for explicitly describing the pleasure/grief cycle.

    I call picking my “zen” time, when I get out of my head, find my calm. I plan for it, constant scanning throughout the day becomes anticipation and calm execution. There’s great pleasure in “extracting” and recognize the deep desire to get something out from ‘under my skin’…. to release it sounds metaphoric but in my life, it’s a very literal, frequent act. It’s deabilitating and has impacted my choices and most devastating, intimacy with my remarkable husband.

    I’m in Canada but will contact the clinic to discuss online or phone options because scars can’t heal when they keep getting ripped open. And thank you – so so much – again for your insight and providing some hope.

    Reply
    • Hi Andi,

      I completely relate to the idea of skin-picking being a metaphor for release. I think this is often noticed when one tries to decrease or eliminate skin-picking behaviors altogether without addressing underlying issues. Thank you so much for sharing your story.

      Reply
    • Andi, I’m in Canada as well. I have had this since puberty at a young age and I suffer from depression/anxiety as well. I believe, in my life, it has a lot to do with how I learned to cope with my overwhelming feelings and situations as a young child and it has never completely stopped. I have a degree in Psychology even, but have never met a therapist or dermatologist who is familiar with treatment. Just wanted to say hello. Tell you that you are strong and beautiful. THIS issue has affected my whole life, all of my relationships and interaction with the world. I’m just beginning to accept and forgive myself for this at almost 40 years of age. I am grateful for others who share their struggles and strength and I can only hope this spreads more awareness and knowledge over time. Not everyone has the financial means to get private therapy so any resources available to anyone online are extremely appreciated.

      Remember that you are strong and beautiful and it takes courage and bravery to understand any struggle and try to learn and grow with it.

      Reply
  • Thank you so much for sharing this.
    It is often times difficult for me to put into words what is going on when describing to my doctor. Now I will be able to share this and explain this is exactly what I am doing. I have acne, but it is not at all severe. It’s on my arms, back, neck and face. But my picking makes it so much worse. I have scars on my body and often times wear sleeved shirts to cover up the scarring. Becoming more self aware and reading books on self-love have helped my mentality, but therapeutic help and these suggestions will hopefully cure the condition for good.
    Thank you again.

    Reply
  • Fantastic. Only thing is that my picking seems to be mostly focused on obsessively peeling at my nail skin/cuticles til they’re bleeding, my scalp until it’s scabbing, my legs, and the worst is the skin on my lips. I bite them until they are just miserable. I wish it was concentrated just on pimples, but that’s definitely not the worst part

    Reply
    • Hi Izzy,

      Skin-picking behaviors can be focused on certain areas of the body, or travel from one area to another. This can be incredibly frustrating, but know that treatment is adapted to address each area that has been picked at in order to reduce damage.

      Reply
  • Thank you for this article. I’ve had this disorder for 16 years and my the people in my life just saw it as a bad habit that I could easily stop. After finding out I wasn’t the only one and that it actually has a name I felt so relieved. Thank you for all this information I am truly grateful.

    Reply
  • This is the first article I have read that made me feel 100% certain that this is something I may suffer from, and that it’s not just a “bad habit”. That’s a reassuring feeling. Also, for anyone seeking relief that may read my comment, I find taking Zoloft makes a HUGE difference in my urge to pick.

    Reply
  • Recently an ex came across an article about skin picking and sent it to me. He was always noticing when I picked around my nails and asked me or told me to stop. I never did, picking the skin around my fingernails until it started to bleed or was just raw is something I do without thinking and it’s oddly relaxing. I am also constantly feeling along my arms, neck, face, back, hairline for bumps or things to pick at. I can spend an hour in front of a magnified mirror finding the smallest bump on my face and removing it. I do have anxiety and depression that went unmedicated majority of my life. So I imagine this habit developed from that and is now ingrained. I also used to tap my fingers together in a rhthymic pattern without thinking too. I don’t feel any shame from it and I have good skin so I don’t get to pick enough to really mar my appearance, so not sure there is any point (at least right now) in finding a “cure”. But, I am working to understand my anxiety better and recognizing this as a symptom will help me track down my triggers better.

    Reply
    • Hi Sarah,

      As you said, working to understand your anxiety and tracking your behaviors are important first steps. From this, you can decide whether treatment may be the best option for you.

      Reply
  • Thank you for this article and the empathy you have shown. I have suffered with this for 50 years, and now have many scars but the worst are mental. The quilt, shame, pleasure, pain ate into me until I felt truly mad as my Father said I must be to hurt myself so. I urge anyone reading this to seek help, talk to supportive people, and don’t suffer on your own. Don’t delay you have the rest of your lives ahead filed with kindness towards yourselves and healing. My own road has been hard but I am almost free, meditation and gel nails are a godsend, although explaining why I want them thick has been tricky, good luck to one and all

    Reply
    • Hi Kay,

      You’re right about the mental scars being more painful than the physical ones. It’s very difficult for a person make sense of skin-picking behaviors, especially when they have yet to identify what Excoriation Disorder is. Thank you for your kind words and sharing your recovery story.

      Reply
  • Thank you so much for writing this article. It resonates very strongly with me, in fact it is the only piece of writing concerning dermatillomania that has ever explained why I would do something so stupid and insignificant, but something that has such a negative effect on my emotions and self confidence. Actually, at age 33 (having been a picker all my life) I had almost given up of ever being able to overcome this addiction, and have resigned myself to scarring myself further. Your article has shown me that this is not how it has to be. Thank you

    Reply
    • Hi Nicole,

      I’d encourage you to avoid labeling your behaviors as “stupid and insignificant” and instead focus on the effort you’ve put into researching your symptoms and possible treatment options. Excoriation Disorder is emotionally painful and can easily cause a person to feel discouraged when they’ve tried eliminating behaviors on their own. I hope that you continue to do research and find that there are many others who can relate and provide support.

      Reply
  • Thanks for this article. I suffered from dermatillomania for 12 years and I have tried so many different ways of stopping it without success: get rid of mirror, sit on my hands, repeat to myself to stop, give as much time to love my skin than I spent destroying it, etc. Nothing worked. I went to dermatologist who prescribed Acutane to me. I started the treatment but it was worst, the skin is more fragile with this medication and the marks and the shame were bigger. I decided it was enought if I wanted to be done with this for good and this medication to be efficient I would have to find a way. I decided to have my nails done in a thick rounded shape so I couldn’t do as much damage by scratching my face. I did my nails for 6 months in a row while taking acutane it was hard but I slowly was loosing the inconscious bad habit of skin picking. Now its been 2 years and it happens to me only 2-3 times a years to have little rush. Good luck to all of you and never give up you can do it too. 🙂

    Reply
  • This has been one of the most insightful articles that I’ve read about Excoriation. I’ve struggled with this since I was 7 years old. I’m 21 now, so it’s been 14 years. I only found out that it was an actual disorder when I was 19, and it came as quite a shock considering the majority of my “growing up” was filled with people (including my parents and a few therapists) saying all the things listed in this article. No, I never grew out of it, and no, it’s not just a bad habit. Thank you for your insightful experiences and helping us understand a little more about what we’er going through.

    Reply
  • Thankyou for the article, I have been dealing with this for 10yrs. I only have 1 wound on my arm instead of several.

    Reply
    • Hi Cheryl,

      Thank you for taking the time to read the article. I’m glad that you’ve been able to decrease the amount of physical damage on your arm. Keep up the good work!

      Reply
  • This is a great article. I find comfort in the fact that I’m not alone. Because after an hour session of trying to dig out hairs to pluck that have not even surfaced the skin yet, being left with big red bloody sores makes me feel very alone, very alienated and very embarrassed. Especially because of the area I pick. I was diagnosed with trichotillomania when I was 13, after picking out every last bit of eyebrow I had since age 11, things just got worse as I went through puberty. So I was able to finally leave my brows alone and grow in and recover from the emotional pain and social anxiety it caused me, because I never wanted to show my face. Then, I started developing darker thicker hairs around my areolas. A nightmare for someone with trichotillomania. At age 23 I have scars all around my breasts now. It looks so horrible and it makes me depressed and self conscious. I actually opted to have laser hair removal because no therapists were helping and I was throwing away money. It has helped me heal b/c there’s no hair for me to try to pick at anymore.

    Reply
  • I am an LMFT and reading your article really hit home. I have been skin picking since early adolescence and I continue to do so at age 72. I have acrylic nails that helps tremendously to curb picking.
    I also suffer from body dysmorphic disorder. LastDecember I have a thigh lift because I’ve always hated them. I also lost 130lbs and I have described my thighs as looking like a “Sha Pei” dog. The skin tore after surgery and I got an infection, landed in the hospital for 12 days with a life threatening infection. I’m still not healed after 4 months. Everyone says to love yourself, you are so beautiful. I respond saying “I’ll never do any more surgery and I’m happy with myself.” Inside I want to have cool sculpting because one thigh is bigger than the other. I hate my wrinkles and feel people stare at me as the old lady. I hate feeling this way at 72. I’d love to live the rest of my life feeling ok just the way I am. It is so painful. I cannot mention it to my family that I need more surgery because they will be furious and angry because I almost died. It is embarrassing to tell my story but, if anyone can understand it’s you.
    Thank you,

    Reply
    • Hi June,

      Thank you for trusting me with your story. I’ve read articles that discuss the relationship between Excoriation Disorder and Body Dysmorphic Disorder (BDD), and can understand how alienating both can be. I’m sorry that you can’t share this emotional pain with your family, but I hope you’ll feel supported knowing that others like myself can relate to your journey.

      Reply
  • Thank you all. The embarrassment and shame I have suffered over decades have defined who I am. I appreciate how open writers have been here in sharing their own stories. I have a long way to go.

    Reply

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    18 Comments
  • Latisse and Body Dysmorphic Disorder (BDD)
    The drug Latisse is prescribed to lengthen eyelashes, but it has significant, under-reported side effects. This raises two questions - is Latisse safe, and does its marketing exploit women's body image concerns? […]
    2 Comments
  • Proposed DSM-5 Changes for OCD and Anxiety Disorders
    The American Psychiatric Association (APA) has proposed significant revisions to its "Diagnostic and Statistical Manual, Fourth Edition" (DSM-IV). Tom Corboy of the OCD Center of Los Angeles discusses changes planned for the new DSM-5, specifically those relevant to Obsessive Compulsive Disorder (OCD) and related anxiety-based conditions. […]
    7 Comments
  • Reassurance Seeking in OCD and Anxiety
    Those with OCD and other anxiety based conditions often seek reassurance that their unwanted thoughts and feelings are not a threat. The OCD Center of Los Angeles discusses the problem of using reassurance seeking as an anxiety management strategy. […]
    92 Comments
  • Phobia Treatment in Unconventional Settings
    Traditionally, phobias have been treated in a therapist's office. But effective help for phobias can now be found in some very unexpected places. […]
    No Comments
  • Body Dysmorphic Disorder (BDD) and Cosmetic Surgery
    Many with Body Dysmorphic Disorder turn to cosmetic surgery in an attempt to alleviate their insecurities. Unfortunately, there are plenty of cosmetic surgeons who are more than willing to cash in on those with this serious psychiatric condition. […]
    No Comments
  • OCD & Anxiety: The Year 2009 in Review
    OCD and anxiety were in the news throughout 2009. Here are our votes for the top stories of the year about OCD and related anxiety based conditions. […]
    2 Comments
  • Bizarre, Disturbing, Weird, and Unwanted Thoughts in OCD
    Everybody has bizarre thoughts. But people with OCD respond differently to these thoughts. From the OCD Center of Los Angeles. […]
    26 Comments
  • Emetophobia treatment at the OCD Center of Los Angeles with Cognitive Behavioral Therapy (CBT)Emetophobia and Cognitive Behavioral Therapy (CBT)
    Emetophobia is the fear of vomit and/or vomiting. Tom Corboy, MFT, Executive Director of the OCD Center of Los Angeles, discusses Emetophobia and its treatment. […]
    85 Comments
  • OCD and Mental Checking
    People with OCD often struggle with 'mental compulsions'. The OCD Center of Los Angeles explores how to manage this sometimes baffling problem. […]
    186 Comments
  • Cyberchondria: Health Anxiety in the 21st Century
    The twin explosions of television and the internet have spawned a sharp increase in Hypochondria, and spawned a new mental health issue - 'Cyberchondria'. […]
    8 Comments
  • Is Compulsive Overeating OCD?
    A discussion of compulsive overeating (aka binge eating) and how it differs from OCD. From the OCD Center of Los Angeles. Serving clients internationally. […]
    No Comments
  • Cy Young, Zack Greinke, and Social Anxiety
    Zack Greinke has overcome his Social Anxiety to become a superstar in major league baseball. […]
    No Comments
  • Exposure Therapy for OCD and AnxietyExposure Therapy for OCD and Anxiety
    Exposure therapy for OCD and other anxiety conditions is discussed by Tom Corboy, MFT, of the OCD Center of Los Angeles. […]
    46 Comments
  • Social Anxiety Research
    Recent Social Anxiety research is discussed by Tom Corboy, MFT, executive director of the CD Center of Los Angeles. […]
    No Comments
  • OCD Awareness Week
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  • CBT and Evidence Based Psychotherapy
    Unfortunately, many psychotherapists dismiss evidence-based treatments such as CBT, instead choosing to do what feels comfortable for them. […]
    No Comments
  • OCD, Mental Health, and the National Health Care Debate
    A look at the national health care debate, especially as it pertains to OCD and related anxiety based conditions. […]
    No Comments
  • Childhood OCD, Strep Infections, and PANDAS
    There is a growing body of research that indicates strep infections are related to rapid-onset OCD in children. […]
    No Comments
  • OCD and the Swine Flu – Part 2
    Panic about the Swine Flu continues, despite facts that suggest there is no cause for increased concern. […]
    No Comments
  • 2009 Obsessive-Compulsive Foundation Conference
    A review of the 2009 Obsessive Compulsive Foundation conference. […]
    No Comments
  • New Trichotillomania Research
    A look at recent research related to Trichotillomania. From the OCD Center of Los Angeles. […]
    No Comments
  • Parenting a Child With OCD
    Parenting any child is a full-time job. But parenting a child with OCD can be particularly challenging. From the OCD Center of Los Angeles. […]
    No Comments
  • Social Anxiety in Baseball
    A look at the recent rash of pro baseball players struggling with Social Anxiety Disorder. […]
    No Comments
  • Michael Jackson and Body Dysmorphic Disorder (BDD)
    A look at the sad tale of Michael Jackson and his mental health issues. […]
    No Comments
  • OCD and the Swine Flu
    The past few months have seen an avalanche of news stories on the Swine Flu, despite its relatively low impact in the US. […]
    No Comments
  • Meet the OCD Center of Los Angeles Staff
    Meet the OCD Center of Los Angeles Staff […]
    No Comments
  • Welcome to the OCD Center of Los Angeles Blog
    Welcome to the OCD Center of Los Angeles Blog […]
    No Comments

    
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