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Excoriation Disorder: The Truth Behind Skin Picking Compulsions

Everyone picks at their skin. You may spend more time than you’d like to admit in front of the mirror squeezing blackheads. When you’re bored, you might pick at the skin around your fingernails or scratch your scalp. You may even go overboard sometimes — popping or picking at a pesky pimple, scratching off a scab, or pulling off dead skin. The experience may be oddly satisfying, but usually ends with sore skin or a little blood — and you wishing that you’d just left it alone. The question is: is this normal grooming behavior, or a diagnosable compulsion?

With skin picking, there can come a point when it’s not just a bad habit, it’s an actual, diagnosable mental illness. It’s called excoriation disorder, but you may also hear it referred to as dermatillomania, or chronic skin picking. Excoriation is a serious, behavioral disorder that is estimated to impact around 5% of the population, although the actual percentage is unknown because many people with the disorder are hesitant — or don’t know — to seek help.

What is excoriation disorder?

Excoriation disorder is officially classified as a “Body-Focused Repetitive Behavior” (BFRB) in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). A similar disorder, called trichotillomania, or hair pulling disorder, has the same classification. In fact, many patients with excoriation disorder also have trichotillomania. Both are classified in the group of obsessive-compulsive related disorders.

People with excoriation disorder become fixated on real or perceived imperfections on their skin. This leads them to pick, scratch, and rub their skin — sometimes to the point of bleeding. Skin infections and permanent scars are common side effects, and some people experience skin lesions and tissue damage. For those with excoriation disorder, the face is most frequently where they pick, but people also pick at their arms, legs, scalp, lips, and the skin around their fingernails. Some spend hours a day picking at their skin.

What causes skin picking disorder?

This is complex. There’s research that shows that skin picking is linked to genetic predispositions, but environmental factors — like temperament, environment, family situations — also play a role.

Some experts believe it’s a maladaptive way (an adaptive behavior that is actually harmful as opposed to helpful) that people cope with emotional stress. Skin picking becomes a way to deal with anxiety, obsessive thoughts, avoidance, or even boredom.

The onset of the illness can occur at any age, but typically coincides with adolescent acne. People with eczema, psoriasis, and other skin conditions may be susceptible to excessive skin picking. It’s also more common in women than in men.

How is excoriation disorder diagnosed?

To be diagnosed with excoriation disorder, a person’s picking behavior is both impulsive and persistent, and results in damage to the skin. People with this disorder feel like they can’t stop the behavior no matter how hard they try — many have made several, unsuccessful attempts. Exclusionary criteria include other mental health issues, drug use, and the use of certain medications, which may cause skin picking as side effects.

Unfortunately, excoriation disorder is often minimized and misunderstood. Sufferers experience significant emotional distress and guilt for not being able to stop their picking habit, and as a result of the physical damage they’re causing to their own skin, sufferers of this disorder often feel embarrassed and ashamed to go out in public. Many spend additional hours each day trying to cover up the lesions or scars with bandages, clothing, and heavy makeup. Some just avoid leaving the house altogether becoming isolated and reclusive.

Does any of this sound familiar? Are you starting to wonder if maybe you are at-risk of skin picking disorder? Don’t be scared — just ask yourself the following questions:

Do you impulsively pick at your skin?

Do you sometimes pick at your skin for hours at a time?

Do you pick without even realizing you are doing it?

Does skin picking greatly interfere with your everyday life and cause you to avoid social events or going into public?

Do you feel significant emotional distress because of skin picking?

If the answers to several of these questions are yes, it’s important that you set up an appointment with a therapist, who can help you treat your disorder.

What treatments are available?

Treatment recommendations for excoriation disorder include both pharmaceutical and behavioral interventions. The most common medications prescribed for skin picking disorder are Selective Serotonin Reuptake Inhibitors (SSRIs), such as Prozac and Zoloft. These drugs are believed to be effective for those with a skin picking disorder because they also treat the related disorders of OCD, depression, and anxiety.

There is also evidence of success with behavioral treatments with licensed therapists, such as cognitive behavioral therapy, mindfulness training, and habit reversal training.

If you feel like skin picking is affecting your life (or the life of someone you love and care about) it’s important to remember this is a treatable illness, and that help is available. To get the help you need, reach out to a professional: therapists, dermatologists or a loved one who can offer support.

  1. I have been doing this for 10 years or more and never knew until last year that more people do this also. I am on Prozac but I don’t believe it helps. It helps with my other stress and anxiety but I still pick!! I love picking and I like picking others if they will let me! My arms, upper legs, butt and chest all have scars and I do hate them! But I just can’t stop, I’ll even pick a scab because I know something is usually under there​. Ugh

  2. I have this I know I do. I feel guilty when I do it but won’t stop. I wear shirts to cover them and hope no one sees them. It’s mainly my upper arms and chest. We don’t have many therapists around here but maybe I’ll check with my dr. Glad to know I’m not alone.

  3. I obsessively pick at my cuticles. I often draw blood and I am embarrassed of showing my hands. I never knew that there were others out there like me.

    1. Me too…I’ve dubbed them my “protein snacks”! For me it’s a method of grooming, all that rough skin must be cleared away. I can watch a 2 hour movie and the whole time I’m going over the cuticles again and again searching for rough patches. Cuticle creams help a little, it’s a relentless situation…

  4. i defenetly have this and didn’t realize it was some type of disorder tbh i love to do it on every part of my body also my boyfriend and i we always fight cause i love to pick on him and i can’t help it im always beggin him for his face just to get satisfied by picking him even tho he doesn’t like it, thats why we always fight cause he doesn’t like it and im a popaholic. I also love to watch Dr Pimpple Popper vids to get more satisfied but honestly i think those videos got me worst but maaan they are so gooood. My boyfriend always ask me that why you don’t start studying that but i always says no cause i know that job its not only popping its more than that and some stuff that maybe for me are disgusting. Anyways thanks you so much for all this information and made me realize that what im doing is so wrong! 😘

  5. Thank you so much for posting this. I have suffered from exorciation disorder since I was 12 years old and only now at 27 have had some success with healing up many of the wounds I’ve opened on myself. Part of what makes it so much worse is getting fungal infections which provide even more to pick at. I’d love it if you did an article on how to care for wounded skin.
    My thanks.

  6. I suffered with trich for years and years and f8nally got control of it about 5 years ago however, this coincides with when i started to pick my skin more excessively. I always picked the skin on my face but have since moved on to primarilary my upper arms and shoulders. Ill take skin picking over hair pulling any fay of the week.

  7. That you so much. I have seen 4 doctor,s and the last one still didn’t know what it was.i have to say they all prescripri bed anibodic. That you Dr Sandra Lee. For sharing this information. People when I am out look at me like I have the aids. Some think I’ve been in a car accident, se think I have been beat up. I have found myself not leaving my home because I don’t like people staring. Thank you ,thank you. I am not crazy. Beth

  8. I have this along with nose picking and nail biting. I used to pull my hair, but skin picking has been my number one go to. I’ve been picking 44 years now and am scarred from the top of my head to the tips of my toes. I believe it started when I was getting molested by my father. I also now have been diagnosed with Sjogren’s Syndrome and peripheral neuropathy which isn’t caused from diabetes but caused by the sjogren’s. I go this week for more blood work and PCP is adjusting my meds due to having a high resting heart rate. I wished I could send pics with this, because I feel my skin picking is at a all new high. It looks terrible and hurts most of the time, but I just cannot stop. Sincerely Margaret Pack

  9. I’m on Zoloft for my anxiety and it hasn’t helped me stop picking. I pick on my chest and I’m tired of it. I’m only 16 and it’s affecting me terribly.

  10. Visit bfrb.org if you have dermatillomania. It is a non-profit organization that has support groups, resources, research and a listing of treatment profrssionals & hair salons that understand dermatillomania and its sister disorder, trichotillomania (hair pulling).

  11. If you think you have dermatillomania, please check out BFRB.org (TLC FOUNDATION FOR BODY FOCUSED REPETITIVE BEHAVIORS). They have a ton of resources about dermatillomania & it’s sister disorder, trichotillomania (hair pulling). The website also has a listing of local support groups, treatment professionals and hair salons. Their goal is to raise awareness of these issues — Thank you Dr. Pimple Popper for doing the same! with love & awareness, Aneela

    1. Thanks for the recommendation. I’m going to look into it as I’ve been suffering from this for years and had no idea it had a name. I just figured it was a lack of self-control.

  12. Thank you so much for this article. I have been literally destroying my face for decades and really need help. It’s a HUGE problem in my life and a great deal if my life focuses around this disorder. I really really need help.

  13. I have actually been fighting with this myself for years. Ever since an abusive relationship. I had always picked at my skin, but never this bad. I’m already on Zoloft for depression, but it doesn’t seem to be helping with my skin picking. At least I know it’s not all in my head anymore!

  14. What happens if you are a serious skin-picker AND you’re already on Zoloft? My legs and arms are disgusting from picking, I also pull hairs out from my legs and head. I’m so embarrassed to wear shorts or tank tops because I’ve got scabs all over my legs and some on my arms.

    1. I’m in a similar situation. I’ve been taking Prozac (first) and now Zoloft for almost 20 years just for my clinical depression. But I pick at my neck (in grown hairs) and now I’m so scarred that it affects how I feel about myself and all the stuff that goes with it (pictures, wearing certain things, using makeup to cover it up, wearing turtlenecks even though I’m sweating underneath). Never knew it was an actual thing. Always jealous of those that can wear tank tops or even just sleeveless shirts, as I also pick at acne on my arms, shoulders, back and face. Was called “pizza face” in middle school, and now at the age of 48 I sometimes feel there is no hope for me. Most days it’s just easier to stay at home, and not have people over, just my family.

  15. I am diabetic for past 52 years. In the past 10 years I have been skin picking compulsively till I bleed. I feel tremendous guilt and shame. I suffer from depression, anxiety and tinnitusI have tried different men’s and none have helped. I want to know if Luvox or Effexor are meds that can help.

  16. Are Luvox or Effexor meds that are used for skin picking? I have diabetes since 1965. I have already caused irreversible damage to my feet resulting in a trans metatarsal amputation of left foot. All due from picking which resulted in an infection and I still have not been able to stop. I have come to believe that I am mentally ill and need some advice about medications.
    Thank you

  17. I have this issue as well however I really disagree with the Prozac or any kind of medication to alter emotions. That will only mask the issue rather than dealing with the problem.

  18. I picked my cuticles without mercy for years. Friends and family badgered me to stop b constantly. So I’d hide my hands under the blanket to avoid detection. Then I put on acrylic nails. They are too thick to catch a good edge to start picking. They are frustratingly impossible to accomplish my goals of removing skin imperfections. Fast forward five years of blissfully clean and clear skin and suddenly I develop an allergy to acrylic. So I take them off. Within minutes I’m right back picking and ripping my nails. Fortunately I discovered silk wrap nails. Same benefits without the chemicals of acrylic. I am blessed to be a girl who can wear nails but if I was a man, I’d do it anyway and keep them short and clear.

  19. Is it called the same thing if you have the same urge or need to pick at other people also? I see something on someone and I feel like I have to get it or I’m going to die! 😂😂😂

  20. Omg…..I’ve been doing this for years to my fingers so I get acrylic nails so that I can’t pick the skin but now I do it to my feet. I’ve gone as far as to use nail clippers to break the skin on my heels and I start pulling on it. It’s getting out of hand. I need help. 😣 it hurts to walk sometimes

    1. Monica I SO understand. I spent far too many years trying to hide my limping around because I constantly pulled the skin off of my feet….toes, heels, sides, bottoms. The compulsion became so great, even on Effexor, that I didn’t realize I was also doing it in public. I couldn’t leave them alone and it was like a daily contest to see how much skin I could pull without making myself bleed. My family tried everything to help me stop but it wasn’t until my husband gave me an Amopé that I was finally able to get relief. It’s changed my life & I pray it might work for you too. Of course for the first 6 months I Amopéd several times a day & even went beyond my feet but it’s been 3 years now and I can’t believe how wonderful it is to have healthy, pretty feet again. I hope the same for you.

  21. I am 68 years old and have had treatment for bipolar disorder and anxiety since 1990 using various medications. My version of skin picking is more accurately described as skin biting though picking also occurs. My battleground is the skin around my nails. Over my treatment years the behaviours have very gradually decreased, so gradually that I only noticed the change about a year ago. I still bite but now have nails I’m not ashamed of. My response to meds has been slow and incomplete, that’s my own chemistry. I encourage anyone taking meds to continue. The tortoise won the race! My hope is your race is shorter than mine.

  22. I do this too. I have depression & anxiety. I’ve been picking as long as I can remember & have been treated for these disorders since I was 12. My doctor recently recommended me to take the NAC supplement which helps with compulsive tendencies.

  23. You forgot a couple of questions – (some of these led to my own aha! with regard to my own picking –

    *Has your mother ever threatened to throw away all your short-sleeved clothing and make you wear long sleeves year-round? Even after you were an adult?
    *Have you ever either cut your natural fingernails as short as you could or had ridiculously long artificial nails because either way made it really difficult to pick at your skin?
    *Have you ever looked up and had someone looking at you with a horrified expression because you are sitting somewhere – a church pew, for example – and you have pushed your sleeves all the way up and are picking at your skin in an incredibly inappropriate setting?
    *Do you avoid buying shirts with tight cuffs because you will only stretch them out or because it’s so much easier to push up sleeves that don’t have a cuff on them?
    *Do you have muscle and joint issues in your hands – this is not a joke – because you spent so much time with your fingers in the “picking position” that now anything that requires you to grip very tightly results in cramps and pain?

    And, last but not least

    *When you look back at your childhood/adolescence, do you remember trying to get rid of your own bumps before your mother saw them and took her own fingernails to your skin?
    *Can you point to any specific scars as the beginning of your belief that ALL bumps must be gotten rid of as soon as they appear on your skin? (mine is above my right eyebrow)
    *How often do you find yourself obsessing over a breakout and, when you complain about it, find out that no one else has even noticed it?

  24. I am 64 this year and have been picking scabs for as far as I can remember. I had an abusive stepdad and my first marriage was violent. I’m embarrassed about the mess my arms and legs are in. I’m getting married again this year, is there anything I can do to make the scars less noticeable?

  25. I am happy I came across this artical. I do have a dermitis disorder, which I pick at off and on all day. Mainly my arms, sometimes it goes to my scalp, yes I do have quite a bit of scars. My husband and family get very annoyed when they catch me scratching or picking at the scab. The rise they’re voice to stop, or if my husband sitting near me. Holds m hand to stop. What the dermatologist tells me I have is Lichen
    Thank you

  26. I bite (not pick) the skin around my fingernails and have done for as long as I can remember. For the most part you wouldn’t know but when my fingers have been wet (after a bath) then you can see the damage.
    Tried various deterrents but still do it.

  27. This is me!! I have been doing this since I was 12 it’s gotten worse over the last 2 years. I hate it, it’s so embarrassing, I can’t stop, I even get the tweezers out because I’m a nail bitter and can’t always squeeze with my fingers 😓😭 is traumatic events the cause of this? I’m at a lose because I also don’t have much memory of my child hood, not sure why but can’t remember much if anything from when I was young.. so wouldn’t have a clue what’s caused this.

  28. I have been picking my toe nails since I found out they come off! I did the same thing with my nails but stopped my nails since getting into the health care field I often draw blood and my toes get infected a lot I also pick and don’t realize I’m doing it I would pick my husbands toes and nails if he would let me! I just thought this was a way of dealing with stress and I thought at least I don’t smoke or drink. I’m currently on an anti depressant as well but don’t feel like it helps either. I think mine stems from stress I was raised mostly by a single mother and moved a lot.

  29. I have done this as long as I can remember. I pick and peel the skin off my lips constantly. Causing bloody spots to stay on my lips for days at a time only to peel it off again. I can put chapstick on but that only delays the inevitable. I pick till they bleed then pick more. I’d say 99% of the time I don’t realize I’m doing it until there’s blood. The higher the stress, the worse it is. Went through nursing school and it was constant. Now as a nurse it still happens constantly and it’s in a place that cannot be covered but it’s still embarrassing. Tried everything to stop in my power, trimmed nails chapstick everything. Nothing seems to help.

  30. I’ve been doing it as long as I can remember. Once I had to be put in the hospital. Between new meds, laser hair removal and finding your web site I don’t pick anymore. You wed site is a life saver, I watch it for hours every day. Thank you so much. 😊

  31. I have been living with this disorder since I was 3 years old. I am now 39. I am tired of it. I have sought treatment in the area of cognitive therapy. I am still on an anti anxiety/depressant medication, and have even doubled up with another med on top of it for focus. I’ve seen dermatologists and psychologists for this. I still pick. I literally cannot stand looking at myself in the mirror. I look at my children’s skin in envy and wish I could go back to the moment when I started and stop myself.
    I feel there is no help for this OCD. It’s definitely misunderstood. The doctors out there that think they understand and highly wrong.
    I’m sorry to be so negative. I’be just gotten to the point where it’s completely hopeless for me.

  32. I want put out there that I have been on Effexor for six years. Initially it helped, but not to the point of stopping. Effexor is also a medication that you cannot just go on and off of. It’s a very serious medication and you shouldn’t try it without the guidance of your doctor.

  33. What if a person has a disorder in which he scratches walls instead of skin ? Like he likes to powder chunks of wall . What is the reason behind this disease ? Please help.

  34. I keep telling myself it’s just a bad hàbit then I look and I’m bleeding again and another scar is added to my arms they frequently loom red and angry the worse was constantly picking and scratching at a scab from a dog bite on my leg eventually I was rushed to hospital with sepsis and was really poorly but that didn’t stop me I’ve been awake after another stressful day and have realised I’ve been picking at my arms again and they’re horrible really nasty to look at and I will have to wear long sleeves this spring/summer so people cànt see my arms. I don’t want to go doctors isn’t there something else I can do to stop this ?

  35. I am glad this can be anonymous so I can finally say it. I have eczema on my hands very bad. I pick constantly and then I eat the little pieces of skin. I pick so much, I’ve lost fingernails, toenails, bleed all the time, infections, too many to count. There’s never not a bandaid somewhere on me to cover it up. I’ve been doing it since I can remember but I’m really good at hiding it. If anyone sees my scabs, I just say I had an allergic reaction to something. I’ve done the acrylic nails but always find a way around it. I remember when I was young, my mother found a razor blade in my room and thought I was suicidal. Really, it was just to pick my skin better. The shame and guilt are horrible. It’s the way I deal with stress and I can’t find a way to stop.

  36. Is biting your fingernails till there’s blood and the nail is way down considered the same as skin picking?

  37. I have picked scabs since i am remember….even as a young child. I became a cutter in my teens and now 67, no longer cut, but continue to pick every scab on my legs or arms I get and watch the blood flow….then wash it off, ointment and bandaide applied and before it heals, find myself doing it again….I did endure much stress in my life with an abusive cruel mother….so maybe the anxiety just remained for my lifetime.

  38. Thank you for posting this. I’ve had this for 15+ years and didn’t know it was a disorder or that there were other people like me for a very long time.

  39. THANK YOU for this!!! I have psoriasis and constantly picked at it. Now that it has been corrected with medication, I do find other areas of my body to pick at. And I quite clearly remember doing it as a child as well. I appreciate that you take the stigma out of things, very humanizing, and very important.

    Thanks again.

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