Body-Focused Repetitive Behaviors
What Is Skin Picking or Dermatillomania?
When is skin picking a problem? Tips for skin pickers.
Posted September 8, 2020 | Reviewed by Matt Huston
I have always been a picker. I remember it from my earliest playground knee grazes—the irresistible urge to peel off the scab as soon as it formed; to see the bright white flesh beneath. I knew I wasn’t supposed to. My teenage acne, which probably wasn’t actually that bad, provided the fuel for a picking frenzy, and consequently, I actually did end up with "bad skin." Hangnails had to be shorn off clean, even if they bled. Don’t get me started on mosquito bites. If it can be picked, I will pick it.
When I was 16, I was referred to a psychiatrist for help with my newly diagnosed OCD, which mainly took the form of compulsive list-making of things I might possibly have done wrong, as well as contamination fears, generally around "infecting" others. I remember my mum suggesting that I should mention "The Picking" to my doctor. I was totally baffled. I simply could not see what relevance it had to either OCD or my mental state. I believed it to be a physical problem, as well as a bit gross and embarrassing.
I am not alone in this misconception. When I tell people that skin picking can be a mental health problem, people are generally quite surprised. Often, these people may be like me in that they are aware that they have been living with OCD or anxiety, but they always saw their skin picking as something "separate" or "unrelated." Often, they haven’t told anyone about it. So, what exactly is skin picking, and when does it become a problem?
Skin picking, also known as dermatillomania, or excoriation disorder, is a body-focused repetitive behavior (BFRB). BFRBs happen when self-grooming habits (which include pulling, picking, scraping, or biting your own hair, skin, or nails), become compulsive, and result in damage to the body. Many people are more familiar with what is sometimes called dermatillomania’s "sister disorder," trichotillomania (compulsive hair-pulling). It is not uncommon for the two to co-exist.
Skin picking disorder is related to OCD; DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) lists it within a new category called "obsessive compulsive disorder and related disorders." While there is therefore significant overlap between the two, and skin-pickers are more likely than others to also have OCD, there are some potential differences.
Most significantly, OCD is driven by obsessions (uncomfortable thoughts and worries, such as about something bad happening), and a compulsion serves to "prevent" or "fix" the concern. On the other hand, compulsive picking of the skin tends to be more of a general tension/stress reliever, or because the picker is trying to "fix/remove" a skin imperfection, rather than responding to specific intrusive thoughts. Thus, skin-picking is generally thought to be an impulse control problem, while OCD is more anxiety-fueled. That said, this distinction may be imperfect, and you’ll recognise this if you, like me, have ever experienced the feeling that you must pick "just one more" spot in order to stop X bad thing from happening.
As in OCD, treatments for skin-picking may involve cognitive behavioural therapy (CBT), and sometimes an SSRI antidepressant. If you are reading this article, you may be questioning whether you have a skin-picking problem. Obviously, lots of us may occasionally pick at something on our skin without having a BFRB. Like with other mental health conditions, considering the amount of time spent on the activity, as well as the level of distress it is causing you, is important. Some useful questions to think about may be: How often is this happening? Does this behaviour happen without me even noticing it? Is this problem really upsetting me?
When skin picking becomes entrenched, you may find yourself experiencing significant tissue damage, scarring, and infections around the affected area. If these are commonplace for you, it’s certainly worth considering taking some action.
Tips for Skin Pickers
As I have said, CBT is a common talking therapy used to address BFRBs, and you may wish to pursue this either through your GP or privately. In the meantime, or as a starting point, below are the things I’ve found to work best:
Identify triggers: Identify the places where you spend most time picking. For instance, this could be the mirror in the bathroom, or at your desk when working. Now that you have highlighted the areas that you are more likely to pick, you can actively try to be more aware of the behaviour and give yourself opportunities to stop. For instance, a reminder post-it above a desk or mirror could help. Setting a "bathroom timer" might also be useful so that you avoid getting drawn into a long picking session. Practice noticing when you are picking and asking yourself (kindly, and respectfully), "Is this something I really want to be doing? Might I be able to step away and start doing something else?"
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Soothing cream: Keep a pot of soothing cream (I use Sudocrem) by the mirror (or wherever you go to pick). The idea is to see it and create a new cue to go for that rather than your face (or wherever you pick). It’s about creating a new healthy habit. This has the positive effect of actually helping with soreness, but also feeling like a "dummy" compulsion—it’s easier to do "something" than to just sit on your hands, and if you have to do something you may as well do something that helps your skin. Also, if you use a thick cream it creates a temporary barrier between your fingers and skin, which can help you wait out the urge to pick.
Make a barrier: As just mentioned, using cream to create a barrier can be really helpful. For pimples, I’ve also recently discovered salicylic acid patches—they are small clear stickers that can be placed on acne. This means you can’t get to the pimple, and the stickers themselves help the pimple recover quickly. You can use plasters or bandages for fingers or other areas.
Fidget toy: Keeping your hands occupied can provide a welcome distraction. There are a great many fidget toys out there, so have a search and find one that works for you. I also scribble/doodle when I can feel my hands are being drawn towards my face, which I find both keeps me occupied and relieves tension.
Keep clean: If you are still picking, making sure that any tools (tweezers, etc.), as well as your fingers and the area you are picking, are sterilised or cleansed is an important way to protect and care for yourself by reducing your chance of skin infection.
If you’ve done all these things, you may also find it helpful to know you are not alone in this. Many of us can't stop picking at ourselves even though we really wish we could! I still pick occasionally when stressed, but becoming more aware of when I pick and implementing the above strategies have meant that thankfully, it is no longer a daily habit. Below are some resources you may find helpful.
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