Dermatillomania (Skin Picking) (2022)

Overview

Dermatillomania (Skin Picking) (1)

What is dermatillomania?

Dermatillomania is a mental health condition where a person compulsively picks or scratches their skin, causing injuries or scarring. Also known as excoriation disorder or skin-picking disorder, this condition falls under the category of obsessive-compulsive disorders (OCDs). When it leads to significant scarring and injuries, this condition can severely affect a person’s mental health, well-being and quality of life.

This condition (pronounced derm-ah-till-oh-main-ee-ah) gets its name from three Greek words:

  • Derma: skin.
  • Tillo: pulling (or picking).
  • Mania: excessive behavior or activity.

What is the difference between dermatillomania and obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is a specific condition that also lends its name to a category of mental health conditions. While dermatillomania falls under the overall category of obsessive-compulsive disorders, it still has some key differences from the specific condition of OCD.

  • Obsessions. OCD involves obsessions, which are thoughts or urges that a person can’t control and doesn’t want. Those kinds of obsessions don’t happen with dermatillomania.
  • Feeling of reward. When people with dermatillomania pick at their own skin, they often feel relief or other positive emotions. That doesn’t happen with OCD.
  • Damage. OCD rarely involves any kind of self-damage or self-injury. With dermatillomania, that kind of self-injury is extremely common.

Who does it affect?

In years past, experts believed this condition was much more common in women. However, recent research shows that only about 55% of people with this condition are women. Women are also more likely to seek treatment for this problem.

The condition usually starts during puberty but can happen at any age. The condition is also more likely to happen to people who have “triggering” conditions like acne or eczema.

How common is this condition?

Dermatillomania is an uncommon condition, with an estimated 2% of people having it at any time and up to 5.4% of people having this condition at some point in their life.

How does this condition affect my body?

Dermatillomania causes a person to pick at their skin compulsively. For some people, picking is an automatic movement, and they might not even realize they’re doing it. Others are aware that they’re doing it but can’t stop themselves.

For some people, picking focuses on areas of skin that are rough or already have some kind of blemish or irregularity. Examples include picking at pimples, patches of dry skin or scabbed-over cuts and scratches (those wounds can come from picking or from other causes).

(Video) Skin Picking Disorder (Dermatillomania)

Picking can create new wounds or reopen old ones, leading to bleeding and scarring. When this condition is severe, it can lead to skin damage that’s extensive enough that it may need surgery, such as skin grafting, to repair the damage. Infected wounds may also need antibiotic treatment.

In rare cases, infections from these wounds can spread throughout your body, leading to an overwhelming immune system overreaction. That overreaction, a condition called sepsis, is a life-threatening medical emergency.

Mental health effects

Often, people with this condition feel embarrassed or ashamed of the visible injuries, trying to hide them with clothing, makeup or other means. Because of that, this condition can be a source of anxiety, depression or social isolation. This condition can also affect people’s work or social lives.

Symptoms and Causes

What are the symptoms of dermatillomania?

The main symptom of dermatillomania is compulsively — meaning, the impulse or urge is impossible or incredibly difficult to resist — picking at your skin. Experts also describe the act of skin-picking using the following words:

  • Scratching.
  • Digging.
  • Squeezing.
  • Rubbing.

Picking usually involves fingernails and fingertips but can also include biting with your teeth (especially when the skin surface affected is on your lips. It can also involve sharp items like tweezers or pins.

Types of picking

This activity usually happens in one of two ways, “automatic” or “focused.”

  • Automatic: This kind of picking often happens without a person thinking about it. Experts sometimes call this “scanning” because it tends to involve running hands or fingertips across areas of skin to find any areas that feel different, which might then become an area for focused picking.
  • Focused: This kind of picking is “focused” on a specific area, and the picking can go on for hours. This kind of picking tends to be more severe and is more likely to cause damage to your skin.

Where it happens on your body

Picking tends to focus on certain areas of your body. Those areas are the ones that you can most easily reach with your hands, including:

  • Head: Face, scalp and neck.
  • Arms: Fingers, hands and forearms.
  • Legs: Thighs, calves, feet and toes.

What causes the condition?

There aren’t any confirmed causes of dermatillomania, but experts suspect a few different factors might play a role, including:

(Video) Re-imagining Compulsive Skin Picking: Art for Recovery | Liz Atkin | TEDxRoyalCentralSchool

  • Genetics. People with dermatillomania are much more likely to have at least one first-degree family member (meaning, a parent, a sibling or a child) who also has this condition.
  • Changes in brain structure. People with dermatillomania are more likely to have some key differences in the structure of brain areas that control how they learn and form habits.
  • Stress, anxiety or other conditions. Dermatillomania might be a coping mechanism for other issues or mental health conditions. It might also be related to boredom or other issues.

Other conditions that happen with dermatillomania

People with dermatillomania are more likely to have other mental health or medical conditions. Some of these include:

  • OCD or other OCD-related disorders like hair-pulling (trichotillomania) or nail-biting (onychophagia).
  • Depression.
  • Anxiety disorders.
  • Bipolar disorder.
  • Prader-Willi syndrome.

Is it contagious?

Dermatillomania isn’t contagious and can’t spread from person to person.

Diagnosis and Tests

How is it diagnosed?

Diagnosing dermatillomania involves a combination of a physical exam, where your healthcare provider looks for signs of this condition on your body. They’ll also ask you questions about your medical history, your life circumstances and any behaviors that might relate to this condition. Diagnostic and lab tests can help rule out other causes for skin picking but are rarely needed to confirm this diagnosis.

Diagnosing this condition requires meeting all five of the following criteria:

  1. Skin picking that’s ongoing or happens repeatedly.
  2. Multiple attempts to stop skin picking or to do it less often.
  3. Negative impact on various aspects of your life, including your work or social life, because of shame, embarrassment or other similar emotions.
  4. Skin picking behavior doesn’t happen because of any other medical condition, such as scabies or other skin-related conditions, or because of a drug (recreational or prescription).
  5. The skin picking behavior isn’t because of another mental health condition, such as body dysmorphic disorder, where you pick at your skin because you believe you have a problem with your appearance and you pick at your skin to try to fix that.

What tests will be done to diagnose this condition?

Medical tests that are used with this condition are almost always to rule out any other medical conditions. Your healthcare provider can best explain what tests they’d like to run for your specific case and why.

Management and Treatment

How is dermatillomania treated, and is there a cure?

Treating dermatillomania usually involves a combination of medication and therapy. Research shows that combining the two tends to help more than just one type of treatment alone.

Medications

The most common medications that healthcare providers prescribe to help treat this condition include:

(Video) How to Recognize Dermatillomania Symptoms

  • Antidepressants. The most likely medications for this are selective serotonin reuptake inhibitors (SSRIs).
  • Anticonvulsants. Lamotrigine is a medication that helps with uncontrollable muscle movements. Research shows it can help in some cases of dermatillomania.
  • Antipsychotics. These medications help by modifying the balance in your brain chemistry. These medications commonly treat many conditions like dementia, bipolar disorder and schizophrenia. Researchers are also continuing to look into how they can help treat conditions like dermatillomania.
  • Nutraceuticals. These are nutrition-related products that can also affect medical or mental health conditions. For dermatillomania, research has found that the amino acid supplement N-acetylcysteine can help reduce the urge to pick.

Therapies

Psychotherapy can help treat this condition in various ways, depending on the therapy method used.

  • Habit reversal therapy. This method involves helping you become more aware of your behaviors and activity patterns. By helping you become more aware, this therapy teaches you to break habits like skin picking.
  • Group therapy and peer support. People with dermatillomania may benefit from specific types of group therapy or support.
  • Cognitive behavioral therapy (CBT). This method involves teaching coping mechanisms and strategies to help change behavior.
  • Acceptance and commitment therapy. This therapy method helps people change behaviors like skin picking by accepting negative feelings that fuel the behavior. Mindfulness and other positive coping mechanisms also play a role.

Other treatments related to dermatillomania

People with severe damage to their skin or their tissue underneath may need additional medical treatment and care. Your healthcare provider is the best person to explain the treatments they recommend, which might include surgery and skin grafting, antibiotics and more.

Complications/side effects of the treatment

The possible side effects and complications depend on the circumstances, the severity of your condition and other factors. Your healthcare provider is the best source of information about what you should expect or watch for because they can tailor the information to your specific case.

How do I take care of myself and manage symptoms?

Dermatillomania isn’t something you should self-diagnose. A trained, experienced mental health provider should be the one to determine if you have dermatillomania or if it’s actually another condition. It also isn’t something you should treat on your own, partly because medication, therapy methods and other types of care need a prescription or other input from a healthcare provider.

How soon after treatment will I feel better?

Your healthcare provider can tell you more about what you can expect as you undergo treatment and what you can do to help yourself through that process. This is because the recovery time and how long it will take you to feel better depend on many different factors, and your healthcare provider can take all those factors into account when they tell you what to expect.

Prevention

How can I reduce my risk or prevent this condition?

Dermatillomania is a mental health condition, but experts still don’t fully understand what causes it. That means it happens unpredictably and it isn’t preventable. There isn’t a known way to reduce your risk of developing it either.

Outlook / Prognosis

What can I expect if I have this condition?

Dermatillomania usually isn’t a dangerous condition unless it's very severe. The main risk from this condition is from open wounds, which might develop infections because of repeated picking or damage. Though this condition isn’t usually dangerous directly, it still commonly has severe negative effects on your quality of life and overall sense of well-being.

(Video) My Journey with Dermatillomania.

People with dermatillomania often feel ashamed or embarrassed, which is why so many people with this condition avoid treatment. Avoiding or delaying treatment increases the risk of having permanent issues like scarring and further mental health problems.

How long does dermatillomania last?

Dermatillomania is a life-long condition because of the risk of relapse. However, people with this condition can go into remission — meaning, they no longer feel the urge to pick their skin or can avoid doing it for long periods, if not indefinitely.

What’s the outlook for this condition?

The outlook for the condition depends on how severe it is and other factors. Most people with this condition don’t suffer physically dangerous effects. But without treatment, most people with this condition will struggle with mental health effects like anxiety, shame or embarrassment.

Living With

How do I take care of myself?

If you have dermatillomania, it’s important to see a healthcare provider (or multiple providers, depending on your specific needs) with training and experience in treating this disorder. They can give you the best guidance on caring for yourself and what you can do to improve your outcome.

In general, you should do:

  • Be honest about your condition. Dermatillomania is a mental health condition that affects your mind and behaviors. Just as you’d see a healthcare provider for an ear infection or a heart problem, you should also see a healthcare provider for mental health conditions like dermatillomania. They can help treat the effects of your condition, physical and mental alike.
  • See your healthcare provider(s) as recommended. This is especially important for therapy sessions, mental health visits and any other care you might need.
  • Take medication if prescribed. Medications can make a big difference in helping you avoid acting on any urges to pick at your skin.
  • Avoid triggers when possible. People with dermatillomania often pick at their skin in certain settings or situations. Avoiding those triggers can make a big difference.
  • Take away the opportunity to pick. People with dermatillomania may benefit from fidget devices or other things that can help them avoid picking behaviors by keeping their hands occupied. Other ways to avoid picking include wearing gloves or clothing that keep you from picking at your skin.

When should I go to the ER?

People with dermatillomania usually don’t need emergency medical care unless they have severe injuries because of this condition. You should seek care in cases with severe bleeding or signs of infection. The signs of infection, including dangerous conditions like sepsis, include:

  • Swelling, redness or other color changes around the injury.
  • Fast heart rate or breathing.
  • Fever or chills.
  • Confusion or delirium.
  • Dizziness or passing out from low blood pressure.

A note from Cleveland Clinic

Dermatillomania is a mental health condition that can severely affect your life due to feelings of shame, embarrassment or guilt. These feelings are common, and seeing a healthcare provider can help you overcome them and receive treatment for this condition. Healthcare providers have special training and experience in treating conditions and their effects, and helping you feel comfortable with getting the treatment you need. With treatment, many people can overcome or manage this condition. That means you can focus on what you want to do in life rather than worrying about what people might notice or think about you.

(Video) Excoriation disorder: current treatment options – Video abstract [ID 121138]

FAQs

Why do I find it satisfying to pick my skin? ›

Stress or mental health conditions: During times of stress, people might pick or scratch their skin, pull their hair, or bite their nails to relieve it. Others might feel compelled to pick their skin as a form of self-grooming or in an attempt to remove real or imagined imperfections in the skin.

Is Picking your skin a coping mechanism? ›

Aim: Skin-picking (excoriation) disorder is considered as a form of maladaptive coping methods used by individuals who have difficulties in applying more adaptive strategies.

What mental disabilities have skin picking with them? ›

Dermatillomania is a mental health condition where a person compulsively picks or scratches their skin, causing injuries or scarring. Also known as excoriation disorder or skin-picking disorder, this condition falls under the category of obsessive-compulsive disorders (OCDs).

What is the root cause of dermatillomania? ›

While dermatillomania can be triggered by negative emotions such as anxiety, it isn't always; boredom, for example, is just as common a trigger. What's more, any pain caused by skin-picking is rarely the intention; instead, the behaviors often are experienced as soothing or relaxing, at least in the moment.

How common is skin picking disorder? ›

Skin picking disorder may affect as many as 1 in 20 people. Although it occurs in both men and women, research suggests that skin picking disorder occurs much more often in women. Skin picking can begin in childhood or adulthood.

Is skin picking a mental illness? ›

Excoriation disorder (also referred to as chronic skin-picking or dermatillomania) is a mental illness related to obsessive-compulsive disorder. It is characterized by repeated picking at one's own skin which results in areas of swollen or broken skin and causes significant disruption in one's life.

Is dermatillomania genetic? ›

It is concluded that pathological skin picking is relatively prevalent problem, particularly among women, and that it tends to run in families primarily due to genetic factors. Non-shared environmental factors are also likely to play an important role in its etiology.

How many people have dermatillomania? ›

Skin-picking disorder, also referred to as excoriation disorder or dermatillomania, is believed to affect as many as one in 20 people.

Is skin picking a form of dissociation? ›

Skin-picking development has been suggested to be preceded by traumatic life events. Dissociative symptoms have been reported as experienced by skin-picking sufferers during picking episodes.

What medication helps with skin picking? ›

SSRIs (selective serotonin reuptake inhibitors) such as Prozac are the best-studied class of medicines for skin picking. Early studies also have begun to examine the possible value of some anticonvulsant medicines, such as Lamictal (lamotrigine) and some supplements such as N-acetyl cysteine.

Is skin picking related to anxiety? ›

Skin picking may be triggered by anxiety as a way to relieve stress. When it becomes frequent and intense, however, it can become a condition called skin picking disorder or excoriation. People with skin picking disorder do it out of habit and may struggle to control the impulse.

What is the best antidepressant for skin picking? ›

A number of studies show that selective serotonin reuptake inhibitors (SSRIs) may be efficacious in reducing skin-picking behaviour.

How can I help someone with dermatillomania? ›

Create a safe space.

Respond to what you see and hear with acceptance and understanding. Let your partner decide who and when to come out to about their disorder. You can be open to discussing it as they are ready. Try to empathize with their emotions.

Does zoloft help skin picking? ›

However, the treatment for hair pulling and skin picking and other BFRB is not the same as for OCD. Medication is often the first line of treatment. Selective Serotonin Reuptake Inhibitors (SSRI) like Prozac, Zoloft, Paxil, and Lexapro offer some symptom relief.

Is skin picking related to ADHD? ›

“While a typical kid might want to squeeze the pimple or pick at the nail, they're able to control their urges and stop themselves.” But kids with ADHD have poor impulse control. They start squeezing or picking to rid themselves of the distraction and persist, although they see that they're scarring their skin.

Can you have dermatillomania without OCD? ›

Skin-picking disorder isn't common, but it's well documented. It's considered a mental health condition related to obsessive compulsive disorder (OCD). Not everyone with OCD will develop skin-picking disorder, but many people who have this disorder often experience OCD, too.

Can dermatillomania be cured? ›

The good news is that therapy, medication, and dermatologic treatments can help. For most, though, no one treatment will be curative, and you will experience remission and recurrence.

Does picking your skin release endorphins? ›

Excoriation can result in the release of endorphins, which elicits feelings of euphoria and pain relief.

Does picking scabs release endorphins? ›

The mild pain associated with picking a scab also releases endorphins, which can act as a reward. Scab picking, like many grooming behaviours, is also a displacement activity that can help to distract us when we are bored, stressed or anxious.

Is excoriation more common in males or females? ›

Most previous studies, mainly conducted in college students, have reported the disorder to be more common in women, albeit with considerable variation, with some studies reporting it to be relatively uncommon in men.

Is dermatillomania serious? ›

Dermatillomania or skin picking disorder is characterized by repetitive skin picking leading to tissue damage. Skin picking disorder can lead to serious medical conditions, such as Scarring, ulcerations and infections (1).

Is skin picking a form of OCD? ›

Skin picking itself is not indicative of obsessive-compulsive disorder (OCD). Many people engage in skin picking behavior when they have a scab or a pimple, or just pick at their cuticles. However, compulsive skin picking can be evidence of OCD or another obsessive-compulsive or related disorder.

Can dermatillomania cause nerve damage? ›

Pulled Tendons/Pinched Nerves/ Arthritis:

Dermatillomania can cause damage to the finger muscles. Just ask Picking Me Foundation Founder and CEO Lauren McKeaney. “I have pinched nerves in my fingers, largely around my knuckles [because of my picking],” McKeaney said.

How do you treat dermatillomania scars? ›

Treatment Of Skin Picking Scar By A Dermatologist
  1. Laser – The best solution to any type of scar removal is Laser. ...
  2. Cryotherapy – Cryotherapy is used along with other treatments to avoid the growth of Keloid like scars.
16 Aug 2022

Why can't I stop picking scabs? ›

Sometimes, however, a person may pick at their scabs compulsively. Compulsive scab picking may be a symptom of a health condition known as dermatillomania. Although picking a scab might seem harmless, in some cases, it can lead to more serious health complications that require medical treatment.

Why do I pick my scabs all the time? ›

Dermatillomania is sometimes referred to as skin-picking disorder or excoriation disorder. Its main symptom is an uncontrollable urge to pick at a certain part of your body. People with dermatillomania tend to feel a strong sense of anxiety or stress that's only alleviated by picking at something.

What happens when you pick a scab over and over? ›

Even though it may be tough not to pick at a scab, try to leave it alone. If you pick or pull at the scab, you can undo the repair and rip your skin again, which means it'll probably take longer to heal. You may even get a scar. So let that scab sit there — your skin will thank you!

Is skin picking related to trauma? ›

Conclusion. We can conclude that trauma may play a role in development of both trichotillomania and skin picking. Increased duration of trichotillomania or skin picking was correlated with decreased presence of post-traumatic stress symptoms.

Can PTSD cause skin picking? ›

Compulsive self-injurious behavior (SIB), including hair pulling, nail biting, skin picking (SP), and scratching, is habitual, repetitively occurs, and is frequently observed as a comorbid condition in various psychiatric disorders, such as borderline personality disorder (BPD), post-traumatic stress, depressive, ...

Can a dermatologist help with skin picking? ›

While skin picking is typically a chronic condition with occasional flares, dermatologic treatments, therapy, and medications can help—but different patients will need different support.

What is neurotic excoriation? ›

Neurotic excoriations are self-inflicted skin lesions produced by repetitive scratching. Because there is no known physical problem of the skin, this is a physical manifestation of an emotional problem.

How long does it take for NAC to work for skin picking? ›

The study showed that NAC significantly reduced the symptoms of trichotillomania compared to a placebo. 56% of subjects reported "much or very much improved" on NAC compared to 16% on placebo (sugar pill or inert substance). Significant improvement was initially noted after 9 weeks of treatment.

Why does my daughter keep picking her face? ›

Some kids pick at their skin because it makes them feel good, and it can be triggered by stress or anxiety. Many children do not even know they are doing it. Skin picking can cause bleeding, scabs, infection and scars. It can also cause shame and embarrassment if other people see the damage.

Why do people with anxiety pick their skin? ›

Skin picking can be triggered by emotional components such as anxiety, boredom, or tension. Pain in not reported to accompany these actions. Often a sense of relief, gratification, and pleasure is achieved following the skin picking.

What is a picking disorder? ›

Excoriation disorder (also referred to as chronic skin-picking or dermatillomania) is a mental illness related to obsessive-compulsive disorder. It is characterized by repeated picking at one's own skin which results in areas of swollen or broken skin and causes significant disruption in one's life.

What is Dermatophagia? ›

Dermatophagia describes the condition of an individual with a compulsion or habit, either conscious or subconscious, that results in that person biting their own skin. The researchers considered this condition analogous to other self-mutilating disorders such as hair pulling or nail biting [5].

How do I know if I have OCD or not? ›

Symptoms of obsessive compulsive disorder (OCD)

If you have OCD, you'll usually experience frequent obsessive thoughts and compulsive behaviours. An obsession is an unwanted and unpleasant thought, image or urge that repeatedly enters your mind, causing feelings of anxiety, disgust or unease.

What is OC disorder? ›

Obsessive-compulsive disorder (OCD) is a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts ("obsessions") and/or behaviors ("compulsions") that he or she feels the urge to repeat over and over.

What is the best antidepressant for skin picking? ›

A number of studies show that selective serotonin reuptake inhibitors (SSRIs) may be efficacious in reducing skin-picking behaviour.

Is skin picking related to anxiety? ›

Skin picking may be triggered by anxiety as a way to relieve stress. When it becomes frequent and intense, however, it can become a condition called skin picking disorder or excoriation. People with skin picking disorder do it out of habit and may struggle to control the impulse.

How common is dermatillomania? ›

Skin-picking disorder, also referred to as excoriation disorder or dermatillomania, is believed to affect as many as one in 20 people.

Is dermatophagia a form of OCD? ›

Dermatophagia or “wolf-biting”5 is another obsessive-compulsive disorder (OCD)-related disorder and is defined as the compulsion to bite one's own skin.

Why do people pick their skin? ›

During a time of stress.

You may absently pick at a scab or the skin around your nails and find that the repetitive action helps to relieve stress. It then becomes a habit. Skin picking disorder is considered a type of repetitive "self-grooming" behavior called "Body-Focused Repetitive Behavior" (BFRB).

How do doctors test for OCD? ›

Many healthcare professionals use a tool called a structured clinical interview to see if your symptoms are consistent with OCD. Structured clinical interviews contain standardized questions to ensure that each patient is interviewed in the same way.

Do I have OCD or am I just a perfectionist? ›

“People with obsessive-compulsive disorder know that their behavior is problematic but they can't stop it. People with perfectionism don't care – it makes their lives orderly.

What is the root cause of OCD? ›

What causes OCD? Experts aren't sure of the exact cause of OCD. Genetics, brain abnormalities, and the environment are thought to play a role. It often starts in the teens or early adulthood.

What does God say about OCD? ›

If you're combatting this disorder, here are some bible verses for OCD that can help you cope with symptoms: 2 Timothy 1:7: For God did not give us a spirit of timidity, but a spirit of power, of love, and of self-control. 1 Peter 5:7: Cast all your anxiety on Him because He cares for you.

What does severe OCD look like? ›

Signs include: excessive hand washing, even if your skin is already raw. arranging objects in a precise way, even when it's not necessary or you should be doing something else. repeatedly checking doors, the stove, or other things to make sure they're off, even if it means you can't leave the house.

How do you break the cycle of obsessive thoughts? ›

Here are 10 tips to try when you begin to experience the same thought, or set of thoughts, swirling around your head:
  1. Distract yourself. ...
  2. Plan to take action. ...
  3. Take action. ...
  4. Question your thoughts. ...
  5. Readjust your life's goals. ...
  6. Work on enhancing your self-esteem. ...
  7. Try meditation. ...
  8. Understand your triggers.

Videos

1. What it's like to have a skin-picking disorder
(Newsy)
2. How to stop SKIN PICKING| Dr Dray
(Dr Dray)
3. I Can't Stop Picking My Skin
(truly)
4. Skin Picking Disorder .. What is it?
(Psych2Go)
5. Why We Pick Our Skin
(The School of Life)
6. What is Dermatillomania, Skin Picking, Excoriation Disorder ?
(Alexandra Lecart)

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