Excoriation (Skin-Picking) Disorder: Understanding and Managing the Urge
Excoriation (Skin-Picking) Disorder—also known as dermatillomania—is a mental health condition marked by recurrent, compulsive skin picking that leads to tissue damage. Often misunderstood or minimized, this disorder is recognized in the DSM-5 under Obsessive-Compulsive and Related Disorders. It affects approximately 1.4% of adults in the U.S., though the numbers may be higher due to underreporting.
Causes and Risk Factors
The exact cause of excoriation disorder is not fully understood, but it is believed to arise from a combination of genetic, psychological, and environmental factors. It often co-occurs with anxiety, depression, and obsessive-compulsive disorder (OCD). Some individuals report picking as a way to relieve stress, boredom, or tension, while others describe it as a response to perceived imperfections in the skin. Family history of OCD or related disorders may also increase risk.
Symptoms and Diagnostic Criteria
According to the DSM-5, diagnosis of excoriation disorder involves:
- Repeated skin picking that results in lesions
- Repeated attempts to stop the behavior
- Significant distress or impairment in social, occupational, or other areas of functioning
- The behavior not being attributable to another medical or dermatological condition
Common picking sites include the face, arms, scalp, and hands. The behavior can lead to infections, scarring, and shame, often driving individuals to withdraw socially or wear concealing clothing.
Evidence-Based Treatments
Treatment for excoriation disorder usually involves a combination of psychotherapy, medication, and behavioral techniques. Cognitive Behavioral Therapy (CBT)—particularly Habit Reversal Training (HRT)—is considered the gold standard. This involves increasing awareness of the picking behavior, identifying triggers, and developing competing responses. Other therapeutic approaches include Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT), especially for clients with comorbid emotional regulation issues.
In some cases, selective serotonin reuptake inhibitors (SSRIs) like fluoxetine or fluvoxamine are prescribed, especially if the disorder is severe or linked with depression or OCD. Support groups and digital apps like SkinPick also offer community and guided tools for self-monitoring and coping.
Conclusion
Excoriation disorder is more than a bad habit—it’s a complex, often hidden mental health condition that requires understanding and structured support. Early intervention, compassionate care, and evidence-based strategies can help those affected regain control and improve their quality of life. Mental health professionals, families, and individuals must work together to reduce stigma and promote healing.