Excoriation Disorder

Excoriation disorder, commonly known as dermatillomania or skin picking disorder, is classified under obsessive-compulsive disorders in the DSM-5. Excoriation disorder is a body-focused repetitive behavior where someone recurrently and compulsively picks at their skin to the point of injury. Excoriation disorder behaviors include repetitive touching, scratching, rubbing, picking, and digging into the skin, and can target healthy or unhealthy skin, scabs, lesions, pimples, or other blemishes. While there is no direct cause of excoriation disorder, there are several conditions that have been connected to the disorder which include: heredity, obsessive-compulsive disorder, anxiety and depression, shame, impulsivity, hormones, thyroid malfunctions, stress, and skin conditions. Excoriation disorder can start at any time throughout the lifespan, but most often starts between the ages of 9 and 13 (the start of puberty). Another age of onset is 30-45 years old. Onset at this age can occur for reasons such as acne, skin conditions, or stressful life events. It begins for many reasons. For many individuals, skin picking begins first by scratching and picking at acne, but the compulsion to scratch and pick at the skin continues even after the acne has vanished.

Some individuals have shared that their urge to pick overwhelmingly strong and have described these experiences as something similar to that of a substance addiction. A sign of excoriation disorder is the history of failed attempts to stop picking. This differentiates excoriation disorder from other obsessive-compulsive disorders because the individual is cognitively aware that the picking is an undesirable behavior and, in turn, makes several attempts to stop. Another sign of excoriation disorder is the significant distress or impairment it causes in social, occupational, and other important areas of functioning. While skin picking provides an individual with instant gratification, it also causes an intense feeling of stress due to the shame and guilt associated with the behaviors. Additionally, skin picking can consume a person’s day to day functioning due to the amount of time spent on picking. Several people report that the picking has caused them to be consistently late or miss social events all together. Overall, the damage caused by skin picking can lead to a great source of embarrassment and shame and often results in individuals isolating themselves.

            The effects of excoriation disorder can be physical and psychological. Physical effects include lesions and wounds in areas of frequent picking, such as the face, arms, legs, and scalp, infection around picking area, and severe tissue damage. Psychological effects include depression, anxiety, embarrassment, helplessness, guilt, and shame. Because this disorder is highly underreported, very few people seek treatment. However, treatment is possible and consists of learning how to manage triggers, urges, and behaviors affiliated with skin picking. There are several evidence-based treatments that have been found to be effective for individuals with skin picking such as cognitive behavioral therapy, exposure and response prevention, and habit reversal training.

If you are someone who may be struggling with skin picking, please know that you are not alone. 1.4% of the population suffer from this disorder, however the prevalence may be significantly higher due to how underreported it is. If you are not ready to seek treatment for excoriation disorder, but are looking to reduce picking habits and behaviors, there are many resources that may be beneficial for you:

·  Pick ‘N Peel Stones are fidget sensory stones created to help calm your brain, especially those who struggle with skin picking. With various stone options, you can choose whether you would like your fidget stone to mimic skin pulling or scab picking. You can find them at this link: https://picknpeelstones.com/

· The Pick Palette is a fun and calming way to satisfy your urge to pick, peel, and dig at things and also mimics skin picking behaviors. You can find them at this link: https://www.etsy.com/listing/1103707320/pick-palette-picking-fidget-toy-bundle?click_key=473ddd21c0cdc035290fdc2edda4709005889826%3A1103707320&click_sum=42591962&ref=shop_home_active_8&crt=1

· Fidget rings are also a useful item as they help calm and distract the brain when you have the urge to pick.

 Overcoming Skin Picking & Hair Pulling: Help for BFRBs is an incredible Facebook support group with 3.7 thousand members who are struggling with body-focused repetitive behaviors (BFRB). The group was created by the Center for Mindfulness and CBT and is moderated by a psychologist who has specialized in treating BFRB for over 12 years. This group is a supportive community that share skills, tips, and strategies that have helped hundreds of people break free from the shame and isolation of skin picking. You can find the group through this link: https://www.facebook.com/groups/helpforbfrbs/

Picking Me Foundation is the only donor-supported nonprofit dedicated to advocating Dermatillomania (Skin Picking Disorder) for sufferers, supporters, and educational communities alike, encouraging individuals to choose themselves over the mental illness that chose them by #PickingMe over Skin Picking. You can find their website through this link: https://pickingme.org/

The TLC Foundation for Body-Focused Repetitive Behaviors is a heart-centered organization dedicated to supporting people experiencing BFRBs, their family members, and loved ones. Through this website, you can find an abundance of resources and information specifically about skin picking. You can find the website at this link: https://www.bfrb.org/bfrbs/skin-picking

Written by: Erika Katzenmayer