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.
Skin picking is a body-focused repetitive behavior (BFRB) that typically begins during adolescence, often with, or after the onset of, puberty around ages 13-15, but may also occur among children or adults. The condition affects between 1.4 and 5.4% of American adults and is experienced by women more often than men.
Individuals may pick at healthy skin, minor skin irregularities (e.g., pimples or calluses), open wounds, blisters, scabs, or other types of lesions. This disorder is usually chronic, with periods of time where there is no picking alternating with periods of greater symptom intensity. If untreated, skin-picking behaviors may come and go for weeks, months, or years at a time. It is common for individuals with this disorder to spend significant amounts of time, sometimes even several hours a day, on their picking behavior. People may use their fingers or other tools, such as tweezers, pins, or pimple extractors, to do their picking.
Currently, no specific cause has been identified for excoriation disorder. However, evidence suggests that there may be factors that influence development of this condition, including:
- Genetics: Individuals who experience dermatillomania are more likely to have at least one first-degree relative (parent or sibling) who also has this condition.
- Changes in brain structure: Individuals with excoriation disorder 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. Skin picking may be a way of coping with other mental health challenges. It may also be related to boredom or other factors.
To be diagnosed with excoriation disorder, a person must show the following signs and symptoms:
- Recurrent skin picking that results in skin lesions.
- Repeated attempts to stop the behavior.
- Significant distress or impairment caused by the symptoms.
- Not caused by a substance, medical, or dermatological condition.
- Not better explained by another psychiatric disorder.
Evidence suggests that both medication and cognitive-behavioral therapy (CBT) may effectively reduce symptoms of excoriation disorder. Specific types of CBT, habit reversal training (HRT), and the comprehensive behavioral model (ComB) may be helpful forms of treatment.
Medication: Successful treatment may include the use of selective serotonin reuptake inhibitors (SSRIs), which are antidepressants that also help reduce obsessive thoughts and compulsive behaviors.
CBT: CBT helps individuals understand how their thoughts and behavior patterns are related in order to reduce repetitive behaviors. Individuals learn how to change their thoughts so that they can avoid picking at their skin.
Excoriation discorder often co-occurs with other mental health or medical conditions. Some of those include:
- Trichotillomania (hair-pulling)
- Onychophagia (nail-biting)
- Anxiety disorders
- Bipolar disorder
- Prader-Willi syndrome
Child Mind Institute (has Spanish option)
Phone: (212) 308-3118
Phone: (203) 401-2070
Picking Me Foundation
Phone: (323) 989-2064
The TLC Foundation for Body-Focused Repetitive Behaviors
Phone: (831) 457-1004
Body Dysmorphic Disorder (BDD)
Body dysmorphic disorder (BDD) is a mental illness characterized by a persistent preoccupation with at least one perceived defect or flaw in a person’s physical appearance
Obsessive-Compulsive Disorder (OCD)
Left untreated, obsessions and the need to perform rituals can take over a person's life. OCD is often a chronic, relapsing illness.
Trichotillomania (Hair Pulling)
Trichotillomania is a body-focused repetitive behavior classified as an impulse control disorder which involves pulling out one's hair.