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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.

Woman scratching her arm

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. 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

  11. 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.

  12. 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!

  13. 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.

  14. 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.

  15. 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

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