Skin picking disorder

Also called dermatillomania or excoriation disorder, skin picking disorder is where you cannot stop picking at your skin. There are things you can try to help yourself, but some people may need professional treatment.


Symptoms

Most people pick at their skin from time to time, but you may have skin picking disorder if you:

  • cannot stop picking your skin
  • cause cuts, bleeding or bruising by picking your skin
  • pick moles, freckles, spots or scars to try to "smooth" or "perfect" them
  • do not always realise you're picking your skin or do it when you're asleep
  • pick your skin when you feel anxious or stressed

You may pick your skin with your fingers, fingernails, teeth or with tools like tweezers, pins or scissors.

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Things you can try

Do

  • keep your hands busy – try squeezing a soft ball or putting on gloves
  • identify when and where you most commonly pick your skin and try to avoid these triggers
  • try to resist for longer and longer each time you feel the urge to pick
  • care for your skin when you get the urge to pick it – for example, by applying moisturiser
  • tell other people – they can help you recognise when you're picking
  • keep your skin clean to avoid infection

Don't

  • do not let your nails grow long – keep them trimmed
  • do not keep things like tweezers and pins where you can easily get at them

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When to get medical help

See a GP if:

  • you cannot stop picking your skin
  • you're causing serious damage to your skin by picking it, like cuts that do not heal within a few days
  • picking your skin is causing you emotional distress or affecting your daily life

What happens at your appointment

A GP will ask you about your skin picking behaviour and look at your skin.

If they think you have skin picking disorder, they may refer you to a specialist for diagnosis and possible treatment.

This could be with a type of talking therapy or medicine.

They may also refer you to a skin specialist (dermatologist) if your skin is badly damaged or you have any underlying skin conditions that may be triggering your skin picking, like acne or eczema.

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Treatment

Talking therapy for skin picking disorder

Talking therapy is currently thought to be an effective treatment to help change skin picking behaviour.

If you're offered this, it'll usually be given through community mental health services.

The most common type of talking therapy offered for skin picking disorder is cognitive behavioural therapy, and may include a technique called habit reversal training.

Habit reversal training works by helping you:

  • recognise and be more aware of your skin picking and what's triggering it
  • replace skin picking with a less harmful behaviour

Medicines for skin picking disorder

Your doctors may recommend some types of medicine to help you control your skin picking behaviour.

This may be prescribed by a GP, but more often it'll be prescribed by a specialist (psychiatrist).

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OCD Action offers more information and support for people with skin picking disorder.

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Causes

Skin picking disorder is related to obsessive compulsive disorder, where the person cannot stop themselves carrying out a particular action.

It can be triggered by:

  • boredom
  • stress or anxiety
  • negative emotions, such as guilt or shame
  • skin conditions, such as acne or eczema
  • other blemishes that the person wants to get rid of (these may not be noticeable to other people)

It's sometimes called a body-focused repetitive behaviour and is similar to repetitive hair pulling disorder (trichotillomania).

It's also related to other obsessive compulsive disorders, such as body dysmorphic disorder, where the person is excessively preoccupied with their appearance.

People with skin picking disorder often also have other obsessive compulsive disorders. These may require their own assessment and treatment.

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